State and Federal Legislative Landscape William J. Castner, Jr. Senior Vice President, Corporate & Regulatory Affairs Horizon Blue Cross Blue Shield of New Jersey

Disclosure Declaration Mr. Castner does not have a vested interest in or affiliation with a corporate organization offering financial support or grant monies for this CE activity. Mr. Castner does not have an affiliation with an organization that has a specific interest in the therapeutic areas under discussion.

New Jersey Update Horizon Blue Cross Blue Shield of New Jersey defeated $300M reserve raid this summer Gubernatorial election on November 7, 2017 All 120 legislative seats up for election Lame duck legislative session Transition through January 16, 2018

Looking Ahead in the State House Opioids Out-of-network reform Stabilizing the individual market Protecting Medicaid Public sector health benefits Women’s health issues Driving down health care costs Continuing toward value-based care

Legislation in the Senate Washington, D.C. Despite a revived version of the American Health Care Act (AHCA) passing the House, health insurance reform stalled in Senate Potential Significant Changes in the Senate Need Support from Both Moderates and Conservatives Three Republican Votes Sink the Legislation in the Senate Priorities: Preserve patient protections and boost subsidies for older individuals Priorities: Repeal as many ACA requirements as possible Moderates Health Affairs blog: http://healthaffairs.org/blog/2017/05/04/house-passes-ahca-how-it-happened-what-it-would-do-and-its-uncertain-senate-future/ Medscape: https://www.medscape.com/viewarticle/883072 Conservatives House and Senate Republicans must come to an agreement if significant changes are made to AHCA in the Senate Democratic Party (D): 46 seats Republican Party (R): 52 seats Independent (D-caucusing): 2 seats

Health Care Policy Discussions White House Continuing to maintain that repealing the Affordable Care Act is a priority Pressuring Senate leadership to abandon filibuster and vote again on repeal and replace Using cost-sharing reduction funding as leverage Congress Bipartisan discussions on stabilizing the market and greater state flexibility Conservatives warning against insurance company “bailouts” Medscape: https://www.medscape.com/viewarticle/883072 Chicago Tribune: http://www.chicagotribune.com/g00/news/opinion/page/ct-obamacare-health-care-repeal-page-perspec-0719-jm-20170718-story.html?i10c.encReferrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8%3D Centers for Medicare & Medicaid Services (CMS) / Health and Human Services CMS regulations aiming to stabilize the individual marketplace have been finalized Secretary Price has encouraged states to take an active role in experimenting with market solutions

Rising Premiums Nationally

Rising Premiums Nationally

Areas of Reform Under Discussion Cost-sharing reductions State flexibility Health insurance taxes Medicaid funding

Forecast