Presented by: Matt Turkstra

Presented by: Matt Turkstra 1

» What s happening in Ohio?» How is health insurance changing? Individual and Group Health Insurance» Important employer terms» Impact small businesses that do not offer insurance? Non-offering employees and the Individual Exchange» Impact small businesses that do offer insurance? Affordable insurance and the SHOP Exchange» Impact on large businesses that do not offer insurance?» Impact on large businesses that do offer insurance?» What s happening in 2014?» How can you help?» Questions and Answers 2

» YES to Medicaid Expansion Expansion of eligibility of health insurance program for low-income individuals up to 138% FPL ($15,856 for individuals; $32,499 for family of 4)» DEFER to Federally-Facilitated Exchange Establishment of two regulated marketplaces for the purchase of health insurance in the individual and small group markets» YES to continuation of offering current, nonqualified policies through 2014 President announced policy change in November + Ultimate decision up to Lt. Governor/Insurance Commissioner in Ohio» Ohio-specific small group insurance requirements Dependent coverage up to age 28 (if offered) Eligibility begins 25-hours per week 3

Current Status of State Medicaid Expansion Decisions, 2014 WA OR NV CA ID AZ UT MT WY CO NM ND SD NE KS OK MN WI* IA* IL MO AR* MS MI* OH IN* KY TN AL VT NY PA* WV VA NC SC GA ME NH MA CT RI NJ DE MD DC AK HI TX LA FL Implementing Expansion in 2014 (26 States including DC) Open Debate (6 States) Not Moving Forward at this Time (19 States) NOTES: Data are as of January 28, 2014. *AR and IA have approved waivers for Medicaid expansion; MI has an approved waiver for expansion and plans to implement in Apr. 2014; IN and PA have pending waivers for alternative Medicaid expansions; WI amended its Medicaid state plan and existing waiver to cover adults up to 100% FPL, but did not adopt the expansion. SOURCES: States implementing in 2014 and not moving forward at this time are based on data from CMS here States noted as Open Debate are based on KCMU analysis of State of the State Addresses, recent public statements made by the Governor, issuance of waiver proposals or passage of a Medicaid expansion bill in at least one chamber of the legislature.

State Health Insurance Marketplace Decisions, 2014 WA OR NV CA ID AZ UT* MT WY CO NM ND SD NE KS OK MN WI IA IL MO AR MS VT NY MI PA OH IN WV VA KY NC TN SC AL GA ME NH CT NJ DE MD DC MA RI AK HI TX LA FL State-based Marketplace (16 states and DC) Partnership Marketplace (7 states) Federally-facilitated Marketplace (27 states) * In Utah, the federal government will run the marketplace for individuals while the state will run the small business, or SHOP, marketplace. SOURCE: State Decisions For Creating Health Insurance Marketplaces, 2014, KFF State Health Facts: http://kff.org/health-reform/state-indicator/health-insurance-exchanges/.

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2013 2014/2015 State benefits mandates State specific regulations State health insurance taxes Early ACA requirements State benefit mandates State specific regulations Early ACA requirements State health insurance taxes Individual mandate No preexisting condition exclusions No annual/lifetime caps on benefits Maximum premium variation (3:1) Maximum out-of-pocket spending caps Federal Essential Health Benefits Federal health insurance tax (HIT) Federal temporary reinsurance fee No cost-sharing for preventive services Minimum actuarial value (60% AV) 7

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» Employer controlled group and affiliated service group aggregation rules.» Employee NOT leased, NOT temporary employees, NOT independent contractors.» Full-time Employee 30 hours/week (130 hours/month).» Full-time Equivalent (FTE) Employees total monthly part-time hours/120. This includes seasonal employees.» Seasonal Employee employed for 6 months or fewer.» Large business averages 100 or more full-time employees or fulltime equivalent employees (FTEs) during 2014.» Small business averages fewer than 50 FTEs during 2014.» Mid-size business averages 50-99 FTEs during 2014.» Employer mandate requirement that large businesses offer health insurance to 70% of full-time employees or pay penalties in 2015. 2016 mid-size and large businesses must offer health insurance to 95% of full-time employees and dependents. 9

» Employers will fall into four six different groups

» No requirement to offer health insurance or pay penalties» Notice of Coverage Options document to ALL employees Distributed to newly hired employees within 14 days of start date + http://www.dol.gov/ebsa/pdf/flsawithoutplans.pdf» Employee concerns Individual mandate Individual Exchange eligibility Subsidized insurance coverage for certain individuals 11

» Qualified Individuals Employees of non-offering businesses, self-employed individuals, employees without offer of affordable health insurance» Subsidized Coverage for Certain Individuals 138%-400% FPL in Ohio Federal Poverty Level (FPL) Individual Income Family of 4 Income Max % of Income Toward Premium 138% $15,282 $32,499 2% 150% $17,235 $35,325 4% 200% $22,980 $47,100 6.30% 250% $28,725 $58,875 8.05% 300% $34,470 $70,650 9.50% 400% $45,960 $94,200 9.50% 12

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» No requirement to offer health insurance or pay penalties Eligible for Small Business (SHOP) Exchange» Increased responsibilities for compliance Notice of Coverage Options document to newly hired employees within 14 days of start date + http://www.dol.gov/ebsa/pdf/flsawithplans.pdf Summary of Benefits and Coverage (SBC) information Voluntary reporting of health insurance value on employees W-2 forms Nondiscrimination requirements (delayed)» Employee Concerns Affordable Health Insurance 14

» Applies to offering employers Employee s taxable wages Box 1 of W-2 statement Employee-only health insurance premium (lowest cost plan if multiple options) Employee s contribution to health insurance premium» Affordable coverage defined Employee s contribution to lowest cost, self-only health insurance premium <9.5% employee s taxable wages» Employee Firewall Employee PROHIBITED from subsidized coverage if insurance is affordable Employees with unaffordable insurance PERMITTED access to subsidized coverage in Individual Exchange 15

Coverage Self-Only Federal Poverty Level (FPL) Income/ Wages Firewall Annual Premium Employee Contribution Employer Contribution Employer Contribution % 100% $11,490 9.5% $5,174 $1,092 $4,082 79% 200% $22,980 9.5% $5,174 $2,183 $2,991 58% 350% $40,215 9.5% $5,174 $3,820 $1,354 26% 401% $46,075 9.5% $5,174 $4,377 $797 15%» Annual Premium figure based off 2013 IRS data for average small group premiums in Ohio» Employer-sponsored insurance remains tax-preferred 16

» Small Business Health Options Program (SHOP) Marketplace for small businesses to shop for health insurance coverage for employees» Qualified employer 2014 Businesses with up to 50 employees 2016 MUST open up to businesses with up to 100 employees 2017 MAY open up to even larger businesses» Small business health insurance tax credit Full credit eligibility - <10 employees; average wages <$25,000 Partial credit eligibility - <25 employees; average wages <$50,000 Employer MUST contribute at least 50% toward employee premiums» Offering arrangements and online enrollment delayed until 2015 17

» Your Business Employer mandate penalties Total liability = (Number of full-time employees 30) x $2,000 + Penalties are non-tax deductible + Increase over time at rate of premium growth» Your Employees Notice of Coverage Options document to newly hired employees within 14 days of start date + http://www.dol.gov/ebsa/pdf/flsawithoutplans.pdf Individual mandate expectations Individual exchange eligible

» Your Business Employer mandate determinations Reporting/Verification of employee health coverage Voluntary disclosure of health insurance costs on employees W-2 forms (mandatory for businesses with >250 W-2s)» Your Insurance Less requirements than small employers Nondiscrimination requirements [delayed] 90-day waiting period limit Notice of Coverage Options document to employees Summary of Benefits and Coverage (SBC) document to employees» Your Employees Affordable health insurance - $3,000 penalty per unaffordable employee Look-back measurement period to determine full-time status (3-12 mo.) Stability period for offer/non-offer (6-12 mo.) Auto-enrollment (businesses with >200 employees) [delayed]

» January 1, 2014 Insurance market reforms take effect for policies renewed after January 1 Coverage in Individual and Small Business (SHOP) Exchanges begins» February 10, 2014 Administration delays employer mandate for an additional year» March 31, 2014 Individual Exchange open enrollment ends Last day to enroll in or change health insurance plans before individual mandate penalty» April 15, 2014 New ACA investment surtax due on passive income >$200,000/$250,000» May 31, 2014 Deadline for health insurers to file 2015 rate proposals with HHS 20

» NFIB needs your help!» Please share your experience with the ACA good, bad or otherwise: www.nfib.com/healthcarestories 21

» Kevin Kuhlman» kevin.kuhlman@nfib.org 22