1. Quick Overview: Healthcare Laws for Small Business Mike Sanborn, MS, RPh, FASHP, FACHE President/CEO Baylor Medical Center at Carrollton

2. Objectives Brief overview of the law and it’s dynamics Implications for business Review of the resources available for small businesses 1

3. We Spend More!

4. Why discuss this?

5. Health care accounts for nearly 20% of Texas government spending from state, federal and other sources 16.7% 19.2%

6. You are Here!

7. Marketed Provisions - Affordable Care Act You’ve heard about these: – Coverage for children up to 26 – Eliminating the doughnut hole for seniors – No cost preventative care – Review of premium increases ≥10% – Removing lifetime caps – Eliminating pre-existing conditions “Affordable” Insurance Exchanges Payment increasingly tied to quality, service, and safety Shared financial responsibility for care outside the hospital

8. Non-Marketed Provisions - Affordable Care Act Insurance Plan Requirements Medicaid expansion participation Medicare Cuts of $716 Billion Medical Device Tax Perverse Penalties and Fees Reimbursement Reductions Doesn’t Address the “Doc Fix” High Deductible Plans Unintended Consequences – Insurance Drops – 50 Worker Provision – 30 Hour provision

9. Implications for Business and Available Resources 8

10. Costs are not Declining 9

11. Felt by Employers and Employees Yet median income has declined by about $4,ooo since 2008 10

12. Employee Share is Highly Variable 11

14. The “Shape” of Insurance is Changing Increased cost sharing by employees and narrower networks.

15. You can keep your doctor…

16. Business Resources are Available SHOP credits are available to employers with fewer than 25 full-time equivalent employees making an average of about $50,000 a year or less.

17. Big differences in plans

18. Employer Requirements and Penalties Multiple caveats based on business size, hours worked, etc. Required for 95% of FT employees in 2016 Must be offered to dependents <26yo Generally triggered by employee shopping on the marketplace

19. So, what does this all this mean? Businesses Individuals will be scrutinizing health expenses more and more – Trying to find a balance between cost and value More uninsured may become insured More insured may become uninsured – May also affect family members Beware of narrow networks in many plans Really depends on individual situations – Many businesses may find affordable plans – Some may have fewer options 100’s of variables going forward, so consult a benefits professional

20. Questions and Discussion 19