Employers’ Council of Iowa Meeting Wednesday, April 24, 2013 PPACA Update Jesse A Patton LUTCF, HIA, MHP, FAHM, HIPAAA, EHBA, PHIAS. Health Reform Implementation…. This is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.
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This is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.
Winston Churchill, November 10, 1942
at the Lord Mayor's Luncheon at Mansion House in London
We are at the
End of the beginning—7 to 10 years of rule making and changes.
“We have to pass the bill so that you can find out what is in it” …. Speaker Nancy Pelosi
On March 21, the House passed HR 3590, the bill passed by the Senate on December 24, 2009, with a 219-213 vote. Signed into law on March 23.
The House and Senate have also passed a reconciliation bill, HR 4872, with a packages of “fixes” to the Senate bill
President Obama signed the reconciliation bill.
Be forewarned, NAIC, CMS, DOL , Dept. Treasury and DHHS will need to issue continued guidance many issues which will impact our understanding of these measures. There are some questions you have today that cannot be answered.
March of 2010, just before the law was enacted, cost $950 billion
August 2012, CBO estimated PPACA would be $1.165 trillion
February 5, 2013, CBO estimated new 10 year cost $1.329 trillion
* Estimate is statistically different from estimate for the previous year shown (p<.05).
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2012.
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2012. Bureau of Labor Statistics, Consumer Price Index, U.S. City Average of Annual Inflation (April to April), 1999-2012; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 1999-2012 (April to April).
Section 1302(b) defines essential health benefits to include:
2014 – Product Framing Workers’ Contributions to Premiums, Inflation, and Workers’ Earnings, 1999-2012
Plus catastrophic plan offering for individuals younger than 30/financial hardship
The benefit requirements listed above for exchange plans will also apply to Individual and small group fully insured plans sold outside of the exchanges
Up to 100 employees,can buy thru Marketplace -2016
2014-2015 2-50 Employees
A web portal “marketplace” for health insurance
(no subsidies for ones offered employer-based coverage, unless that coverage is “unaffordable”)
Self-insured plans not eligible to Participate
©2010 Steptoe & Johnson LLP
Catastrophic policy with essential benefits package available to young adults and people who cannot find plan premium <8% of income
Notes: FPL refers to federal poverty level; levels are for 2011. Actuarial values are the average percent of medical costs covered by a health plan. Premium and cost-sharing credits are for the Silver plan.
Source: Commonwealth Fund Health Reform Resource Center: What’s in the Affordable Care Act? (PL 111-148 and 111-152), http://www.commonwealthfund.org/Health-Reform/Health-Reform-Resource.aspx.
Appendix A: List of Questions in the Online Application to Support Eligibility Determinations for Enrollment through the Health Insurance Marketplace and for Medicaid and the Children’s Health Insurance Program
The transition relief includes the following components:
Although these regulations are proposed and not final, employers can rely on them until final guidance is issued.
Summary of Potential Employer Penalties under PPACA, Congressional Research Service
May 14, 2010