1. ACA Impact on Employers Budget Overview | www.gbpi.org Georgia Budget & Policy Institute Timothy Sweeney, Director of Health Policy September, 27 2013

2. Budget Overview | www.gbpi.org Presentation Overview ACA Expands Health Coverage New Rules for Insurers Individual & Employer Responsibility Politics Driving Sporadic Implementation

3. Budget Overview | www.gbpi.org Who We Are State policy think tank Nonprofit Non-partisan Founded in 2004

4. Coverage Trends Over Time – Adults 18-64 Source: U.S. Census figures compiled by GBPI

5. Coverage Trends Over Time – Adults 18-64 Employer Coverage Declines Offset by Increased Public Coverage Source: U.S. Census figures compiled by GBPI

6. 29% $2.6 billion 71% $5.2 billion Source: 2012 Census Data data compiled by GBPI Those Without Employer Insurance Likely Uninsured

7. 29% $2.6 billion 71% $5.2 billion Source: 2012 Census Data data compiled by GBPI Medicare and Medicaid Fill Coverage Gaps for Children and Elderly (2012 data)

8. US Health Care by the Numbers 48 Million without health insurance (2012) 21 Percent of “working age” adults without coverage 93 Percent of firms with 50+ workers offer benefits 45 Percent of firms with 3-9 workers offer benefits

9. Budget Overview | www.gbpi.org Rising Health Costs Outpace Wage Growth Since 1999

10. Budget Overview | www.gbpi.org Low Wage & Younger Workers Have Less Access to Coverage

11. Budget Overview | www.gbpi.org Spike in Self-Funded Plans in 2010

12. Budget Overview | www.gbpi.org Long-Term Decline in Employer Sponsored Coverage

13. Consumer protections Individual & employer responsibility Insurance marketplace “exchanges” Insurance Reform Tax subsidies for moderate income families & individuals Tax subsidies for small businesses Help with Costs Modifications to coordinate with insurance exchange New coverage for low-income adults Medicaid Role How ACA Improves Access to Coverage

14. No Requirement to Offer Coverage Essential Health Benefits Package Applies No Annual or Lifetime Caps Out-of-Pocket & Deductible Limits Small Group Plans (<50) Employer Shared Responsibility Coverage of Preventive Services No Annual or Lifetime Caps Out-of-Pocket Limits Large Group Plans (>50) Insurance Reforms & Employer Impact

15. No Req. to Offer Coverage Essential Health Benefits No Annual or Lifetime Caps Out-of-Pocket & Deductible Limits Small Group Plans (<50) Employer Shared Responsibility Coverage of Preventive Services No Annual or Lifetime Caps Out-of-Pocket Limits Large Group Plans (>50) Insurance Reforms & Employer Impact

16. SHOP Exchange Small Business Tax Credits Essential Health Benefits Ambulatory Services Emergency Services Hospitalization Maternity & Newborn Care MH & SA Rx Rehab Care Lab Services Preventive Pediatric (incl oral & vision) Up to 50% of Employer Contribution Credit Depends on Employer Size & Avg Wages Available to Employers <25 Avg Wages < $50k Employers with < 50 FTEs Compare Health Plan Options Access Tax Credits Small Employer Impact

17. ≥ 50 FTEs in preceding calendar year Seasonal employee exemption if over 50 FTE for less than 120 days Defining “Large” ≥ 30 hours per week FTE Calculation based on 120 hours / month Defining Full Time and FTE Large Employer Shared Responsibility

18. $2,000 per full-time worker if ANY full-time worker receives premium tax credit First 30 employees exempt from calculation Penalties NOT tax deductible “A” Penalty: Non- Offering Penalties only for employees who receive Premium Tax Credits $3,000 penalty per employee receiving Premium Tax Credit “B” Penalty: Offering Employers Delayed for 2014 No Penalty for Employees on Medicaid No Penalty for Employees < 30 hours More Details Calculating Potential Penalties

19. When the Minimum Value of the Employer Plan is < 60% Coverage Is Not Adequate If Employee Share of Premium is > 9.5% of Income Coverage Is Not Affordable Single: $11,500 to $46,000 Fam of 4: $23,600 to $94,200 Income is 100-400% of Poverty How is Subsidy Eligibility Triggered?

20. Budget Overview | www.gbpi.org Most States Elect a Federal Marketplace

21. Based on Income & Family Size Tied to cost of 2 nd cheapest silver plan Cost-sharing help for some Tax Credits Platinum, Gold, Silver, Bronze Options within each tier Guaranteed issue & community rating 4 Tiers of Coverage Web portal and paper application Navigators and brokers Open enrollment October 1, coverage begins January 1 Access Points Marketplace Overview

22. Determining Subsidy – Family of 4

23. Determining Subsidy – Individual

24. Plan TierActuarial Value Platinum90% Gold80% Silver70% Bronze60% Actuarial value is the proportion of costs covered for a typical group of enrollees. Defining the Coverage Tiers

25. Flip Side of Guaranteed Issue Rules for Insurers Individual Responsibility Rules

26. FY 2014 State General & Motor Fuel Funds Budget ($18.8 billion) Americans Face Significant Coverage Gaps Lack of Medicaid Expansion Will Increase Regional Coverage Disparities

27. Half of All States Set to Expand Medicaid Graphic Credit: Center on Budget & Policy Priorities

28. Budget Overview | www.gbpi.org Lack of Expansion Greatly Affects Southeast More than 4-in-10 uninsured adults in U.S. live in 12 southern states 8 million potentially eligible, uninsured individuals in 10 non- expanding southern states

29. Budget Overview | www.gbpi.org Not Expanding Leaves Significant Coverage Gaps Americans below poverty level ineligible for Premium Tax Credits on Marketplace Safety-net providers face significant financial hardship without expansion

30. Budget Overview | www.gbpi.org Findings & Graphic Courtesy of University of Michigan, Via NPR.org

31. Budget Overview | www.gbpi.org Increased Access Improved Mental Health Greater Financial Stability Oregon Health Study Confirms Value of Medicaid

32. Begins in 2018 40% tax above thresholds: $10,200 for individual plan; $27,500 for a family plan. Excise Tax on High Cost Plans More coverage choices in 2015 Expanded access for employers with 50 to 100 employees in 2016 Expanded SHOP Features Marketplace could reduce employer COBRA costs How will political landscape change? Will it allow for improvements? System Responds to Changes Coming in Future Years

33. Budget Overview | www.gbpi.org Helpful Resources for ACA Information www.Healthcare.gov www.kff.org/health-reform www.kaiserhealthnews.org www.smallbusinessmajority.org www.healthaffairs.org/blog

34. FY 2014 State General & Motor Fuel Funds Budget ($18.8 billion) Q & A Budget Overview | www.gbpi.org

35. FY 2014 State General & Motor Fuel Funds Budget ($18.8 billion) Visit us: www.gbpi.org

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