ACA Impact on Employers Budget Overview |Georgia Budget & Policy Institute Timothy Sweeney, Director of Health Policy September, Budget Overview |Presentation Overview ACA Expands Health Coverage New Rules for Insurers Individual & Employer Responsibility Politics Driving Sporadic Implementation Budget Overview |Who We Are State policy think tank Nonprofit Non-partisan Founded in 2004 Coverage Trends Over Time Adults Source: U.S. Census figures compiled by GBPI Coverage Trends Over Time Adults Employer Coverage Declines Offset by Increased Public Coverage Source: U.S. Census figures compiled by GBPI 29% $2.6 billion 71% $5.2 billion Source: 2012 Census Data data compiled by GBPI Those Without Employer Insurance Likely Uninsured 29% $2.6 billion 71% $5.2 billion Source: 2012 Census Data data compiled by GBPI Medicare and Medicaid Fill Coverage Gaps for Children and Elderly (2012 data) US Health Care by the Numbers 48 Million without health insurance (2012) 21 Percent of working age adults without coverage 93 Percent of firms with 50+ workers offer benefits 45 Percent of firms with 3-9 workers offer benefits Budget Overview |Rising Health Costs Outpace Wage Growth Since 1999 Budget Overview |Low Wage & Younger Workers Have Less Access to Coverage Budget Overview |Spike in Self-Funded Plans in 2010 Budget Overview |Long-Term Decline in Employer Sponsored Coverage Consumer protections Individual & employer responsibility Insurance marketplace exchanges Insurance Reform Tax subsidies for moderate income families & individuals Tax subsidies for small businesses Help with Costs Modifications to coordinate with insurance exchange New coverage for low-income adults Medicaid Role How ACA Improves Access to Coverage No Requirement to Offer Coverage Essential Health Benefits Package Applies No Annual or Lifetime Caps Out-of-Pocket & Deductible Limits Small Group Plans (50) Insurance Reforms & Employer Impact No Req. to Offer Coverage Essential Health Benefits No Annual or Lifetime Caps Out-of-Pocket & Deductible Limits Small Group Plans (50) Insurance Reforms & Employer Impact SHOP Exchange Small Business Tax Credits Essential Health Benefits Ambulatory Services Emergency Services Hospitalization Maternity & Newborn Care MH & SA Rx Rehab Care Lab Services Preventive Pediatric (incl oral & vision) Up to 50% of Employer Contribution Credit Depends on Employer Size & Avg Wages Available to Employers 9.5% of Income Coverage Is Not Affordable Single: $11,500 to $46,000 Fam of 4: $23,600 to $94,200 Income is % of Poverty How is Subsidy Eligibility Triggered? Budget Overview |Most States Elect a Federal Marketplace Based on Income & Family Size Tied to cost of 2 nd cheapest silver plan Cost-sharing help for some Tax Credits Platinum, Gold, Silver, Bronze Options within each tier Guaranteed issue & community rating 4 Tiers of Coverage Web portal and paper application Navigators and brokers Open enrollment October 1, coverage begins January 1 Access Points Marketplace Overview Determining Subsidy Family of 4 Determining Subsidy Individual Plan TierActuarial Value Platinum90% Gold80% Silver70% Bronze60% Actuarial value is the proportion of costs covered for a typical group of enrollees. Defining the Coverage Tiers Flip Side of Guaranteed Issue Rules for Insurers Individual Responsibility Rules FY 2014 State General & Motor Fuel Funds Budget ($18.8 billion) Americans Face Significant Coverage Gaps Lack of Medicaid Expansion Will Increase Regional Coverage Disparities Half of All States Set to Expand Medicaid Graphic Credit: Center on Budget & Policy Priorities Budget Overview |Lack of Expansion Greatly Affects Southeast More than 4-in-10 uninsured adults in U.S. live in 12 southern states 8 million potentially eligible, uninsured individuals in 10 non- expanding southern states Budget Overview |Not Expanding Leaves Significant Coverage Gaps Americans below poverty level ineligible for Premium Tax Credits on Marketplace Safety-net providers face significant financial hardship without expansion Budget Overview |Findings & Graphic Courtesy of University of Michigan, Via NPR.org Budget Overview |Increased Access Improved Mental Health Greater Financial Stability Oregon Health Study Confirms Value of Medicaid Begins in % tax above thresholds: $10,200 for individual plan; $27,500 for a family plan. Excise Tax on High Cost Plans More coverage choices in 2015 Expanded access for employers with 50 to 100 employees in 2016 Expanded SHOP Features Marketplace could reduce employer COBRA costs How will political landscape change? Will it allow for improvements? System Responds to Changes Coming in Future Years Budget Overview |Helpful Resources for ACA Information FY 2014 State General & Motor Fuel Funds Budget ($18.8 billion) Q & A Budget Overview | FY 2014 State General & Motor Fuel Funds Budget ($18.8 billion) Visit us: LETS STAY CONNECTED Please sign up for our electronicalerts on our website, like us on Facebook and follow us on Twitter.