Combs

HCMT 1005-001
Assignment # 4 module 8
HIE

An exchange, as created under the Affordable Care Act (ACA), is a place where
consumers can purchase subsidized health insurance coverage. Each state has an exchange,
operated by either the federal government or by the state. In Ohio, there is a federally facilitated
exchange. Every plan offered on the exchange must be certified as a Qualified Health Plan
(QHP). To receive the QHP certification, the plan must offer at least a uniform benefits package,
called Essential Health Benefits (EHB), be licensed by the state and have a sufficient network.
Each exchange will offer four levels of coverage and a catastrophic plan for those under 30 or
those who meet certain income levels.
Generally, the benefits will be the same among the plans, while the percentage of total average
costs for covered benefits that a plan will pay will vary between metal tiers:

Bronze: The plan must cover 60% of expected costs and the consumer is responsible for 40%.
This is the lowest level of coverage.
Silver: The plan must cover 70% of expected costs and the consumer is responsible for 30%.
Gold: The plan must cover 80% of expected costs and the consumer is responsible for 20%.
Platinum: The plan must cover 90% of expected costs and the consumer is responsible for
10%.
Since 2014, every new plan sold to individuals and small group, both on and off the
exchange must include a basic package of benefits, called Essential Health Benefits (EHB).

Ohio's EHB package consists of benefits in at least the following categories:

Ambulatory patient services,

Emergency services,

Hospitalization,

Maternity and newborn care,

Mental health benefits and substance use disorder services,

Prescription drugs,

Rehabilitative and habilitative services and devices,

Laboratory services,

Preventive and wellness services and chronic disease management, and

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HCMT 1005-001
Assignment # 4 module 8
HIE

Pediatric services including oral and vision care.

A week after the start of open enrollment for 2017 coverage, Donald Trump won the
presidential election. The future of the ACA suddenly became uncertain, and the Trump
Administration scaled back advertising for HealthCare.gov within days of Trumps inauguration,
both of which were likely factors in 2017s lower enrollment. Initially, it seemed that the ACA
would be repealed via reconciliation, but that is becoming less likely as time goes by and GOP
lawmakers become more divided in terms of where they want to go from here.

If the ACA were to be repealed, Ohio stands to lose a lot. HHS reported that from 2010 to
2015, the number of Ohio residents with health insurance grew by 664,000 as a result of the
ACA a number that has continued to climb since 2015. ACA Signups estimates that 945,000
people in Ohio could lose their health insurance if the ACA were to be repealed and the
replacement isnt as robust. The vast majority of those (691,000) have coverage under Ohios
expanded Medicaid.

Ohio Governor, John Kasich, who ran for the GOP presidential nomination in 2016, has
pushed back against Congressional Republicans proposals to repeal Medicaid expansion. Kasich
met with President Trump and HHS Secretary Tom Price in February to address his concerns and
discuss health care reform possibilities.

Kasich favors a modified version of Medicaid expansion, covering people with incomes
under the poverty level (as opposed to the current eligibility rules, which allow people with
income as high as 138 percent of the poverty level to enroll in Medicaid). His proposal calls for
transitioning people with incomes above the poverty level (between 100 percent and 138 percent
of the poverty level) to private, subsidized plans in the exchange. All of this, however, is
contingent on the basic framework of the ACA remaining in place.
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HCMT 1005-001
Assignment # 4 module 8
HIE

References

Federal Health Reform FAQs

Retrieved from
http://www.insurance.ohio.gov/Consumer/Pages/FederalHealthReformFAQs.aspx

Louise Norris. March 1, 2017. Ohio marketplace history and news10 insurers offering plans;
239k people enrolled.

Retrieved from https://www.healthinsurance.org/ohio-state-health-insurance-exchange/