Affordable Care Act Update

Transcription

1 Affordable Care Act Update Amy L. Crawford, SPHR President, Crawford Consulting Group, Inc. Founded in 2000 Over 25 years exp. in HR & Business (multiindustry) Hospitality, Technology, Healthcare, etc. HFTP South Florida Chapter, Former President HFTP South Florida Chapter, Speaker/Former Board Member HFTP Gold Coast, Speaker/Former Board Member 10/25/2017 Crawford Consulting Group, Inc. 2 1

2 Yelena I. Fernandez, SPHR President, Aperio Group, Inc. Founded in 2000 Over 25 years exp. in HR & Business (multiindustry) Hospitality, Commercial Property Development/Management, Manufacturing, etc. HFTP South Florida Chapter, Speaker/Member HFTP Gold Coast, Speaker/Member 10/25/2017 Crawford Consulting Group, Inc. 3 10/25/2017 Crawford Consulting Group, Inc. 4 2

3 4 ACA Terms Employers Need to Know 1. Minimum Essential Coverage 2. Affordable Coverage 3. Minimum Value 4. Medical Loss Ratio 10/25/2017 Crawford Consulting Group, Inc. 5 Minimum Essential Coverage Any insurance plan that meets the Affordable Care Act requirement for having health coverage. 10/25/2017 Crawford Consulting Group, Inc. 6 3

4 Affordable Coverage Coverage is generally considered affordable if the employee s required contribution for the lowest cost self only health plan is 9.69% or less (2017). 10/25/2017 Crawford Consulting Group, Inc. 7 Minimum Value An employer sponsored plan provides minimum value if it covers at least 60% of the total allowed cost of benefits that are expected to be included under the plan. 10/25/2017 Crawford Consulting Group, Inc. 8 4

5 Medical Loss Ratio (MLR) A basic financial measurement used in the Affordable Care Act to encourage health plans to provide value to enrollees. If an insurer uses 80 cents out of every premium dollar to pay its customers' medical claims and activities that improve the quality of care, the company has a medical loss ratio of 80%. A medical loss ratio of 80% indicates that the insurer is using the remaining 20 cents of each premium dollar to pay overhead expenses, such as marketing, profits, salaries, administrative costs, and agent commissions. The Affordable Care Act sets minimum medical loss ratios for different markets, as do some state laws. 10/25/2017 Crawford Consulting Group, Inc. 9 For calendar year 2017, the applicable peremployee dollar penalties of $2,000 and $3,000 are adjusted to $2,260 and $3,390, respectively. ER not offering Coverage $2,260 ER Offering Coverage that is Not Affordable or does Not Provide Minimum Value $3,390 10/25/2017 Crawford Consulting Group, Inc. 10 5

6 Repeal and Replace 10/25/2017 Crawford Consulting Group, Inc. 11 What s on the horizon? CHANGES to ACA How and when still uncertain Conflicting Reports/Data Repeal will lead to jobs cuts 2.6 mm Passage led to job cuts 21% of employers thought they would cut staff Approx. 4% actually did How many curtailed hiring FT ee s? Unknown! The Commonwealth Fund Findings No. of uninsured individuals increase by 16 million to 25 million relative to the ACA. Coverage losses disproportionately affect low-income individuals and those in poor health. Enrollees with individual market insurance would face higher out-of-pocket spending than under current law. Because the proposed reforms do not replace the ACA s financing mechanisms, they would increase the federal deficit by $0.5 billion to $41 billion. 10/25/2017 Crawford Consulting Group, Inc. 12 6

7 The ACA A Spectrum of Possible Changes Total Repeal Eliminate tax exclusion for employerpaid coverage and provide standard deduction Expand use of HSA s Eliminate or modify employer mandates Lift Reporting Req./Penalties Repeal Cadillac Tax Plan by April for 2018 Signals to the insurance market for future planning 10/25/2017 Crawford Consulting Group, Inc. 13 American Health Care Act 5 Employer Benefits Politics AHCA 1. Repeal ER Tax penalties related to mandate 2. Delay Cadillac Tax until Expand HSA & FSA 4. Eliminate Taxes on Medical Devices and Health Insurers 5. End ACA s complex & burdensome ER reporting requirements 10/25/2017 Crawford Consulting Group, Inc. 14 7

8 Favored Parts of ACA Elimination of pre existing condition exclusions (38 percent of respondents favor keeping). Coverage of adult children to the age of 26 (31 percent). Increased wellness incentives (31 percent, again). No cost sharing for preventive care (25 percent). 10/25/2017 Crawford Consulting Group, Inc. 15 Politics ACA What we KNOW By now everyone knows the initial attempt to replace Obamacare with a more workable solution has failed. I m sure another attempt will resurface later. Let s focus on what we know and how President Trump s executive order, signed in January, impacted Obamacare. President Trump s executive order is still in effect. The primary focus of the executive order was for Federal agencies to minimize the economic burden of the Affordable Care Act (ACA), pending repeal of the law. However, until further guidance or legislation, all ACA requirements remain in effect, including penalties for noncompliance. The executive order specifically calls upon agencies to exercise authority and discretion to: Exercise all authority and discretion available to them to waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the Act that would impose a fiscal burden on any State or a cost, fee, tax, penalty, or regulatory burden on individuals, families, healthcare providers, health insurers, patients, recipients of healthcare services, purchasers of health insurance, or makers of medical devices, products, or medications; Provide greater flexibility to States and cooperate with them in implementing healthcare programs; and Encourage the development of a free and open market in interstate commerce for the offering of healthcare services and health insurance, with the goal of achieving and preserving maximum options for patients and consumers. Although the penalties for noncompliance remain in effect it does give the appearance that there is an out. 10/25/2017 Crawford Consulting Group, Inc. 16 8

9 Politics ACA What we KNOW Executive Order (10/12) Association Health Plans Insurance Across State Lines Expand Short term Limited Duration Insurance Expand HRAs 10/25/2017 Crawford Consulting Group, Inc. 17 Politics ACA What we KNOW Trump Ends Cost Sharing Reduction Subsidies Effective Immediately (10/13) Marketplace Turmoil Obama Administration did not receive approval for subsidy expenditures through congress 10/25/2017 Crawford Consulting Group, Inc. 18 9

10 Public Option and Single Payer What s the Difference? Public option, is a government sponsored plan designed to compete alongside private insurers. It is intended to address the market failure where consumers are faced with only one or two health insurers offering coverage in their area. As a public plan it could have the power to dictate prices, provider networks, and provider reimbursements. It could also potentially indemnify itself for unexpected costs, allowing it to offer insurance at below market costs. 10/25/2017 Crawford Consulting Group, Inc. 19 Public Option and Single Payer What s the Difference? Single payer is a health insurance system that is wholly sponsored and administered by a single entity with no direct private market competition. Private insurers would not be able to offer any primary coverage, although in some proposals they would be able to offer supplemental coverage to those who choose to purchase. Providers would be compensated directly by the government, which would also set reimbursement rates, networks, and costs of services. Rationing of services would be among its strongest tool to control costs. 10/25/2017 Crawford Consulting Group, Inc

11 What to do now? 10/25/2017 Crawford Consulting Group, Inc. 21 Health Insurance Cost Control Strategies Changing the DeliverySystem Link Incentives to Health Behaviors 10/25/2017 Crawford Consulting Group, Inc

12 Health Insurance Cost Control Strategies Changing the Delivery System* Telehealth Pre Active Medicine Medical Tourism 10/25/2017 Crawford Consulting Group, Inc Dental Discount 2. Vision Discount 3. Teledoc 4. Doctors Online 5. Wellness 6. Health Advocacy 7. Medical Bill Saver 8. NurseLine What s New? Bundling Crawford Consulting Group, Inc. 10/25/

13 Thank you! Crawford Consulting & Aperio Group Together, we offer businesses a "high touch" suite of customized services, including premier human resources, training, and consulting. 10/25/2017 Crawford Consulting Group, Inc