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Deirdre Savage November 2013

Deirdre Savage November 2013. 1. ACA: Moving Forward. Post Supreme Court, 2012 Election, federal government moved forward with ACA implementation Timeline was aggressive and called for accelerated delivery of regulations and guidance Many ACA provisions were already in place before Oct 1

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Deirdre Savage November 2013

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  1. Deirdre SavageNovember 2013 1

  2. ACA: Moving Forward Post Supreme Court, 2012 Election, federal government moved forward with ACA implementation Timeline was aggressive and called for accelerated delivery of regulations and guidance Many ACA provisions were already in place before Oct 1 Benefits changes in place Rates submitted and approved One Countdown Over – Another Has Begun… What is going on in DC? 2

  3. ACA: Why so confusing? Clarifications “Fixing” regulatory missteps or omissions “Late Breaking” guidance on numerous significant issues: Employer Mandate Compliance Standard National Differences Exchanges State-based Exchanges (SBEs): 16 states (including MA) plus DC Federally-facilitated Exchanges (FFEs): 27 states State Partnership Exchanges: 7 states Medicaid Expansion 23 states moving forward with expansion 24 states not moving forward with expansion $8.4 billion/3.6 million people Locally State/ACA Reconciliation Bill signed by Governor Elimination of Mass Fair Share Assessment Requirement Rating Factor Waiver “Request” 3

  4. ACA: Why So Confusing… Part Deux:Massachusetts Health Reform with a Twist ACA creates a new (sometimes “revised”) lexicon requiring a deep understanding of definitions, process and impacts of a myriad of health reform terminology. Massachusetts has added complexity of reconciling national and local practices Medicaid & Subsidy Expansion Expands Medicaid to 133% (with no limitations but FPL limit) Subsidies expanded to 400% FPL (vs. Mass 300% FPL) Individual Mandate Penalties Mass: Half the cost of the lowest price plan in the Connector ACA Individual Penalties: $95 or 1% of income for 2014 (but grows) Employer Responsibility Mass: Fair Share Contribution (11+ employees/$ amount)– Repealed August, 2013 ACA Employer Penalties: (50+ employees/$ amount) – Delayed until 2015 Public Exchanges Mass: The Connector ACA: Federally Facilitated Marketplace (FFM), State Based Exchange Partnership, State Based Exchange, Individual Marketplace, Multi State Plan, Small Employer Health Options Program 4

  5. ACA: Why So Confusing… Part Deux:Massachusetts Health Reform with a Twist Products & Benefit Changes Mass: MCC; Bronze, Silver, Gold, Young Adult Plan ACA: EHB Benchmark; Bronze, Silver, Gold, Platinum (AV driven) MOOP! Rating Changes Small Group Size – expansion to 100 employees by 2016 Elimination of several rating factors (e.g. industry, size) – Phased-in to 2016 Challenge of merged market/Annual Rate Filing Risk Mitigation Risk Adjustment Temporary Reinsurance Risk Corridors 5

  6. What’s on the Minds of Employers? 6

  7. ACA: Great 8 – What YOU Need to Know • Open Enrollment Timeline – limited relevance • 2014: October 1 – March 31 • Employer Shared Responsibility • Federal “Pay or Play” Postponed • Don’t postpone your understanding… • Medicaid Expansion • Why does this matter to my business? • Minimum Employer Value • Do you first understand “Actuarial Value”? • Taxes and Fees • What taxes and fees am I exposed to? Now? Future? • Who is responsible for paying? • How much do they impact premium? • Employer Administrative Responsibilities • W-2 Reporting underway • SBC underway • Employee Exchange Notice • Exchange • Public? Federal? State? Private? • Essential Health Benefits • Why does this matter to small group? Why does this matter to large group

  8. ACA: Municipal Concerns • Employer Shared Responsibility • Federal “Pay or Play” Postponed • Taxes and Fees • What taxes and fees am I exposed to? Now? Future? • Who is responsible for paying? • How much do they impact premium? • Employer Administrative Responsibilities • W-2 Reporting underway • SBC underway • Employee Exchange Notice • Essential Health Benefits

  9. ACA: Looking Ahead… • National Rollout of Health Reform • Technical challenges • Implementation hiccups • Public Support? • Post Open Enrollment • Products & Benefit Changes • Rating Factor Phase-Out Impact • Expansion of Small Group market • Impact of 3Rs – Risk Adjustment, Reinsurance, Risk Corridors • Employer Shared Responsibility Provisions • Reporting, Reporting, Reporting • Compliance tightening 9

  10. Wrap-Up • Questions?

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