Presented by Marianne Fazen, PhD. Texas Business Group on Health

Transcription

1 1 Presented by Marianne Fazen, PhD President & CEO Texas Business Group on Health June 20, 2013

2 A state-wide coalition of Texas employers committed to maintaining a market-based healthcare system that delivers high quality, efficient and affordable care for Texas workers Non-profit 501(c)6 Texas Corporation Formed in 1985 Members in Austin, Amarillo, Dallas, Fort Worth, Houston, Odessa, San Antonio 2

3 We support Texas employers efforts to maintain healthy, productive employees through value-driven benefits and high quality healthcare. We do this by providing educational opportunities, sharing information and best practices, providing tools and resources to support informed benefits decisions, And by advocating high quality, cost-effective, accountable health care across Texas. 3

4 Uncertainty about the economy Uncertainty about health care reform Uncertainty about health care costs Unhealthy, unconcerned and unengaged employees 4

5 Attract, develop, retain talent Remain competitive Keep employees healthy and improve productivity Achieve operational excellence & profitability 5

6 61% of U.S. employers offer group health insurance Most will continue to play Maintain employee morale Reduce employee turnover Avoid negative public opinion Keep tax deduction on employer-paid premiums 6

7 Cost Coverage Compliance Communication 7

8 Individual Mandate: All individuals must enroll in basic health coverage, or pay a penalty (limited exemptions) Employer Sponsored Insurance: Large Employers with 50+ employees must offer affordable coverage to full time employees, or pay a penalty Small Employers with less than 50 employees are exempt from penalty Public Health Insurance Exchanges/Marketplaces States must offer health insurance to individuals and small employers through a Public Insurance Exchange by 2014* State Insurance Exchanges must be open to large employers by 2017 *Requirement postponed for small employers in states with federal-run exchanges 8

9 Effective January 1, 2014 All legal U.S. residents must have minimum creditable health coverage or pay a penalty Penalty is the greater of the fixed dollar amount or a percentage of household income (see table below) Penalty paid with income tax return Year Fixed Dollar Penalty Percentage Income Penalty 2014 $95 1% 2015 $325 2% 2016 $ % 2017 and Beyond Indexed with Inflation Capped at the national average premium for Bronze coverage 9

10 A competitive, consumer-focused marketplace that simplifies the search for affordable health insurance by gathering all the options in one place Health Insurance Marketplace/ Exchange Other Familiar Exchanges 10

11 Open Enrollment: Oct. 1, 2013 Mar. 31, 2014 Qualified plans offered by private insurance companies 3 plan levels: Bronze, Silver, Gold, with different contribution amounts All plans offer Minimum Essential Benefits Standardized cost and coverage information Apples to apples comparisons Est. Premium for Silver Plan-2014 $4,762/yr. Individual $13,476/yr. Family of

12 PLAY Offer affordable coverage to all FTEs (>30 hrs/wk) and dependents Pay $2,000/EE penalty if even 1 employee buys subsidized coverage through Public Exchange Redesign high cost Cadillac Plans to avoid 40% excise tax in 2018 PAY Pay non-deductible annual penalty of $2,000 per FTE Pay $3,000 penalty for any employee who can t afford company plan and buys subsidized health insurance through Public Exchange 12

13 Offer affordable coverage to employees (up to 9.5% of salary) Purchase small group plan from commercial insurer Purchase group plan on Exchange (postponed until 2015 in Texas) No penalty if employee opts out Keep tax exemption on employer paid premium Drop coverage and send employees to public Exchange No penalties But lose tax exemption for employer share of premium 13

14 Young, healthy workforce; low risk industries: Expect to pay more Est. rate increase: 30% - 40% vs. 15% -20% Older, unhealthy workforce; high risk industries: Expect to pay less Est. rate increase: 10% vs. 18% - 25% 14

15 Additional sneak attack fees Pay annual Patient-Centered Outcomes Research fee for 7 years Purpose: To fund comparative clinical effectiveness research up to 2019 $2 per plan participant per year ( ) Pay annual Transitional Reinsurance Program fee for 3 years Purpose: To raise $25 billion to partially reimburse insurers for writing policies for high risk/high cost individuals 2014: $63 per plan participant 2015: est. $42 per plan participant 2016: est. $26 per plan participant Applies to all Fully Insured and Self-Insured plans Insurance carriers will pay fees directly for fully insured plans Employers will pay fees directly for self-insured plans Fees probably will be included in plan rates 15

16 Pay up to 9.5% of salary for employee share of premium Low wage employees would rather keep their cash than pay their share of premium Purchase coverage from Exchange (subsidies may be available) Example: $9/hr: Pay $70/mo., or $840/yr. for subsidized premium $10 - $13/hr: Pay $140/mo., or $1,680/yr. for subsidized premiums Go bare and pay penalty: The greater of $95 or 1% of household income in 2014; increases in 2015 Example: $30,000 HH income Pay $300 penalty 16

17 Increase employee share of premium (up to 40%) Renew early before Jan. 1, 2014 (postpones compliance for 1 year) Join small employer group (Chamber of Commerce) Participate in Private Corporate Exchange Self-insure Better for young, healthy workforce Avoids richer benefits and pricing rules that impact healthy workforce Offer Bare Bones policy ($40 - $100/mo.) Avoids penalty 17

18 Already in effect Dependent coverage to age 26 No lifetime or annual dollar caps No exclusions for pre-existing conditions W2 reporting of dollar value of coverage Effective in 2014 No cost to employees for preventive care No gender or industry discrimination Limited age discrimination Smoker discrimination allowed 18

19 1. Ambulatory care 2. Emergency services 3. Hospitalization 4. Prescription drugs 5. Maternity & newborn care 6. Mental health & substance use services 7. Rehabilitative services 8. Laboratory services 9. Preventive and wellness services; chronic disease management 10. Pediatric services, including oral vision care Applies only to fully insured plans for individuals, small employers, and Exchanges Large employers must cover only preventive with no lifetime or annual caps 19

20 Determine number of full-time employees (>30 hrs/wk). Determine affordability of company plan (<9.5% of salary). Determine if plan covers 10 minimum essential benefits. Report dollar value of health benefits on W-2 Forms. Notify all employees by Oct. 1, 2013 about coverage options available through the Public Exchanges. 20

21 Employees will need lots of help: Understanding the Individual Mandate Weighing the cost of buying insurance or paying penalty Shopping for a health plan in the Public Exchange Choosing an Exchange health plan option (Bronze, Silver, Gold) Finding information from reliable sources: health plans; insurance broker; benefits consultants; 21

22 Develop initial and long-term communication plans Start an open dialog with employees & retirees Explain impact of ACA on company benefits Reinforce company benefits philosophy & employee value proposition Set expectations about next steps and timing of decisions Engage company leaders and key influencers Communicate immediate changes and reiterate key messages Keep up Culture of Health momentum 22

23 Cliff?? Bumpy road?? 23