Federal Health Care Update For Public Employers – An Uncertain Future Anthony Ashenhurst & Anne Mergen

Which Public Employers are Covered by the Affordable Care Act? Public employers with 50 or more employees

Small Public Employers What if a public employer does not have 50 or more employees? It is not covered, but may be affected If the public employer provides health insurance, it might have to pay more to cover Essential Health Benefits

Large Public Employers Do “large” (50 or more employee’s) Public Employers Have to Provide Coverage? No But, if at least one employee applies for and receives a subsidy for insurance through an exchange, then a $2,000 penalty per full time employee applies

Affordable Care Act Issues Premiums Increasing Insurers Leaving the Marketplace Six states only have one carrier now: Alabama, Alaska, Oklahoma, South Carolina, Iowa and Wyoming Iowa’s carrier out of 94 counties (total 99) Illinois lost 4 for 2017

2017 Rate Increases The Illinois Department of Insurance average approved rate increase based on metal level average rate increases across the state: Lowest-cost Bronze plan = 44 percent (60/40) Lowest-cost Silver plan = 45 percent (70/30) Second-lowest-cost Silver plan = 43 percent (70/30) Lowest-cost Gold plan = 55 percent (80/20)

Polls Show Public Concern

Where the President Stands on Medicaid Expansion Letter from Secretary Tom Price and CMS Administrator Seema Verma to all Governors Medicaid has departed from historical mission in covering non-disabled, working age Easier waiver approvals Assist low income individual with skills and employment Move working age non-pregnant, non-disabled to private coverage

What comes next? Repeal Repeal and Replace Fix the ACA

Impact of Repeal on Municipal Owned Hospitals Likely to have to provide more uncompensated care More Emergency Department Visits

The Amending the ACA through the “Reconciliation” Process Reconciliation only for measures that directly affect the budget The process can: Eliminate Taxes on the wealthy, insurance companies, and medical companies Eliminate The individual mandate Undo the Medicaid expansion Eliminate financial assistance to insurance companies Reconciliation cannot: Eliminate the pre-existing condition rule

Policy Proposals American Health Care Act (AHCA) The House Plan The “Better Care Reconciliation Act” The Senate’s Attempt at a Plan The Cruz-Lee Amendment “Skinny Repeal” Problem Solver’s Caucus

The “Skinny Repeal” As originally proposed Most taxes would remain No penalty for failing to buy health insurance Eliminating the individual mandate No penalty for employers who don’t provide Health insurance

Impact of Policy Proposals The House AHCA? The Senate Better Care Plan? Skinny Repeal Premiums would likely rise Fewer people would be covered by insurance

The Problem Solver’s Caucus Created by the House Includes 43 members Republicans and Democrats Goal of stabilizing the individual insurance market

Medicaid Likely Changes Medicaid Expansion Block grants or Per capita funding States would choose Work Requirements Premiums

Questions? What do you think is Next?