Marketplaces Alan D. Albright Senior Associate General Counsel Anthem, Inc.

Public Exchanges 14 states created their own exchanges Remaining states have federally facilitated exchanges 2

Open enrollment in fall of 2013 had significant operational problems Open enrollment period was 10/1/13 to 3/31/14 In order for coverage to be effective on January 1, 2014, enrollment was required by December 15, HHS issued IFR on December , extending the enrollment deadline to December 23 for coverage with a January 1 effective date. 3

Fall of 2014 open enrollment was better Original open enrolment period was 11/15/14 to 1/15/15 HHS extended date to 2/15/ open enrollment is scheduled to be 11/1/15 to 1/31/16 4

Individual Enrollment 20148,019, *11,688,074 Growth %46% *as of 5/24/14 5

Almost 6.5 million individuals qualify for an average advance premium tax credit of $268 per month More than 8 in 10 individuals with a plan selection for 2015 Marketplace plans qualify for an advance premium tax credit Advance premium tax credits will reduce premium costs by over $1 billion a month The average advance premium tax credit covers about 72 percent of the gross premium The average net premium is $105 per month among individuals with plan selections qualifying for an advance premium tax credit 6

– Market continues to expand but limited uninsured and Hispanic penetration to date Future growth will require improved awareness of subsidies / penalties & improved value proposition – Number of carriers participating on Exchanges increased by 19% since 2014 OEP and number of products grew by 27% 50% of carrier growth came from nationals, other 50% regional / local Co-ops continue but are a watch item for failure Provider-led plans continue to emerge but competitiveness is more limited Medicaid entrants improved their price leadership position in

Private Exchanges Employer offers fixed amount and employee chooses plan Accenture estimates enrollment of 40 million by 2018 Primarily mid-size and smaller employers Generally offered by benefit consulting firms 8

Small Business Health Options Program (SHOP) Public exchange for small employers (50 or fewer employees) 2014 implementation delayed until

What Does the Future Hold? Alan D. Albright Others

ACA withstood two major legal challenges Expect more challenges, but none likely to derail the ACA Republican efforts to repeal are likely to continue, although it is not clear what alternative would be enacted 11

Further expansion of Medicaid is likely Even Republican governors are beginning to accept expansion Republican states e.g., AR and IN may receive approval to modify Medicaid 12