1. Healthy Utah Good for Utah Business? Chad Westover President, Molina Healthcare of Utah December 4, 2014

2. What is it like to live on $15,000 per year? (<133% of FPL)

3. $7.25 per hour without health insurance Crystal Dupont, 25 “I try to live within my means, but sometimes you just can’t.” No doctor visit in two years Behind on car payments Pawn shop / Payday loans to cover monthly expenses Eats beans and oatmeal Lives with disabled mom Attending Community College with loans By the grace of God': How workers survive on $7.25 per hour BY ALLISON LINN, STAFF WRITER, NBC NEWS

4. $7.25 per hour without health insurance John White, 61 “It’s by the grace of God that I am having ends meet” Wages have fallen over last decade Delivers pizzas Wage drops to $4.50 hour while delivering – expected to earn tips Church members help him pick up odd jobs Gets $135 month in food stamps (SNAP) Church sometimes helps pay electric/phone bill or needed car repairs By the grace of God': How workers survive on $7.25 per hour BY ALLISON LINN, STAFF WRITER, NBC NEWS

5. How far does an income of $833* a month go in Utah? Average rent for a 1-bedroom apartment $450 Grocery bills (ramen noodles) $125 Car Insurance $66 Gas (10 miles/day) $72 Clothing / Sundry items $25 Utilities (gas, water) $20 Entertainment (DVDs) $15 Savings / Debt $50 Everything else $10 *Equal to an income of $10,000 a year, or 86% of the federal poverty level $833 Sara’s monthly income

6. How far does an income of $833* a month go in Utah? Average rent for a 1-bedroom apartment $450 Grocery bills (ramen noodles) $125 Car Insurance $66 Gas (10 miles/day) $72 Clothing / Sundry items $25 Utilities (gas, water) $20 Entertainment (DVDs) $15 Savings / Debt $50 Everything else $10 *Equal to an income of $10,000 a year, or 86% of the federal poverty level $833 Sara’s monthly income The cheapest Bronze-level health insurance plan for a 25 year-old in Salt Lake County is $134 a month - or more than 13 times than what Sara has leftover each month

7. Who falls in the coverage gap WITHOUT Healthy Utah? NOTE: Applies to states that do not expand Medicaid. In most states not moving forward with the expansion, adults without children are ineligible for Medicaid. 50% FPL Parents 0 % FPL Childless Adults 100 % FPL ($11,490 for an individual) 400% FPL ($45,960 for an individual) Childless adults below 100% of poverty Parents between 46 - 100% of poverty

8. Who does Healthy Utah impact? NOTE: Applies to states that do not expand Medicaid. In most states not moving forward with the expansion, adults without children are ineligible for Medicaid. 50% FPL Parents 0 % FPL Childless Adults 100 % FPL ($11,490 for an individual) 133% FPL ($15,521 for an individual) 400% FPL ($45,960 for an individual)

9. What about those that fall into 100-133% FPL? NOTE: Applies to states that do not expand Medicaid. In most states not moving forward with the expansion, adults without children are ineligible for Medicaid. 50% FPL Parents 0 % FPL Childless Adults 100 % FPL ($11,490 for an individual) 133% FPL ($15,521 for an individual) 400% FPL ($45,960 for an individual)

10. Where should this person go? NOTE: Applies to states that do not expand Medicaid. In most states not moving forward with the expansion, adults without children are ineligible for Medicaid. 100 - 133% FPL Healthy UtahMarketplace Less premium No deductible Lower co-pays Sliding scale subsidy for premium Deductibles (based on plan) Co-pays (based on plan) ($15,521 for an individual)

11. What’s wrong with this story? Melissa is a 24-year old Utah mom who works, pays taxes, and earns $7,000 a year Melissa and her daughter receive health insurance through Utah Medicaid Last week Melissa’s boss offered her a better job… …and a $2,000 raise, but no health insurance But Melissa turned it down because extra income would cause her to lose her health insurance and fall in to Utah’s coverage gap

12. How big is the impact to Utah? Sven E. Wilson, PhD: THE ECONOMICS OF THE HEALTHY UTAH PLAN: A PRELIMINARY ANALYSIS, August 2014 Value of Insurance IndividualsIndustryGovernment Uncompensated Care Economic Expansion Reduction in Public Assistance Tax Revenues Program Costs to State Benefits Costs

13. Essential Economic Features Sven E. Wilson, PhD: THE ECONOMICS OF THE HEALTHY UTAH PLAN: A PRELIMINARY ANALYSIS, August 2014 Puts federal Medicaid dollars into Private Insurance Fills the “Coverage Gap” Strengthens the State Economy Strengthens the Safety Net for the Poor

14. Sven E. Wilson, PhD: THE ECONOMICS OF THE HEALTHY UTAH PLAN: A PRELIMINARY ANALYSIS, August 2014 The most important political feature of the plan is that it is completely reversible There are no up-front costs No long-term commitments required No large expansion of state government required The legislature can end the program at the same time it enacts it. In 2017, the state may want to design a new program, as allowed under the ACA Reversibility

15. Sven E. Wilson, PhD: THE ECONOMICS OF THE HEALTHY UTAH PLAN: A PRELIMINARY ANALYSIS, August 2014 Employer-sponsored plans: Will crowd out occur? Private Insurance Medicaid Under a FULL Medicaid expansion, tens of thousands of Utahns would move from private insurance to Medicaid.

16. Under Healthy Utah, they stay in the private market. Sven E. Wilson, PhD: THE ECONOMICS OF THE HEALTHY UTAH PLAN: A PRELIMINARY ANALYSIS, August 2014 Employer-sponsored plans: Will crowd out occur? Private Insurance Medicaid

17. Employer-sponsored plans: Will businesses dump their plans? Sven E. Wilson, PhD: THE ECONOMICS OF THE HEALTHY UTAH PLAN: A PRELIMINARY ANALYSIS, August 2014 Insurance offered for business reasons Tax incentives Market pressure from Insurers Competition for employees Healthy workforce Healthy Utah puts money in employee’s hands Likely to increase the number of employer- sponsored coverage among low-income Utahns Healthy Utah does not create incentives for employees to drop insurance plans

18. “Not expanding Medicaid could expose UT employers to $11 to $17 million in annual ACA shared responsibility payments.” Jackson Hewitt, “The Supreme Court’s ACA Decision and Its Hidden Surprise for Employers: Without Medicaid Expansion, Employers Face Higher Tax Penalties Under ACA” March 2013 Impact on business

19. “Premium increases would be even higher among those states that do not expand Medicaid. Premium increases would be borne by nonsubsidized purchasers and by the federal government… Exchange premiums also may increase…” American Academy of Actuaries, “Implications of Medicaid Expansion Decisions on Private Coverage” September 2012 Impact on business

20. “Pressures will be greatest in states that opt out of Medicaid expansion, but have a relatively high proportion of uninsured residents.” Moody's, "Reduction of Medicaid & Medicare Disproportionate Share Hospital Payments a Looming Challenge for States and Hospitals.” March 14, 2013 Impact on business

21. Impact on State and Local government “We estimate that 3.6 million fewer people would be insured, federal transfer payments to those states could fall by $8.4 billion, and state spending on uncompensated care could increase by $1 billion in 2016… In terms of coverage, cost, and federal payments, states would do best to expand Medicaid.” RAND Corporation, “For States That Opt Out Of Medicaid Expansion: 3.6 Million Fewer Insured And $8.4 Billion Less In Federal Payments,” June 2013