What the Affordable Care Act Means for Michigan Small Businesses

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1 What the Affordable Care Act Means for Michigan Small Businesses Mary Huttlinger Small Business Majority About Small Business Majority Founded and run by small business owners National offices in Washington, DC plus six states: California, Colorado, Missouri, New York, Ohio and Virginia Research, communications and advocacy on issues of top importance healthcare, taxes, entrepreneurship & capital, clean energy, financial reform, workforce and immigration On-the-ground business organizing and education: 16 key target states + additional work in 18 others 1

2 Small Businesses Struggling With Costs " Soaring cost of health insurance especially for small businesses 25% of small business owners are uninsured (2012 Kaiser study) " 28% self-employed: not covered " Small firms pay 18% more than large businesses Our national study: Small business health costs would more than double by 2018 to $2.4 trillion without healthcare reform Small Businesses Struggling With Costs Our most recent opinion survey: Small employers who don t offer coverage say lack of affordability is the biggest reason (70%) Which one or two of the following best describes the reasons you do not provide health benefits? My business cannot afford it 70% My employees get coverage elsewhere 32% I do not believe it is the responsibility of my business to provide health insurance Waiting to see what happens with the federal health care reform law Too much paperwork and administration Choosing the right insurance plan is too complicated 16% 9% 5% 2% 0% 20% 40% 60% 80% 2

3 Small Businesses Struggling With Costs Another opinion survey of ours found: 72% of those who do offer say they are struggling to do so My business is really struggling to afford the cost of health coverage. (Asked of those who do provide coverage) 28% 72% 0% 20% 40% 60% 80% The Affordable Care Act Builds on existing healthcare system Aims to rein in healthcare costs Upheld by U.S. Supreme Court Implementation primarily the responsibility of the states (small business input essential) Some important benefits went into effect immediately Others implemented from

4 Immediate Consumer Protections Insurers will no longer be able to deny coverage for patients with pre-existing conditions As of August 2012, 2,204 previously uninsured residents of Michiganders are now insured Ban on lifetime caps that set lifetime limits on coverage Already, 3,547,000 people in Michigan, including 1,315,000 women and 977,000 children, are free from worrying about lifetime limits on coverage Adult children under 26 can stay on their parents plan As of December 2011, 94,000 young adults in Michigan gained insurance coverage as a result of the health care law Immediate Consumer Protections Bans health plans from dropping coverage when: someone gets sick either the employee or their employer made an unintentional mistake on their paperwork First-dollar coverage for preventive care for all new plans In 2011 and ,386,000 Michiganders with private health insurance gained preventative service coverage with no cost-sharing Increased access to care - community health centers In Michigan, 32 health centers operate 194 sites, providing preventive and primary health care services to 546,245 people 4

5 Key Small Business Provisions Immediate tax credits for most small businesses Establishes competitive marketplace for small businesses (SHOP) and self-employed (individual) Small Business Tax Credits Available to businesses with employees Available now (took effect tax year 2010) Which businesses are eligible? þ Fewer than 25 full-time employees þ Average annual wages <$50,000 þ Employer pays at least 50% of the premium cost 5

6 Michigan Small Business Tax Credits Our report: 126,300 Michigan small businesses are eligible (85.1% of all businesses); 39,600 businesses eligible for the maximum credit Small$Businesses$That$Are$Eligible$for$Premium$Tax$Credits$for$2011$ NonDeligible$businesses$ 22,000$ 126,300$ 39,600$ 87,700$ Eligible$businesses$ Maximum$Premium$Tax$Credits$ Some$Tax$Credits$ Small Business Tax Credits National Snap Shot 2 in 5 business owners qualify eligible for max 19.3M employees work for eligible businesses Total value of the credit for tax year 2011:$15.4B An average of $800 in savings per employee 6

7 Small Business Tax Credits Tax credits on a sliding scale: o Up to 35% o Up to 50% any two years (2014) Premium expenses: comprehensive medical coverage (includes: dental, vision, long-term care) Does not cover premium expenses of owners or their families nor the self-employed Can amend your taxes Nonprofits Also Eligible Tax credits on a sliding scale: o Up to 25% o Up to 35% any two years (2014) Include amount on line 44f of Form 990-T Does not have to be publicly reported Refund for tax-exempt employers 7

8 How to Claim the Small Business Tax Credit Small employers (businesses or tax-exempt) will use new Form 8941, available on Small businesses will include the amount of the credit as part of the general business credit on their income tax returns The credit can be reflected in determining estimated tax payments for a year The credit applies towards income tax, not employment tax Tax Credits as a Percentage of Employer Premium Contributions Average Wage Firm size Up to $25,000 $30,000 $35,000 $40,000 $45,000 $50,000 Up to 10 35% 28% 21% 14% 7% 0% 11 33% 26% 19% 12% 5% 0% 12 30% 23% 16% 9% 2% 0% 13 28% 21% 14% 7% 0% 0% 14 26% 19% 12% 5% 0% 0% 15 23% 16% 9% 2% 0% 0% 16 21% 14% 7% 0% 0% 0% 17 19% 12% 5% 0% 0% 0% 18 16% 9% 2% 0% 0% 0% 19 14% 7% 0% 0% 0% 0% 20 12% 5% 0% 0% 0% 0% 21 9% 2% 0% 0% 0% 0% 22 7% 0% 0% 0% 0% 0% 23 5% 0% 0% 0% 0% 0% 24 2% 0% 0% 0% 0% 0% 25 0% 0% 0% 0% 0% 0% Source: CONGRESSIONAL RESEARCH SERVICE, SUMMARY OF SMALL BUSINESS HEALTH INSURANCE CREDIT UNDER PPACA (P.L ) 3 (Apr. 5, 2010). 8

9 Example: Main Street Mechanic Workforce: 10 FTE employees Wages: $250,000 ($25,000/employee) Healthcare costs: $70,000/year $24,500 credit (35%) 2014 $35,000 credit (50%) Example: Downtown Diner Workforce: 20 FTE employees (40 PTE) Wages: $500,000 ($25,000/employee) Healthcare costs: $240,000/year $28,000 credit (11.7%) 2014 $40,000 credit (16.7%) 9

10 Healthcare Tax Credits Example Mark Hodesh, owner Downtown Home & Garden Ann Arbor, MI This is finally a chance to get some money back and I put it into the business." Pays 75% of employees healthcare premiums ($60K/yr) = $15,000 credit in Wellness Programs Wellness programs affect plans starting on Jan. 1, 2014 Two types of wellness programs: 1. Participatory wellness programs- Do not provide reward OR do not include conditions for obtaining a reward that are based on an individual satisfying a standard related to a health factor. 2. Health-contingent wellness program- Require individuals to meet a specific standard related to their health obtain a reward (namely a specified % of the cost of health coverage) 10

11 Wellness Programs Examples Medical Loss Ratio: 80/20 rule 80% of premium on medical claims & quality improvement 20% on administrative & profits Rebates to customer if exceed Estimated $1.1B given back in 2012; $321M in the small group market $13M in Michigan Average rebate per enrollee in small group plan: National: $174 Michigan: $214 11

12 4/16/13 Rate Review Insurance companies required to: Publicly disclose and justify rate increases of 10% Explain increase on HealthCare.gov; each state s rate review program will give customers a chance to comment State can approve or reject unreasonable or excessive increase if has its own law No state program: federal government will conduct reviews State Health Insurance Exchanges: Coming in 2014 Large marketplace to shop for health coverage Private insurance plans will compete RAND study: Expand coverage to 85.9% of small business employees (currently at 60.4% today) an increase of 10.5 million workers 12

13 State Health Insurance Exchange One-stop shop web portal Small Business Exchange INSURANCE PLANS EXCHANGE Choice Comparison Billing Tax Credits SMALL BUSINESSES o Compare plans and get detailed information about price, quality and service o Plans organized by category: bronze, silver, gold, platinum o Calculator to compare costs across plan options State Insurance Exchanges Small business workers and self-employed receive affordability tax credits (up to 400% of federal poverty level $90K for family of 4) Ensure more $$ to medical care reduced administrative costs Reduce hidden tax 13

14 State Insurance Exchanges: Coming in 2015 More bells and whistles Incentives for administrative efficiency and modernization Employee choice Streamlined billing process (premium aggregation) State Insurance Exchange Insurance will still be sold outside exchange Members of Congress must use the exchange 14

15 State Exchanges States will enter into the federally-facilitated exchange (FFE), state-federal partnership, or set up a state-based exchange Exchange Decision State-based exchange (18) State-federal partnership (7) Federally-facilitated exchange or FFE (26) State CA, CO, CT, DC, HI, ID, KY, MA, MD, MN, NM, NV, NY, OR, RI, UT, VT, WA AR, DE, IA, IL, MI, NC, WV AK, AL, AZ, FL, GA, IN, KS, LA, ME, MO, MS, MT, ND, NE, NH, NJ, OH, OK, PA, SC, SD, TN, TX, VA, WI, WY Michigan Exchange Governor Rick Snyder (R) supports the creation of MI Health Marketplace, a nonprofit to oversee the state s health insurance exchange Moving forward for a state-federal partnership exchange Michigan will perform plan management and consumer assistance functions and defer other exchange management functionality to the federal government On March 5, 2013, Michigan received conditional approval from the U.S. Department of Health and Human Services to establish a partnership exchange 15

16 Shared & Individual Responsibility Businesses with fewer than 50 full-time workers 96% of all businesses are exempt from any requirement to offer insurance. Size of American Businesses Nationally: o 4.8M businesses with fewer than 50 employeesoffer health insurance o 1.7M businesses with 50 or more employeeshealth insurance o Michigan: o 148,151 businesses with fewer than 50 employeesoffer health insurance o 48,987 businesses with 50 or more employeesoffer insurance offer Small Business Majority and Kaiser Permanente poll: After learning about features in the exchange, percentage of California small business owners who said they d be likely to offer insurance jumped from 32% offering to 42% 16

17 For Larger Employers Am I above or below 50 full-time employees? At least 50 full-time employees or combination of full-time/part-time employees equivalent to 50 fulltime employees Full-time employees: at least 30 hours per week Part-time employees: at least 15 hours a week Seasonal employees: 120 days per year Size determined annually Amount owed determined monthly For Larger Employers Potential requirements for larger employers (those with more than 50 employees): 1. Failing to Offer Coverage 2. Failing to Offer Affordable Coverage $2,000/employee/year Excludes the first 30 FTEs $3,000/employee/year EEs purchasing individual coverage with a subsidy triggers the penalty Affordable: EEs contribution > 9.5% of Box 1 on W2s, OR Plan pays < 60% of health care expenses *Affordability penalty cannot exceed that of failing to offer coverage. Business will pay lesser of the two. 17

18 Medicaid Expansion Accessing Medicaid coverage does not trigger an employer penalty Nearly 27,000 Michigan employees who otherwise would have utilized Medicaid eligible for premium tax credits Jackson Hewitt Tax Service study, works out to a combined $55,000-$80,000 in associated payments for the state s employers States that choose not to expand Medicaid are shifting what would have been expansion costs paid by the federal the government at no cost to the state directly on to local employers Medicaid Expansion: Case Study Case Study: Small Business > Garden Center & Nursery Details: 67 employees 13 salaried employees and 54 hourly employees (half of which are Medicaid eligible) Outcome: One provision of Medicaid expansion involves the requirement of the Affordable Care Act that businesses with 50 or more employees either offer health insurance or pay a penalty. It would appear that this employer would be required to offer health insurance. However, workers on Medicaid are not counted toward the total number of employees, so the Medicaid expansion would mean that even many small businesses with 50 or more employees could avoid paying a penalty for not offering health insurance. 18

19 How We Are Paying for the ACA Medicare savings Payment reform and quality care Employer and individual penalty taxes Reduction in fraud and abuse Reductions to payments to hospitals that pay for uninsured patients High income earners pay increased Medicare and unearned income taxes Tanning bed taxes Taxes on medical devices Additional health insurance company taxes Take-A-Ways Do you employ +/-50 employees? -50: not required to do anything +50: status quo for 98%, other 1.7% need to make a decision Exchanges are an OPTION Tax Credit is retroactive ACA aims to reign in double digit premium increases, NOT reduce premiums Consumer protections are already having an impact 80/20 and Rate Review are Checks & Balances Fill Out Sign-in sheet to receive ppt and links to formulas and other hotlinks 19

20 Resources National HHS website: SBM Coverage Guide: Spring 2013 Our website: o What s in Healthcare Reform for Small Businesses o Healthcare Policy Page o Detailed FAQ o Tax credit calculator Mary Huttlinger Small Business Majority (513)

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