Small Business Conversations What are the conversations today and what will they be in the future as health care reform takes hold in the small business community? Scott Lyon, Vice President, Small Business Association of Michigan

Key Elements of Health Care Reform Medicaid and CHIP Expansion Premium Subsidies for Lower Income Health Insurance Exchanges Insurance Market Reforms Individual and Employer Responsibilities Quality and Delivery System Reforms

Why Reform? Increasing Cost of Health Care Driving Insurance Premiums Higher Erosion of Employer Sponsored Health Insurance Increasing Number of Uninsured Rapid Growth in Medicaid Costs and Enrollment Pressure on Budgets

Rising Costs Have Driven a Steady Erosion of Employer Sponsored Plans Share of all Firms offering health insurance: 69% offered in 2000 60% in 2009 Share of small firms (3 – 6 employees) 57% offered in 2000 46% in 2009 The above has driven a steady increase in the number of the uninsured across the country and in Michigan Source: Kaiser/HRET Survey of Employer Sponsored Health Benefits 2000-2009

The Employer Group Health Insurance Market One Employee Groups Individual or Group Market – Fully Insured 2 – 49 Employee Groups Group Market – Fully Insured, FSAs, HRAs, HSAs 50 – 99 Employee Groups Group Market, fully-insured, some partial self-insurance, FSAs, HRAs, HSAs 100 – 499 Employee Groups Fully Insured, ASO, Self-Insured, etc 500 + Employee Groups Self-Insured Customers

So, what is the conversation in the small business community? The same as it has been for at least 25 years Small businesses need access to affordable health insurance for themselves, their families and their employees… The rising cost of health care, and therefore health insurance premiums, continues to be the number one conversation/concern

So, what is the conversation in the small business community? Small Business Tax Credits – treating the symptom… 2010 Tax Year Part I – 2014 Part II – 2 years Tax credit equal to 35% (50% in Part II) of the employers health insurance costs, if: 10 or fewer full-time equivalent employees Average annual wages of less that $25,000 (not including owner’s or owner’s family member wages) Employer pays 50% or more of the premium Part II – Must Purchase via Exchange Companies with between 11 and 25 workers and an average wage of less than $50,000 are eligible for partial credits If currently offer – Qualify or Not? Or just maintain plan… If do not offer, is the incentive enough to begin?

So, what is the conversation in the small business community? 2011 Over the Counter Drug Exclusion: Over the counter drugs are excluded from eligibility for Section 125 flexible spending accounts W2: All employers must include on their employees W2s the aggregate cost of employer sponsored health benefits. Why is this requirement out there. Taxing benefits? Simple Cafeteria Plan: A new vehicle for small businesses to provide tax-free benefits to their employees by lowering the administrative hurdles of sponsoring a cafeteria plan.  This provision also exempts employers who make contributions for employees under a "Simple Cafeteria Plan" from nondiscrimination requirements. Available to companies with fewer than 100 employees Note: just like regular 125 plans, SIMPLEs cannot cover a sole proprietor, S Corp, 2% or greater shareholder, partnerships, or LLC treated as a partnership. 1099 – MISC Reporting: Track payments to individuals and corporation for services and goods.

So, what is the conversation in the small business community? 2011 Section 125 Limits: Section 125 flexible spending accounts contributions are limited to $2,500 per year Tax Change: Threshold for deducting unreimbursed medical expenses from federal taxes increases from 7.5% to 10% Medicare Tax Rate: For individuals who earn $200,000+ (family $250,000+) the Medicare tax rate will increase by .9% (1.45% - 2.35%) – for employee share only and a 3.8% tax on unearned income

So, what is the conversation in the small business community? 2014 Individual Mandate - Requires all U.S. citizens and legal residents to have qualifying health coverage or face a penalty if they do not. Those under FPL or those that do not file a tax return – no penalty Employer “Mandate”/Free Rider - Employers with more than 50 employees must offer either “affordable” coverage or potentially be subject to a “free rider” penalty. What is the penalty? What is the calculation to determine 50 or more? How often do I need to make the calculation? Should I keep my business below 50 employees? Does the Mandate make employer sponsored insurance more or less valuable as an employee benefit?

So, what is the conversation in the small business community? 2014 Free Choice Voucher - Employers are required to provide any employee with income under 400% of federal poverty level and whose share of premium exceeds 8%, but is less than 9.8%, of their household income and who choose to enroll through the exchange with a “free choice voucher”. The voucher would be equivalent to the premium you would have paid had the employee enrolled in your plan. Who will be responsible for the calculations? How often will calculations be made? Health Insurance Exchanges: State based American Health Benefit Exchanges and Small Business Health Options Program (SHOP) where individuals and small businesses with up to 100 ees can purchase qualified coverage. (states can limit to 50 ees until 2016) Who in Michigan is thinking about their structure? One Exchange or Two Exchanges? Role of Agents and Brokers?

So, what is the conversation in the small business community? 2018 Cadillac Tax An excise tax on insurers or employer health insurance plans with aggregate values that exceed $10,200 for an individual and $27,500 for a family takes effect. Tax is indexed to the CPI-U beginning in 2020 Cadillac Tax is 40% of the value above the threshold. Have you done the math? We have…