1. ACA Implementation: What’s Next Karen Ignagni Health Affairs Conference Tuesday, July 17, 2012, National Press Club, Washington, D.C.

2. Interaction of 2014 Provisions Premiums Premium Subsidies Premium Tax Age Rating Compression Essential Benefit Changes Modest Incentives to Purchase Coverage Cost-sharing Subsidies

3. WA OR CA NV UT ID MT ND WY AZ NM CO SD NE KS OK TX AK HI LA AR MO IA MN FL MS AL GA WI IL MI INOH KY WV VA NCTN SC ME PA NY MD DE NJ CT RI VT MA NH Rate bands 5:1 or greater Rate bands less than 5:1 Age-Rating Compression: Higher Premiums for Younger Individuals in 42 States The ACA limits the age band to 3:1, which will increase costs for younger individuals in the 42 states that currently allow health insurance rates to vary by age by 5:1 or more

4. Independent State Studies Show Impact of Essential Benefits Requirement Study Increase in Non-Subsidized Individual Market Premiums due to Federal EHB Requirements Ohio (Milliman - Prepared for the Ohio Department of Insurance) 20%-30% Maine (Gorman Actuarial/Gruber - Prepared for the Maine Bureau of Insurance ) 33% Maryland (Oliver Wyman – Prepared for the Maryland Health Care Commission) 8%-10% Minnesota (Gorman Actuarial/Gruber – Prepared for the Minnesota Department of Commerce) 6%-7%

5. Impact of the Premium Tax in the Fully-Insured Market Increase in premiums 1.9%-2.3% in 2014 2.8%-3.7% in 2023 10-year increase in the total cost of coverage in the individual market For Individuals: $2,200 For Families: $5,100 10-year increase in the total cost of coverage in the small group market For Individuals: $2,800 For Families: $6,800 Oliver Wyman. Estimated Premium Impacts of Annual Fees Assessed on Health Insurance Plans. October 31, 2011.