Of center is Carrie Banahan who comes to us all the way from kentucky pictures responsible for the implementation and operation of the kentucky exchange. Into my far right, mila kofman who want a shorter commute. Shes the executive director of the d. C. Exchange. If youre watching us live today on cspan2, we welcome you and encourage you to tweak your questions to us. Will try to get them to our speakers, to answer today. You can use the hashtag oe3, and you also we will be live tweeting today, so we welcome you of course to live tweet with a picnic in the hashtag is oe3. Im going to turn over now to sara collins with the Commonwealth Fund. Thank you. Enka, maryland dont have of pashtun thank the panel succumbed and also extend a warm welcome to the audience. In looking ahead to the 2016 open enrollment period, an estimated 29 Million People remain uninsured. Hhs estimates about 10. 5 Million People are eligible, uninsured people are eligible for coverage through the marketplaces. In addition about 9 million currently have coverage to the marketplaces, and most if not all are likely going to want to reenroll. To gain some insight into what both current and prospective enrollees may be thinking about as they consider their options this year im going to share some recent findings from the Commonwealth FundAffordable Care act tracking survey which is at the end of the 2050 open a momentary in the spring. Im going to focus in particular on the issue of affordability and i will highlight it about the cost of people based by people who are currently enrolled in the plans and how thethey compare to cause an upwd base plans. And also look at how affordability factor into peoples decision about health as bishop in the marketplace is cheaper so i will just need the in our analysis of the survey data, we found premium costs for people with marketplace plans are comparable to those with employer plans among low and moderate income adults, but fewer people in marketplace plans said was easy to afford the premiums compared to those in the powerplants although differences were narrow among people with low and moderate incomes. With regard to deductibles, people in marketplace plans have high deductibles on average compared to those in employer plans by making differences were narrow among adults with low and moderate incomes. Among marketplace enrollees, premium costs with most important factor in their choice of a plan. And affordability was the top reason given by adults who shop in the market places that didnt end up enrolling in a plan. About 60 of adults with health plans that they purchased t through the marketplaces paid about 125 a month or nothing for single policies. A similar percentage enrolled in an employer plans reported they had paid that much. The similarity is due to the fact that most marketplace enrollees were eligible for subsidy and didnt pay the full premium. Likewise, most employers pay part of their employees premiums. The effect of the subsidies was most pronounced for people earning less than 250 of the Poverty Level. People with higher incomes and marketplace plans paid more and more than people in employer plans. This is because the amount of the premium subsidy and marketplace plans faces out at higher incomes which means people put increasing amount to the premium as income rises. Overall, adults with marketplace plans consider their Health Insurance to give us affordable than people who have employer coverage. That differences in perception of affordability to adults and marketplace and employer plans were wider among higher income adults than they were a monk lower income adults. People in marketplace plans on average reported higher deductibles than those in employer plans. 43 in marketplace plans that perperson deductibles of 1000 or more compared to 34 of adults in employer plans. Differences in deductibles between those in marketplace plans and employer plans were wider among higher income adults than they were among lower income adults. This is likely because people with incomes under 250 of in poverty who enroll in silver level plans are eligible for costsharing reduction subsidies that lower their deductibles, copays and out of pocket limits. In the most recent open a momentary the premium costs on average mattered more to people when they were choosing a plan thank you that the deductible whether doctor was in the plans network. Consistent with this finding we found more than half of marketplace enrollees who had the option chose a plan with a limited or Narrow Network of providers in exchange for a lower premium. Among people who visited the marketplaces but didnt enroll in the plan, affordability was a key factor in the decision to walk away. 57 who visited the marketplaces but did no not in will say they could not find a plan they could afford. Looking closely at this group of adults who told they didnt go because they couldnt afford a plan and also letting people who came covered someplace else, 26 were living in a state that an expanded medicaid and incomes under 100 of poverty which meant they were not eligible for the premium subsidies. More than half who couldnt find an affordable plan that incomes in the range and made them eligible for the subsidies. People who shop in the marketplaces but did not enroll at greater difficulty comparing features of health plans like premiums and out of pocket costs compared to people who didnt enroll. 50 said it was difficult to compare the premiums of different plans, and 60 who didnt enroll said is difficult to compare plans and what the potential out of pocket costs might be. Receiving personal assistance appears to make a difference in whether people enroll. When we controlled for demographic differences we found 70 of adults who said they received some kind of the distance ended up and vote in a marketplace plan or medicaid. In contrast only 56 who did not receive assistance in world. Just to recap the major finding of the analysis come the Affordable Care act subsidies have been effective in making premiums for marketplace plans similar to those in employer plans. People in marketplace plans have high deductibles. Cost was the most important factor when people were considering health plans and its the primary reason why many adults do not enroll. Findings suggest many people who shop for insurance may not have the information they needed to help them buy coverage pick me difficulty comparing basic features of plans. Personal assistance thats if you tell people enroll but the lack of Medicaid Expansion in 20 states is clearly an insurmountable barrier for the poorest residents in those states are i will stop there and look forward to your questions. Great. If youre in the room with us, you have the results of these tracking surveys that series discussing in your folder on the left side. If you are not in a room with us you can still access these materials on our website, www. Allhealth. Org, and i will turn it over now to jon. Let me point out for those of you standing, to our seats on the other side of the room. Thank you, thank you. I also would like to thank sara and the Commonwealth Fund thank you, marilyn. I would also like to thank sara and the Commonwealth Fund for making this work possible. I also would like to thank ed howard for his many years of service, bringing the work of the Research Community to the policy community. Did i just and lets go back. This is a history of the employer based Health Insurance since 1988. I show it to provide context for the historic record. Now, you may be asking right now, why are you showing employerbased insurance . Why not individual insurance . And the answer is simple. Because we are incapable of showing that record for individual insurance. But i want to emphasize three points. Number one, theres the history of volatility take 1989, premiums increased 18 that year. Secondly, premiums almost always outpace increases in workers wages and the overall Consumer Price index. So now lets turn to results for exchanges. This is early information, very early information. It is limited to five northeastern states. Most of them are very small states. And it is also, why these five states . Because these are the states which have posted all the information so far on their website. And when i said all the information from im talking costsharing information in addition to premiums. So currently on these five states we note that the average increase is 4. 9 , and the median is 2. 1 . Now, i would also add that mackenzie says that the number of carriers coming into the marketplace industry your with the up and it looks like its got at least 10 for last year and that may have a dampening effect on premium increases. If we look at the benchmark plan, the benchmark plan is so important because it is the basis for what the federal government will pay and also the basis for what enrollees will pay. We see the average increase is 6. 7 . We see that the median is 5. 8 . Kaiser Family Foundation recently posted increase in benchmark plans for 14 states, and their numbers are lower. Their average is 4. 4 for the benchmark plans. So what is happening to costsharing . We know an employer based Health Insurance that deductibles are today about seven times as great as they were in the early 2000s. And this increase in deductibles has held down premium increases. On the exchanges we are not seen much change. We are seeing on average a drop of about 5. 9 , and the median is the. 3 . 3. 3 . Another important point of costsharing is the out of pocket max. And here we are saying the next increase of fivepoint a precipitous is entirely almost due to maryland. And beating increase is 2. 3 . So let me summarize what is only returned are. How typical are these five states of the rest of the nation . Its difficult to say. What we do know is there are great differences from state to state. Last year, 10 states that doubledigit increases and according to our data the overall increase was 0 . So the average, this is what i daresay based on early returns. Number one, average premium increases will be higher than last year. Benchmark plans show greater increases and average increase for silver plans. The averages are going up, but it is not a catastrophe as some have reported. On the drivers that may be underlying these trends. Before i get to that, a quick reminder of the components of premiums. Claims make up the largest share of premiums and reflect not only who has coverage, but also what their medical spending is. Other preemie and components include in ministered costs and profit and laws and regulations can affect each of these components. I wont get into this slide in detail, but i wanted to highlight some the elements in the Premium Development process. One thing that insurers have to do is to interurban to turn their plan design and perform actuarial testing to make sure their plans polenta one of those metal tears. Another thing they have to do is examine their prior claims and enrollments experience making necessary adjustments and project that information forward to 2016. I will talk a bit about those adjustments in a minute. Insurers also have to negotiate with providers to get their provider payment to rates. I will talk about three major drivers of 2016 premium changes. The first of these is medical trends, which is the underlying growth in health care spending. Although, medical spending has been relatively slow recently compared to historical trends, Prescription Drug spending has been increasing fairly rapidly due to the introduction of specialty drugs. On average 2016 premiums reflect and medical trend of about six to 8 and a Prescription Drug trend of about 10 to 12 . The second major driver of premium changes for 2016 is the scheduled reduction in the Reinsurance Program. The Reinsurance Program subsidizes plans for their high cost enrollees. It does so by offsetting some of the high cost claims. By offsetting claims, that Reinsurance Program lowers premiums. The reduction in the Reinsurance Program means that there will be a lower offset to claims and that lower offset will in turn produce some upward pressure on premiums. On average, the reduction in the Reinsurance Program could increase 2016 premiums by about three to private 5 . I heres more detail on the Reinsurance Program perimeters and how they are changing over time. The third major driver of premium changes is how the expectations regarding the 2016 risk pool profile differ from those that underlie 2015 premiums. As a reminder, when insurers put together their 2014, premiums they didnt have a lot of information to go on in terms of who was enrolling in coverage and what their Health Spending would be. In 2015, for that planned year insurers had a bit more information to go on. They just had the first few months of enrollment in 2014. Looking forward to 2016, insurers have a lot more information on their own experience for 2014 in terms of who enrolling coverage and what their help spending is. They also have a few months worth of data from 2015. They have more information and are able to change their assumptions regarding 2016 accordingly and these changes in assumptions can either be too higher or lower premiums. I noted earlier the need to adjust Prior Experience data when projecting that forward to 2016. In 2014, enrollees who were more likely to enroll early in january for coverage were those who would be more likely to have high healthcare needs and high healthcare spending. Those individuals who were healthy may have been more likely to delay coverage to later on in the open enrollment time. That is one thing that needs to be adjusted for. Another adjustment might need to be made to reflect demand. People who are newly insured in 2014, those who were uninsured in 2013, who then gained coverage in 2014 might experience a temporary fight in their spending based on pentup demand. They put up off obtaining services until they had coverage and some will be temporary. Its not expected to kind of be at the high level permanently. Not accounting for these two things, in terms of enrollment timing in 2014, and the pentup demand, if those arent accounted for this could result in an overestimate of 2016 claims. Insurers might also need to trust the risk profile expectations if they think that the increase in the individual mandate penalty will lead more people to obtain coverage especially among the healthy folks. An influx of people who have lower healthcare needs could actually put some more downward pressure on premiums. So, johns slide shows how premium changes can vary across states. One of the reasons for this is the transition policy come zero which allowed individuals to hold onto their non ac eight compliant coverage is sometimes this is referred to as gran mothered plans. , but on all states adopted that transition policy. In states with that who did have the transition role policy, people who kept their old plans might have been those who were more healthy because they might have gotten lower premiums and they didnt necessarily care about preexisting conditions, exclusions or things like that, so they kept their old coverage. Whereas, people who had high healthcare needs with preexisting conditions and maybe previously had been rated higher because of all conditions, they would be more likely to switch into the new ac eight compliant coverage, so states that adopted that transition role might see meyer he premium increases than states that did not. Finally, i want to point out that we hear a lot of information coming out in this past couple weeks regarding premium changes, but i want to caution you that this is really just looking at averages either in the state as a whole or for particular insurers. Particular crewmen consumer bases in terms of his or her own change will likely differ from that average. The premium change that a consumer faces will reflect that consumers particular plan, that consumer age, and right away that will result in an increase in premium. Consumers can also have changes in their premium subsidy eligibility and they may have other changes as well. So, those are things to keep in mind when comparing a consumer individual premium change as opposed to the change in the market as a whole. Thank you. Ray, thank you corey. We will turn out to carry with the kentucky exchange. Thank you for inviting me here today to talk about kentuckys Health Benefit exchange, connect. As the state based exchange, kentucky was able to develop an integrated eligibility system with online realtime determinations of eligibility for medicaid and qualified health plans. This is why we were able to enroll over half a Million People into coverage for the first time. This resulted in a decrease rates of the uninsured from 14. 3 to eight and a half percent based on some recent u. S. Census data. This was the largest decrease in the nation. Based on a gallup poll on the first half of 2015, or individuals under age 65 we these decrease the rate of uninsured from 20. 4 to 9 and i was the second largest decrease in the nation. Prior to the 04 book, kentucky basically had to Insurance Companies in the individual market. When we launch connect in 2013, we had three insurers that offered products on our exchange. Due to our success in 2015, we had two additional insurers and we are very excited to say 42016, we will have eight Insurance Companies offering products. We have added at back, United Healthcare kentucky and baptist health, which was formally known as bluegrass family health. You know, without the Affordable Care act kentuckians would not have these additional choices. Also, i wanted to note that outside of the exchange in our regular commercial market there is about two or three additional insurers that will offer products. In connect kentuc