The Affordable Care Act Repeal, Replace, Reconciliation: a Roadmap Shenandoah Valley Society For Human Resource Management March 7, 2017

Overview What is this presentation? What this presentation is NOT? An attempt to explain, and perhaps anticipate, the many moving parts of GOP efforts to repeal or modify the Affordable Care Act post-Trump’s inauguration What this presentation is NOT? A political commentary All efforts will be made to caveat editorial statements A civics lesson SVSHRM extended invitation to present on ACA-related topic on Oct 20, 2016 Presidential Election: Nov 8, 2016

Health Care Reform Purpose – Assist the 54M uninsured in obtaining medical insurance. Also known as: Patient Protection and Affordable Care Act (PPACA) Affordable Care Act (ACA) ObamaCare What is it? Sweeping Health Care legislation that: Requires Individuals to purchase medical insurance Requires Employers to provide it (or pay a penalty) Establishes access mechanisms in the form of insurance exchanges, i.e., the MarketPlace Expands Medicaid eligibility (state by state decision) 3 3

Trump/Congress Order and Efforts

Item Likely Not Subject to Reconciliation…

CIAB Intelligence Notes The Clarity on Repeal is Ripening…or is it? The best line we’ve heard from one of the most influential health staffers in the Senate this week: If somebody is saying they know what’s going to happen, they’re lying Repeal might be expanded to include several other provisions that are listed in Title I of the ACA, which notable could include the repeal of the Medical Loss Ratio. Repealing the Cadillac Tax is nearly certain, but it will likely be compromised with a hit to the employer tax exclusion to recoup lost revenue. It looks increasingly likely that the employer mandate penalty will be reduced to zero dollars, essentially repealing the mandate. Reconciliation rules won’t allow for a repeal of the associated employer reporting requirements to also be repealed. We’ve been advised there will be a two-step process on this – one legislative and one regulatory – whereby the Administration would work in tandem with Congress and issue a notice that the reporting requirements would not be enforced. History tells us that relying on regulatory actions in tandem gets complicated and tricky, but we’re optimistic that this gets done and solves the complicated reporting requirements.

Plan to Comply until Further Notice 2017 Compliance Plan to Comply until Further Notice New Overtime Rules In effect Dec. 1, 2016 National injunction issued 11/23 leaves us in limbo W-2 Reporting Employer Shared Responsibility Offers of Coverage – 95% 1095/1094-C Filings Reinsurance Payments (final year) Section 1557 Nondiscrimination Injunction issued 12/31/16 Issue new SBC in April, 2017

Medicaid Expansion Provided coverage to approximately 14 million individuals GOP Freedom Caucus Adamant it will not support alternatives that preserve Medicaid expansion Moderate Republicans in Congress feel just as determined to keep Medicaid expansion Many states that Trump carried in the general election, and have heavy GOP representation in Congress, benefited greatly from Medicaid expansion Kentucky, Arkansas, West Virginia Sustainability President Trump and his advisors have indicated that they will pursue a Medicare block grant as part of their attempt to repeal the Affordable Care Act.  20 20

What To Watch For… Medicaid expansion Advanced refundable tax credits How subsidies work today on the Marketplace; GOP representatives are split on whether they should continue Income-based vs. Age-based subsidies Trump’s involvement Selling policies across state lines Will insurance companies be willing to “play ball”? One-third of counties currently have just one insurance company option on the Exchange/Marketplace 21 21

BB&T Insurance Services Scot A. Chancy BB&T Insurance Services (540) 470-8253 schancy@bbandt.com