California ARCA / MCA Health Care Reform Presentation

Transcription

1 Mark Straus Dee Shaw Disclaimer: The ACA is constantly being revised and updated and the information contained in these slides was based on best information available to date. Atlanta Cleveland Los Angeles Miami Washington, D.C.

2 Health Care Reform Also known as (AKA): Affordable Care Act (ACA) Patient Protection and Affordable Care Act (PPACA) Health Care Reform (HCR) Obamacare 1

3 Back to HealthCare Reform *Taken from Castlight Health s 9/5/2013 Implications of the ACA presentation 2

4 Back to Health Care Reform (cont.) *Taken from Castlight Health s 9/5/2013 Implications of the ACA presentation 3

5 Back to Health Care Reform (cont.) *Taken from Castlight Health s 9/5/2013 Implications of the ACA presentation 4

6 Back to Health Care Reform (cont.) ACA Effects on Employers Direct Indirect Employer responsibility for providing coverage and relationship to individual mandate Requirements for minimum value of coverage and benefits Incentives and guidelines for wellness programs New fees, taxes, and compliance requirement for employers Creation of subsidized public exchanges for individuals and small groups, and introduction of risk adjustment Increasing interest in private exchanges and defined contribution for employers Impact of public delivery system reform efforts and payment model changes on cost growth and the employer market *Taken from Castlight Health s 9/5/2013 Implications of the ACA presentation 5

7 Employer Mandate Employers with 50 or more full-time employees (generally working 30 hours per week) or equivalent full and part-time mix must to offer affordable health insurance benefits with a minimum value to at least 95% of full-time employees and their dependent children or pay a penalty. Penalty for not offering coverage is $2,000 each year for each full-time employee in excess of 30 employees if one employee gets a subsidy on the exchange. Penalty for unaffordable coverage is $3,000 multiplied by the number of employees who receive a subsidy through the exchange. 6

8 Employer Mandate 7

9 Health Insurance Exchanges Public health insurance exchanges for individuals and small employers can purchase four metal levels of health insurance (60% - bronze to 90% platinum) Multi-employer plans will not be able to purchase coverage through the exchanges 16 states, including California and the District of Columbia are setting up exchanges 7 states are planning to set up exchanges in partnership with the federal government 27 states have defaulted to the Federal Exchange State websites contain information on the exchange in that state 8

10 Exchange Offerings in Southern California Small Business Three insurance carriers will offer plans in the five-county greater Los Angeles region Blue Shield Health Net Kaiser Permanente Businesses with fewer than 25 full time employees may be eligible for federal tax credit Up to 50 percent of the cost of premiums Beginning on January 1, 2014 If they buy employee health insurance through the Small Business Health Options Program (SHOP) exchange 9

11 Exchange Offerings in Southern California Individual Exchange Anthem Blue Cross of California Blue Shield of California Health Net Kaiser Permanente L.A. Care Health Plan Molina Healthcare Sharp Health Plan 10

12 Health Care Reform: Cost of Care On Exchanges Unsubsidized Single Lowest Cost Silver and Bronze Monthly Premiums California Rating Area 15 (Los Angeles) Two Lowest Cost Silver Plans Age 25 Age 40 Age 60 Health Net of California Standard Copay Silver 008 $176 $224 $475 California Physicians Service, d.b.a. Blue Shield of CA Standard Coinsurance Silver 003 $200 $255 $541 Lowest Cost Bronze Plan L.A. Care Health Plan Standard Coinsurance Bronze 004 $147 $188 $398 11

13 Health Care Reform: Cost of Care On Exchanges (cont.) Monthly Premiums Before and After Tax Credits California Rating Area 15 (Los Angeles) Single Adult 25-Year-Old $25,000 Income (218% FPL) Family of Four Two 40-Year-Olds $60,000 Income (225% FPL) Couple Two 60-Year-Old Adults $30,000 Income (193% FPL) Total Premium for Secondlowest-cost Silver Plan $200 $763 $1,082 Tax Credit $56 $354 $932 Second-lowest-cost Silver Premium After Tax Credit Lowest Cost Bronze Plan Before Tax Credit Lowest Cost Bronze Plan After Tax Credit $144 $409 $150 $147 $562 $797 $91 $208 $0 12

14 Health Care Reform: Fee Impact Mandate Effective Date Estimated Costs Expanding dependent children eligibility to age % to 3% Remove lifetime limits (annual limit removal will vary) % to 2.50% New taxes/fees on pharma, insurers and medical device companies passed on to plans % to 3% on insured plans Temporary Reinsurance Fees % to 2% Comparative Effectiveness fees (research) 2013 $2 PEPY* Required plan provisions 100% preventive services Emergency room parity Clinical trial procedure expenses Limit out-of-pocket maximum to $6,350/$12, % to 4% * Per Employee Per Year 13

15 How are Exchanges Expected to Impact Employers? Transition rule for employers to satisfy the pay or play provision when they contribute to a multi-employer plan There is considerable uncertainty about the impact of exchanges on employers and plans. Small business employers with non-union employees are expected to compare the cost of the plans in the exchanges with their current benefit plans Larger employers are expected to continue to offer benefits in the current manner \:\H&W\California ARCA MCA - HC Reform Presentation pptx 14

16 Questions? 15