1. OUT IN FRONT Jefferson Chamber Health Care Reform Conference How Will The Affordable Care Act Affect My Business? Legal Background and Issues March 21, 2013 Charles F. Castille, Esq. Adams and Reese LLP | 225.378.3227 | charles.castille@arlaw.com

2. Major Provisions of Affordable Care Act Individual Mandate –Required Purchase of Health Insurance –Shared Responsibility Payment Health Insurance Exchanges –Tax Credits –Cost Sharing Subsidies

3. Major Provisions of Affordable Care Act Medicaid Expansion –138% of Federal Poverty Level (FPL) (133% of FPL and 5% Income Disregard = 138% FPL) Reduction of Disproportionate Share Hospital (DSH) Payments –50% Reduction Maintenance of Effort –Medicaid Eligibility Frozen Until 2014

4. Legal Challenges to ACA National Federation of Independent Business v. Sebelius –Alleged individual mandate unconstitutional Florida v. Department of Health and Human Services –26 states (including Louisiana) sued to overturn ACA –Alleged individual mandate and Medicaid expansion unconstitutional Cases consolidated by U.S. Supreme Court

5. Supreme Court Decision Holding (5 - 4) decision –Individual Mandate Constitutional Under Federal Taxing Power Medicaid Expansion –Unconstitutional as Required by ACA –Optional for States

6. Post Election Observations Status of ACA –“Elections matter” –“Law of the land” Possible impact of federal deficit reduction on ACA

7. State Decisions Health Insurance Exchange –Louisiana opted for a Federally Facilitated Exchange (FFE) Medicaid Expansion –Governor Jindal has refused to expand Medicaid in Louisiana –“Arkansas deal”?

8. Hidden Surprise for Employers Why should business care about Medicaid expansion? –Jackson Hewitt Study –Possible negative impact on employers if Louisiana does not expand Medicaid $51.7 to $77.6 million per year

9. OUT IN FRONT Jefferson Chamber Health Care Reform Conference How Will The Affordable Care Act Affect My Business? Legal Background and Issues Charles F. Castille, Esq. Adams and Reese LLP | 225.378.3227 | charles.castille@arlaw.com