1. Heartland Council Education Conference September 29, 2011

2. Impact of Health Reform on Employers Agenda Introduction Uncertainties Around Healthcare Reform Key Components of Reform – Benefit Exchanges – Individual mandate – Employer requirements – Case Study Summary – Impact on Employers – Controlling Costs/Primary care focus Q&A

3. Speaker Bios Jay Eckersley Senior Health Care Consultant with Gosser Group, St. Louis and Principal at Employers Health Network, Springfield, MO. Currently advises employers, providers and health plans how best to integrate their respective interests to meet local marketplace demand for effective managed care contracting, guaranteed cost controls and published reporting of quality patient care outcomes. As CEO, 1999-2006, Jay Eckersley inspired and led St Johns Health System in Springfield Missouri to the top ten position in Verispan/SDI’s most Integrated Health Care Systems, nationally. Eckersley has held similar Health System Leadership positions in St. Louis, Columbus OH, Minneapolis-St. Paul and Salt Lake City. Bruce Gosser Bruce Gosser established Gosser Group, a Healthcare Business Consulting company, in 2009. Bruce has over 30 years of experience in the Healthcare Industry and has built several businesses in this time. He has aligned the Gosser Group to build upon his previous experience and his visions of the industry’s future. David Gosser Marketing and Research Director at Gosser Group in St. Louis. As a consultant, David manages the development and implementation of marketing and communications strategies for healthcare organizations. He has focused on the delivery and payment changes created in health reform and the movement towards patient-centered care. Gosser Group is also comprised of Medical and Nursing Directors along with IT and Operations Consultants

4. Uncertainties of Reform Minimum requirements for plans Premium rates through the exchange Will individual mandate be over-ruled? Little change to delivery system doesn’t address high cost growth

5. Implementation Timeline 2010: Reform Enacted 35% tax subsidy available to small employers (<25 FTEs) until 2014 2011: MLR Guidelines take effect Retiree drug subsidy ended 2014: Benefit exchanges offered to public Individual and employer fines begin 50% tax subsidy available to small employers (<25 FTEs) 2019: Full Implementation of Reform 32 million additional Americans are covered 2018: Excise tax on high-cost plans

6. Patient Protection and Affordable Care Act (PPACA) requires many bipartisan refinements

7. Three Key Components of Reform for Employers Benefit Exchanges Individual Mandate Employer Requirements

8. Benefit Exchanges Regulated marketplace for insurers to offer plans to individuals and small businesses Greater coverage and more transparencies Tax subsidy for employer-based coverage remains in place 400% of poverty level or less eligible for income-based subsidy

9. Individual Mandate and Coverage Individuals who remain uninsured will realize a tax penalty Penalty of $695/person/year to a maximum of $2,085 per family or 2.5% of family income by 2016 Exemption through financial hardship (cost is greater than 8% of income) and religion For larger firms, this mandate reinforces the employer fines Medicaid Expansion Up to 133% of federal poverty level Medicaid payments to primary care physicians will increase to 100% of Medicare rates in 2013 & 2014

10. Employer Requirements $2,000 penalty per FTE for business over 50 FTEs not offering insurance Excise tax on high-cost plans – 40% tax on the top portion of plans costing over $27,500 for family and $10,200 for individuals Children can remain on policy until 26 No lifetime or annual maximum benefit limits Termination of retiree drug subsidy

11. Key Details of Employer Penalty Penalty is only effective if 1 worker receives subsidy through the exchange Part-time employees are included in the total count of workers Fair Labor Standards Act amendment – prevents firing of workers who trigger the fine – avoidance of hiring new workers needed Tax subsidy for employer-based coverage remains in place

12. Next Steps for Employers Determine value of benefits by offering insurance to employees or by having them acquire insurance through benefit exchanges Re-evaluate benefit design packages – Reduce costs – Promote responsible use – Wellness incentives

13. Low-Income Workers Can Benefit from Exchanges A worker earns about $20,000 The employer contributes $3,000 towards $4,000 policy Maximum subsidy of $1,500 per worker Worker could be eligible for larger subsidies through exchange (or Medicaid) and would receive higher wages if the firm did not offer them health insurance

14. Provide Coverage to Avoid Fine Employee cost for coverage is $4,000 Employer cost is $5,000 After Reform Fine of $2,000 per worker Individual fine of $695 New “value” of coverage is $6,695

15. Summary Impact on Employers Top Employer Concerns Key Considerations Controlling Costs

16. Heartland Council Education Conference Contact Us Jay Eckersley: (315) 272-7878 David Gosser: (314) 402-3744