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An interview with Jimmy Lee of Anthem – Part 2

Jimmy LeeAs of January 2017, approximately 27,000 employers have active coverage through SHOP Marketplaces, covering nearly 230,000 individuals. These numbers fall significantly short of the Congressional Budget Office (CBO) estimate that 4 million people nationwide would enroll in coverage through the SHOP Marketplaces by 2017. According to a survey conducted by Mercer, many small employers are considering higher deductibles and correspondingly lower premiums.

In part two of this two-part interview, Anthem’s former President of Consumer Division and SVP of Commercial Segments, Jimmy Lee, offers his perspective on the small group market, and approaches health plans can adopt in order to better serve their small group lines of business.

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An interview with Jimmy Lee of Anthem – Part 1

Jimmy Lee

As of January 2017, approximately 27,000 employers have active coverage through SHOP Marketplaces, covering nearly 230,000 individuals. These numbers fall significantly short of the Congressional Budget Office (CBO) estimate that 4 million people nationwide would enroll in coverage through the SHOP Marketplaces by 2017. According to a survey conducted by Mercer, many small employers are considering higher deductibles and correspondingly lower premiums.

In part one of this two-part interview, Anthem’s former President of Consumer Division and SVP of Commercial Segments, Jimmy Lee, offers his perspective on the small group market, and approaches health plans can adopt in order to better serve their small group lines of business.

SFTN: With FF-SHOP having shut down on 1/1/18 and the uncertainty in ACA, how will this impact the small group segment for health plans?

JL: According to Mercer’s survey, many small employers are considering higher deductibles and corresponding lower premiums. This cost shift to employees often comes through the form of health savings accounts (HSAs) to help employees pay medical expenses. The combination of a high deductible plan and a HSA is a consumer-driven health plan – it puts more accountability on the employee as to where and how health dollars are spent. Survey results show that 10% of employees in companies with between 10 and 50 workers will purchase consumer-driven health plans, while 20% and 37% will purchase these plans in the 50 to 199 employees and 200 to 499 employee segments, respectively. The number of small employers that are self-funded is 15%; much less than the 79% at large companies. However, this number is growing in small groups, with product offering level funded options down to 10 lives.

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Does the Healthy Indiana Plan 2.0 have national aspirations?

For the last six years, the Healthy Indiana Plan (HIP) has delivered quality care, encouraged the use of preventive services, and received measurable results. By incorporating the essence of a high deductible health plan and health savings account (HSA), the Medicaid expansion project became the first in the nation to adopt – and successfully demonstrate – the linkage of personal responsibility with subsided health protection to low-income individuals.

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10 States move to impose Medicaid work requirements; Kentucky HEALTH becomes first to implement

Earlier this week, we examined a major shift involving states’ proposals to impose work requirements for Medicaid recipients through Section 1115 waivers. The move, which was announced by the Trump Administration on January 11, would affect nearly 70 million low-income people receiving benefits.

According to CMS, ten states – Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah, and Wisconsin – have already sent in proposals to add work requirements for Medicaid. On January 12, Kentucky became the first to gain CMS approval. Mississippi has also submitted a waiver proposal to CMS, but it has not yet been certified as complete.

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Trump Administration releases guidance on Medicaid work requirements

What happened?  

In a major shift that could affect millions of low-income people receiving benefits, The Trump Administration announced Thursday, January 11, that it will open the door for states to require work requirements for Medicaid recipients.  

The guidance was published in a letter from CMS Deputy Administrator Brian Neale to State Medicaid Directors Thursday morning. In the letter, Deputy Administrator Neale stated that the move would help “improve Medicaid enrollee health and well-being through incentivizing work and community engagement.” 

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Alex Azar on track to become next HHS Secretary

Following yesterday’s Senate Finance Committee hearing, it appears Alex Azar, the former head of Pharmaceutical company Eli Lilly’s U.S. operation, is on track to be confirmed as the Head of the Department of Health and Human Services (HHS). If confirmed, Azar will replace Thomas Price M.D., a former congressman who served as the HHS secretary for seven months before resigning. 

Despite a probe by Democrats, including that from Sen. Ron Wyden (D-Oregon), on his drug industry ties, Republicans have focused on the fact that Azar would come to the job with greater working knowledge of the sprawling agency, with its budget of more than $1.1 trillion and far-flung staff of nearly 80,000, than many of his predecessors, according to the Washington Post 

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What’s new for SHOP in 2018

The Small Business Health Options Program (SHOP) will remain open for small businesses with 1-50 employees in 2018, and will boast new features that’ll impact how small employers and their employees enroll in and manage their coverage for SHOP plans starting on or after January 1, 2018.

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