Your Bottom Line: What Healthcare Reform Means For Your Small Business

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1 Your Bottom Line: What Healthcare Reform Means For Your Small Business

2 Agenda About Us Small Business Majority & US PIRG Overview of healthcare problem and reform. US PIRG What does it mean for my small business? Small Business Majority What would repeal mean? US PIRG Questions Small Business Majority & US PIRG Please note: These calls are closed to press.

3 About Small Business Majority Public policy advocacy organization founded and run by small business owners National based in California offices in Sacramento and Washington, DC Research and advocacy on issues of top importance to small businesses (<100 employees) and the self-employed Very focused on healthcare over the past 3 years top issue in all of our research

4 About U.S. PIRG U.S. Public Interest Research Group: The Federation of State PIRGs U.S. PIRG, the federation of state Public Interest Research Groups (PIRGs), takes on powerful interests on behalf of the American public, working to win concrete results for our health and our well-being. The state PIRGs are independent, statebased, citizen-funded organizations that advocate for the public interest. Since 1970, we have been delivering results-oriented citizen activism to protect our environment, encourage a fair and sustainable economy, and foster a responsive democratic government. AkPIRG / Arizona PIRG / CALPIRG / CoPIRG / ConnPIRG / Florida PIRG / Georgia PIRG Illinois PIRG / INPIRG / Iowa PIRG / Maryland PIRG / MASSPIRG / PIRGIM (PIRG in Michigan) / MoPIRG / NCPIRG / NHPIRG / NJPIRG / NMPIRG / NYPIRG / Ohio PIRG / OSPIRG / PennPIRG / RIPIRG / TexPIRG / WashPIRG / WISPIRG

5 The new federal law Builds on and fixes our exis)ng healthcare system not a government takeover Aims to rein in healthcare costs; reduces deficit by over $100B by 2020; by $1.3T by 2030 Complicated, because it s a compromise Implementa)on is primarily the responsibility of the states essenfal to have small business input Important immediate benefits other key provisions to be implemented over the next 3 years

6 The Diagnosis: What Led to the Affordable Care Act Multiple Interrelated Symptoms Cost Growth: Costs growing three times faster than wages Coverage: Employer based coverage eroding Quality : 100,000 deaths a year due to medical errors according to the Institute Of Medicine

7 The Prescription: Comprehensive Reform Insurance Reforms Coverage No one can be denied a policy due to a preexisting condition Cost can t be based on medical history Medicaid Expansion Tax Credits for Individuals and Small Business Shared Responsibility Minimum Coverage Provision Free Rider Provision

8 The Prescription Cont d Taming Costs, Dose One Exchanges leverage pooled purchasing power for price reduction and stability Expanded coverage reduces cost-shifting Limits on plans profits and admin costs Incentives for prevention and wellness including small business grants Penalizing Cadillac insurance plans in 2018

9 The Prescription Cont d Taming Costs, Dose Two Utilizing Medicare s payment policies to incentivize better care Paying for quality of care, not quantity Scaling up Geisinger s and Mayo s low-cost, high-quality care To limit industry and political influence on Medicare payment policy, creates independent board to recommend Medicare reforms New investments in research on which treatments are most effective

10 Background Soaring cost of health insurance especially for small businesses 54% of businesses <10 employees don t offer (Kaiser study) 28% self-employed: not covered Small firms pay 18% more than large businesses Our national study: small business health costs will more than double over the next 10 years $2.4 trillion total ($243 billion in CA)

11 Background Our opinion surveys: 86% of small businesses don t offer because of cost; 72% of those who do offer say they are struggling to do so

12 What s in the new law for you? Provides immediate tax credits for most small businesses ($40 billion in credits by 2019) Provides immediate access to a Preexisting Condition Insurance Plan for the self-employed Establishes a competitive marketplace for small businesses and the self-employed Provides subsidies for many small business workers and self-employed entrepreneurs Eliminates preexisting condition exclusions Includes grandfather clause for existing plans Begins systemic cost containment

13 Small business tax credits Available to businesses with employees Takes effect immediately (tax year 2010) Which businesses are eligible? o Fewer than 25 full-time-equivalent employees o Average annual wages <$50,000 o Employer pays at least 50% of the premium cost

14 Small business tax credits Our report: More than 4 million businesses are eligible (83.7% of all businesses); 1.2 million businesses eligible for the maximum credit

15 Small business tax credits Tax credits on a sliding scale: o Up to 35% of premium expenses for o Up to 50% of premium expenses for any two years beginning 2014 Tax credits do not cover premium expenses of owners or their families Tax credits can not be claimed by the selfemployed

16 How to claim the 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

17 Preexisting Condition Insurance Plan (formerly high-risk pools) Available to individuals, incl. self-employed Takes effect immediately Eligibility: People who have been uninsured for six months and have been denied for a preexisting condition Plans = lower premiums due to federal funding Available until full implementation in 2014 (no gap in coverage)

18 Other immediate benefits Temporary re-insurance program for employers that provide benefits to retirees age (June 1, 2010) Bans health plans from dropping insurance coverage when an individual gets sick (Sept. 23, 2010) Free preventative care for all new plans (Sept. 23, 2010) Grants for up to 5 years to small employers that establish wellness programs (2011) Simple cafeteria plan for small (<100) employers to offer tax-free benefits (2011) Increased access to care - community health centers (2011) Many small business workers and self-employed entrepreneurs will receive premium subsidies o Up to 400% of federal poverty level (approx. $90,000 for a family of four) No more job lock connecting access to healthcare to employment status

19 State insurance exchange Large marketplace to purchase health coverage pools buying power and reduces administrative costs Private insurance plans will compete Benefits will be standardized, so that plan information can be easily compared, and premiums are stabilized Insurance can still be sold outside exchange One-stop shopping web portal Members of Congress must use the exchange

20 Additional responsibilities 50 employees or fewer: exempt from any shared responsibility requirements absolutely no obligation to offer coverage (fewer than 0.2% of businesses have more than 50 employees and aren t offering health coverage) W2 reporting requirement for information only Current law: expanded 1099 reporting requirement tacked onto legislation; has nothing to do with healthcare reform Congress committed to fixing before it would take effect in 2012

21 The Co$t of Repeal Four million small businesses lose tax credits $2.4 trillion in additional costs to small businesses Decreased job mobility Slower job creation: million fewer jobs over the next 10 years Sources: The Cost of Repeal, U.S. PIRG The Economic Impact of Health Care Reform on Small Business, Small Business Majority

22 Weighing the Arguments for Repeal Minimum coverage requirement is burdensome Mandate in Massachusetts drove down premiums on the individual market Medicaid expansion costs states 95% of costs born by federal government Medicare advantage changes hurt seniors Premiums went down in 2010 for MA plans

23 The Alternative: Finding Common Ground Where could ACA opponents and proponents possibly find agreement? Creating strong state exchanges Encouraging multi-payer payment reforms Linking latest evidence on treatment effectiveness to new Health IT systems Accelerating administrative streamlining Crack down on balance billing

24 Resources U.S. PIRG Website: Key Reports: Delivering on the Promise: A State Guide to the Next Steps for Health Care Reform The Cost of Repeal: Examining the Impact on Consumers and Small Businesses of Repealing the New Federal Health Care Law Located at

25 Resources National HHS website: Small Business Majority website: o What s in Healthcare Reform for Small Businesses o Detailed FAQ o Tax credit calculator o (866) or o Join our small business owner network o We can speak or do webinars for your group!

26 Thank you & questions!

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