1. January 2016 Many part-time K-12 and higher education employees would likely pay more if insured through the Exchange John Woolley and Eric Thomas, JLARC Staff Briefing Report: Washington Health Benefit Exchange Options Legislative Auditor’s Conclusion:

2. Report is first phase of possible two phase study January 2016 Washington Health Benefit Exchange 2/22 Report estimates impacts of shifting coverage: not an audit of Washington Health Benefit Exchange Original design: possible two phase study Question for JLARC: Is preliminary information sufficient, or does JLARC wish to attempt a more precise answer with a second phase?

3. Washington Health Benefits Exchange offers marketplace for individual insurance plans What would be the effect of moving part-time K-12 and higher ed employees from employer group coverage to the Exchange? January 2016 Washington Health Benefit Exchange 3/22

4. Estimate: Many likely to pay more if purchasing coverage through Exchange January 2016 Washington Health Benefit Exchange 4/22 Many employees unlikely to qualify for subsidies to help reduce higher premiums Older part-time employees could pay higher premiums on Exchange Needed for exact answers: age, where employee lives, household income, # of dependents, spouse’s access to coverage— some of this key information not available

5. Part-time employees currently have employer group coverage $275M state and local dollars for health care Higher Ed. 13k employees 0.5 - 0.75 FTE PEBB Coverage K-12 20k employees <0.75 FTE District Coverage Up to 33,000 part-time employees January 2016 Washington Health Benefit Exchange 5/22

6. 3 analyses to estimate potential impact of shifting part-time employees “What if?” scenarios: Some could pay less, others more Data-driven estimates: Many employees likely to pay more Policy considerations: Potential for additional impacts January 2016 Washington Health Benefit Exchange 6/22

7. “What if?” scenarios: Some could pay less, others more Data-driven estimates: Many employees likely to pay more Policy considerations: Potential for additional impacts 3 analyses to estimate potential impact of shifting part-time employees January 2016 Washington Health Benefit Exchange 7/22

8. Scenarios model effects of age and income Premium Assistance Less than 400% of federal poverty level  Scaled based on income  $47K for an individual  $95K for a family of four Out of Pocket Expenses Less than 250% FPL  Scaled based on income  $29K for an individual  $61K for a family of four Federal Subsidies are Based on Income January 2016 Washington Health Benefit Exchange 8/22 Premiums Increase with Age on Exchange 57$589 27 $253 AgeMonthly Premium Comparable plan to PEBB

9. Some may pay less: Lower premiums, subsidies available Washington Health Benefit ExchangeJanuary 20169/22 Premium assistance subsidy Employee pays $48 less per month than current premium Out of pocket expense subsidy

10. Some may pay more: Higher premium despite subsidy Washington Health Benefit Exchange January 2016 Washington Health Benefit Exchange 10/22 Employee pays $728 more per month than current premium Premium assistance subsidy Out of pocket expense subsidy

11. Some may pay more: Higher premium, no subsidy Washington Health Benefit Exchange January 2016 Washington Health Benefit Exchange 11/22 Premium assistance subsidy Employee pays $1,193 more per month than current premium Out of pocket expense subsidy

12. Rates for the same plan on the Exchange vary by location Washington Health Benefit Exchange 35 years old January 2016 Washington Health Benefit Exchange 12/22

13. “What if?” scenarios: Some could pay less, others more Data-driven estimates: Many employees likely to pay more Policy considerations: Potential for additional impacts 3 analyses to estimate potential impact of shifting part-time employees Washington Health Benefit Exchange January 2016 Washington Health Benefit Exchange 13/22

14. Answering question requires data that the state does not collect Factors that affect premiums Part-time higher ed Part-time K-12 Factors that affect eligibility for subsidies Household income Dependents Spouse’s access to coverage Age Where they live   Incomplete  January 2016 Washington Health Benefit Exchange 14/22

15. Older employees could pay higher premiums 26 27 37 47 57 65 $725 $299 $253 $247 $378 $589 Age Premium Cost 42-64% of K-12 and Higher Education employees are older than 47 Washington Health Benefit Exchange January 2016 Washington Health Benefit Exchange 15/22

16. Many employees are unlikely to qualify for subsidies Have working spouse who may have access to other coverage 44-67% Live in households above 400% of the federal poverty level 42-61% $ $ Washington Health Benefit Exchange January 2016 Washington Health Benefit Exchange 16/22

17. “What if?” scenarios: Some could pay less, others more Data-driven estimates: Many employees likely to pay more Policy considerations: Potential for additional impacts 3 analyses to estimate potential impact of shifting part-time employees Washington Health Benefit Exchange January 2016 Washington Health Benefit Exchange 17/22

18. Insurance Adult vision and dental coverage Unknown impact to PEBB and districts’ risk pools Reimbursement IRS ruled that employer cannot reimburse portion of premium or out of pocket costs for Exchange Personnel Recruitment and retention Equity: employees performing similar work treated differently McCleary decision May be implications, employee benefits are part of compensation Policy issues for Legislative consideration Washington Health Benefit Exchange January 2016 Washington Health Benefit Exchange 18/22

19. Next steps Is preliminary information sufficient, or does JLARC wish to attempt a more precise answer with a second phase? January 2016 Washington Health Benefit Exchange 19/22

20. Additional study does not guarantee more accurate answer January 2016 Washington Health Benefit Exchange 20/22    Proposed Approach Risks $30-$40K for social science research firm Same data challenges – key data not collected Propose using older, national level data. Accurate for WA? $630K for health care actuary Propose voluntary survey of employees for personal data. Response rate?

21. Summary: Many likely to pay more if purchasing coverage through Exchange January 2016 Washington Health Benefit Exchange 21/22 Many employees unlikely to qualify for subsidies to help reduce higher premiums Older part-time employees could pay higher premiums on Exchange Needed for exact answers: age, where employee lives, household income, # of dependents, spouse’s access to coverage— some of this key information not available

22. Contact information John Woolley, Project Supervisor john.woolley@leg.wa.gov 360-786-5184 Eric Thomas, Research Analyst eric.thomas@leg.wa.gov 360-786-5182 John Bowden, Research Analyst john.bowden@leg.wa.gov 360-786-5298 www.jlarc.leg.wa.gov