Encouraging Employer-Sponsored Health Insurance

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1 Encouraging Employer-Sponsored Health Insurance Christina Wessel Minnesota Budget Project Deputy Director Minnesota Council of Nonprofits 2314 University Avenue West, Suite 20, Saint Paul, Minnesota ph: What we'll cover today: New requirements for health insurance Opportunities for small employers Responsibilities for large employers The choices and challenges 1

2 ACA adds consumer protections No exclusions for preexisting conditions Fair health insurance premiums Guaranteed issue and guaranteed renewal No discrimination based on health status No excessive waiting periods No annual or lifetime limits Basic package of benefits Free preventive services Grandfathering plans Plans in place in March 2010 may not need to meet these new requirements if there has been no significant changes in coverage. Grandfathered plans cannot have lifetime limits, unreasonable annual limits, or exclude children with pre-existing conditions. They must cover employees children under 26 years. 2

3 Small businesses need reform Businesses offering insurance: 54% of businesses with less than 50 employees 94% of firms over 50 employees Nationally, small businesses pay 18% more than big business for the same health insurance coverage New insurance mandate will increase pressure for employer-sponsored insurance Opportunities for small employers Employers with fewer than 50 FTEs are not required to offer insurance but the ACA has new tools to help them do so. Tax credits SHOP Exchange Hopefully create a healthier workforce. 3

4 Small business tax credits Fewer than 25 FTEs for the tax year Average annual wages paid are less than $50,000 per FTE (indexed to inflation after 2014) Employer pays at least 50% of premium cost Sliding-scale tax credit up to 35% of employer s eligible premium expenses now, increases to 50% in (Nonprofits: 25% now and 35% in 2014) The SHOP Exchange Small Business Health Options Program (SHOP) where employers can shop for coverage Starts January 1, 2014 SHOP required to: certify plans, provide standardized comparative information, set up a toll-free hotline Serves firms with up to 100 employees (state can restrict it to 50 employees through 2016). In 2017, it can start serving large employers. 4

5 Benefits of a SHOP Exchange Pools small business buying power Makes it easier to shop for and compare plans Increases choices for employers and employees Could allow employers to offer defined benefit or defined contributions options Reduces administrative barriers for business Anticipate reduction in cost of premiums Coverage potentially more portable A healthier workforce $200 million to help small businesses set up wellness programs $16.5 billion invested in community-level prevention programs, indirectly helping small businesses 5

6 No employer-sponsored insurance? Individuals can purchase insurance through a health insurance Exchange. Up to 400 percent of federal poverty line qualify for premium tax credits. Up to 250 percent of federal poverty line qualify for cost-sharing subsidies. Small employers (under 50 FTEs) will not face a penalty if employees choose to purchase insurance through the Exchange and qualify for a subsidy. 6

7 Better outcomes for small businesses Nationally, small employers premium contributions are expected to fall 8.2 percent. Insurance-offer rates among small businesses expected to rise significantly. Winners and losers in Minnesota: 20% in small group market may see increase in premiums more than 20%. 44% may see premium decrease. Overall impact is flat. Responsibilities for large employers Employers with 50 or more FTEs must offer insurance to its full-time employees (and their dependents) play or pay In order to qualify, employer-sponsored insurance must meet minimum essential coverage standards: Cover at least 60% of health care costs (actuarial value) Cost less than 9.5% of employee's W-2 income 7

8 Large employer scenarios Employer offers plan that meets minimum essential coverage standards: Hurray! Employer offers no coverage: If one employee qualifies for tax credits in the exchange, employer is fined $2,000 per employee (first 30 employees exempted) Employer offers inadequate coverage: Employer is fined $3,000 for each employee that receives tax credits (there is a limit) Choices facing Minnesota Will we set cap for SHOP Exchange at 50 or 100 employees? Expand beyond 100 in 2017? Will we merge the SHOP pool with the individual insurance pool? What kind of administrative services will the SHOP Exchange offer? How will we pay for administering the SHOP Exchange? How much flexibility will employers have? 8

9 Challenge of employers dropping coverage Large employers could find penalty more affordable than providing coverage that meets minimal standards. May particularly be tempting for firms with low-wage workers. Low-income employees might find insurance in the Exchange more affordable (due to tax credits and cost-sharing subsidies). Overall anticipate 10,000 fewer Minnesotans will get insurance through employer. Challenge of part-time workers Large employers are only required to offer health h insurance to full-time workers defined d as averaging 30 hours per week. Could see large employers reducing hours to reduce insurance costs and/or avoid penalties. 9

10 Challenge of the self-insured market Small employers with healthier workforce could opt to self-insure to avoid new ACA regulations might result in a sicker pool in the Exchange Large employers could create self-insured plans that encourage high-risk employees to opt for coverage in the Exchange. Reality check: The Affordable Care Act is the law Supreme Court has upheld the ACA President Obama has been reelected Governor Dayton supports the ACA The DFL has regained control of the Minnesota Legislature SO time to figure out how to make this work!! 10

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