1. An ACA Update for 2018: What Lies Ahead!
presents
An ACA Update for 2018: What Lies Ahead!
Presented by: Rodger Bayne
President, Benefit Indemnity Corporation

2. Course Objective: Students will be brought up to date with various changes to the ACA landscape. Changes initiated by regulators, the administration, Congress (through the Tax Reform legislation & Budget negotiations) will be reviewed for discussion and impact. The class will look forward to the impact, cause and effect of various potential changes and market responses by health insurance carriers, insurance producers and what those mean to consumers.

3. Introduction ACA Changes Effective or Imminent Tax Reform
Individual penalty / mandate
20 states file suit
Idaho defies ACA
Association Health Plans pending
Utah Rx initiatives/requests
Short term medical plans

4. Tax Reform Three Taxes delayed by Tax Reform Individual Penalty
Health Insurance Tax
Suspended in 2017
In place for 2018 – projected $14.8 billion
Suspended for 2019 by Tax Reform
Cadillac Tax
Delay in this tax extended till 2022
Medical Device Tax
Tax Reform extends the delay of this 2.3% tax through 2019
Opens New ACA Repeal Argument

5. Individual Mandate Repealed
Individual Behaviors
No penalty after 2018
No demand for individual penalty avoidance
Reduction in employee MEC preventive plan contributions
Employer Behaviors
Pay 100% of preventive only MEC plans
Avoid penalties where possible
Insurance Professional Behaviors
Ignore the changes
Sell individual during open enrollment or as a service to group customers
Spurs new Constitutional Challenge to the ACA

6. 20 States File Suit The “New Coke” Smart or Lucky?
ACA Revised by Tax Reform to no longer include penalty tax
Requirement to purchase still exists
Re-opens an admitted constitutional challenge
Establishes grounds for full repeal
Courts have already concluded that the ACA cannot be separated from the Mandate
Mandate NOW unconstitutional with no taxation “out”

7. Idaho Ignores Federal Law
Idaho offers to approve non-ACA complaint health plan filings
Higher costs for sicker “groups”
$1,000,000 maximum
Older age rates above “modified community rate”
More…
Carriers Swiftly Adopt and File Product
Stay Tuned!

8. Association Health Plans Pending
Subject to Final Regulations
Association Health Plans
Could look like Idaho
Could change the face
Could, Could, Could… maybe.

9. Utah and Others Request Canadian Rx
Utah, Vermont, West Virginia, Oklahoma
Requesting the right to import Canadian prescription drugs for distribution in their states
2003 federal law that created the Medicare Part D program. That law says the U.S. Department of Health and Human Services can approve drug importation plans if it is convinced the plans will save money and will not create any public health concerns.

10. Short Term Medical Plans
New Expansion Regulations
Donald trumps Obama’s Executive Order Reversing the Restriction on Short Term Policies to last no longer than 90 days.
Could be used to just under 1 year
Could Create More Aggressive Use
“Wild wild west of product sales”
“ACA becomes more established as high risk pools”

11. Market Evolution
Minimum Essential Coverage Preventive Only plans (often called MECs)
Individual value
Avoided penalty
Provided Only Preventive Coverage

12. Market Evolution
Minimum Essential Coverage Preventive Only plans (often called MECs)
Employer value
Enrollment avoids penalty A implications

13. Market Evolution
Minimum Essential Coverage Preventive Only plans (often called MECs)
Broker value
Satisfying employer demand for solutions
Small revenue (often – sometimes abused)
Helps gain participation for overall group

14. Market Evolution Self-Funded Plans Employee value More Options
Quality Coverage
Most Often Better Service

15. Market Evolution Self-Funded Plans Employer value More… Lower Cost
Options
Innovation
Transparency
Lower Cost

16. Market Evolution Self-Funded Plans Broker value All of the above
Solutions for their customers

17. Market Evolution Worksite Products Individual/Employee value
Greater in the WW West scenario
Short Term plus…

18. Market Evolution Worksite Products Employer value Same scenario
Offer smaller benefits with employer dollars
Offer voluntary plans to cover gaps

19. Market Evolution Worksite Products Broker value More work
More revenue?
More confusion?

20. Summary The hole in the ACA dike is expanding rapidly
Conceivable complete failure within the ten years “we” predicted
Change = Opportunity

21. Questions?
For a copy of the Presentation,