Recommendations from Community Catalyst From Best Practices in Creating Consumer- Oriented Exchanges: Strategies for 2012 – Get Engaged Early – Become the Expert – Frame the Issue – Encourage Decision Makers to Conduct Consumer Outreach – Build Consumer Coalitions > ACA Implementation

Two Key Issues Affordability Test for Families Essential Health Benefits and IOM Report

Affordability Test – Individual Premium cost for: Income of: Self-only Household > 9.5% Subsidies for an employee with an ESI coverage offer Are available only if:

Affordability Test – Family Premium cost for: Income of: Self-only Household > 9.5% Subsidies for a family with an ESI coverage offer Are available only if:

Affordability Test – Preferred Outcome Premium cost for: Income of: Household > 9.5% Subsidies for a family with an ESI coverage offer Are available only if:

Essential Health Benefits IOM Report Key Points: – Premium target Based on small employer premiums Modified to include ten required categories – State flexibility, but only if: State operates exchange Consistent with ACA and IOM criteria Open, public process Of equivalent value to national EHB

Essential Health Benefits Debate on mandates coming to your state – IOM recommends no preference for state mandates – States must fund premium cost of mandates not included in EHB Does your state have a plan for evaluating its mandates? – Who provides cost data? – Will it be verified?