advancing the health of Ohioans through informed policy decisions Insurance basics: Provisions of the Affordable Care Act and how Ohioans are covered Reem Aly, HPIO

advancing the health of Ohioans through informed policy decisions Our goal is that by the end of this talk, you will… Have a sense of the potential impact of the ACA on how Ohioans are covered Understand how ACA reforms impact coverage Understand emerging issues and trends in coverage

advancing the health of Ohioans through informed policy decisions 3 How were Ohioans covered in 2013? Source: Kaiser Family Foundation State Health Facts

advancing the health of Ohioans through informed policy decisions 4 How will Ohioans be covered in 2014 and beyond?

advancing the health of Ohioans through informed policy decisions 5 Impact of ACA on how Ohioans are covered

advancing the health of Ohioans through informed policy decisions ACA reforms impacting coverage

advancing the health of Ohioans through informed policy decisions 7 Snapshot of ACA coverage reforms,

advancing the health of Ohioans through informed policy decisions 8 Individual mandate Income is defined as total income above the tax filing threshold The penalty for 2016 and beyond is indexed based on the cost of living Penalty cannot exceed the national average premium for the lowest cost bronze plan in the marketplace

advancing the health of Ohioans through informed policy decisions Health Insurance Marketplaces

advancing the health of Ohioans through informed policy decisions 10 Subsidized health coverage eligibility for Ohioans in 2014

advancing the health of Ohioans through informed policy decisions 11 Potential Ohio enrollment in the individual marketplace Source: Kaiser Family Foundation State Health Facts

advancing the health of Ohioans through informed policy decisions 12 Current Ohio enrollment in the individual marketplace Source: Kaiser Family Foundation State Health Facts

advancing the health of Ohioans through informed policy decisions 13 Individual marketplace coverage in Ohio Source: Kaiser Family Foundation State Health Facts

advancing the health of Ohioans through informed policy decisions Source: Kaiser Family Foundation State Health Facts Enrollees in marketplace, by plan type (2014) Individual marketplace coverage in Ohio

advancing the health of Ohioans through informed policy decisions Source: Kaiser Family Foundation State Health Facts Individual marketplace coverage in Ohio

advancing the health of Ohioans through informed policy decisions Small Business Health Options Program Open to employers with 50 or fewer FTEs No restricted enrollment period Online shopping for 2015

advancing the health of Ohioans through informed policy decisions 17 Employer mandate  To avoid a penalty, employers with 100 or more (50 or more in 2016) FTE employees in the previous year are required to offer coverage that is affordable and provides minimum value. Affordable Employees do not have to pay more than 9.56% of family income (measured against safe harbor amounts) for employer coverage Minimum value Insurance pays for at least 60% of the covered health expenses for typical population

advancing the health of Ohioans through informed policy decisions 18 Employer mandate  Penalties are triggered when a full-time employee receives a premium tax credit or cost-sharing subsidy on the marketplace. Penalty for not offering coverage 2015: $173 per month times the number of full-time employees minus : $173 per month (updated by growth in insurance premiums) times the number of full-time employees minus 30 Penalty for not offering coverage that is affordable and provides minimum value 2015: $260 per month for each full-time employee receiving a premium tax credit or cost sharing subsidy that month up to a maximum of $173 times the number of full-time employees minus : $260 per month (updated by growth in insurance premiums) for each full-time employee receiving a premium tax credit or cost sharing subsidy that month up to a maximum of $173 times the number of full-time employees minus 30

advancing the health of Ohioans through informed policy decisions 19 Emerging issues and trends in coverage

advancing the health of Ohioans through informed policy decisions 20 SCOTUS case on premium tax credits

advancing the health of Ohioans through informed policy decisions

23 Increase in high deductible health plans

advancing the health of Ohioans through informed policy decisions 24 Increase in high deductible health plans Ohio enrollment in HSA-Qualified high-deductible health plans, Source: AHIP Center for Policy and Research

advancing the health of Ohioans through informed policy decisions 25 Private health insurance exchanges

advancing the health of Ohioans through informed policy decisions Network adequacy