The Affordable Care Act: What Does it Mean for Your Small Business?

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1 The Affordable Care Act: What Does it Mean for Your Small Business?

2 Georgia Health Policy Center Integrating research, policy, and programs to advance health and well being A research center within the Andrew Young School of Policy Studies at Georgia State University in Atlanta Provides evidence based research, program development, and policy guidance locally, statewide, and nationally Working in more than 200 communities across the United States to achieve health improvement

3 1. Sources of coverage Health Reform

4 More Americans with health insurance coverage (non elderly) Baseline Scenario in 2019 Full Expansion of Medicaid in

5 1. Sources of coverage 2. Financial Implications Health Reform

6 funding and spending Medicare Savings Insurance Premium Subsidies ~ 1.6 trillion ~ 1.6 trillion Fees, Taxes and Penalties Medicaid

7 Health Reform 1. Sources of coverage 2. Financial Implications 3. Major change components

8 Changes in Public Coverage Changes in Private Coverage Improving Health Care Quality Improving Health

9 Public Coverage Medicaid Medicare CHIP

10 Changes in Public Coverage Expansion Decisions Map

11 Private Coverage Health Insurance Marketplace Insurance Market Regulations Employers

12 Marketplace Participation Changes in Private Coverage reform/state indicator/marketplace enrollment as a share of the potential marketplace population/#

13 Improving Health Care Quality Best information Coordinated care Provider incentives and penalties

14 Improving Health National health strategy Research and public health innovation Mandatory preventive care Healthier communities

15 Health Reform 1. Sources of coverage 2. Financial Implications 3. Major change components 4. Timeline

16 Changes Already in Effect: Insurance Regulation Tax and Spending Changes Improving Quality Measures Reduced Payments Medicare Quality Incentives and Demonstration Projects Coverage Expansions Individual Mandates Enacted

17 Upcoming Changes: Additional limits, fees, incentives

18 Stages of Health Care Reform ACA Legislation Legislative & Legal Rulings Implementation

19 What Does it Mean for Entrepreneurs? 3 Perspectives on Employers and the Affordable Care Act

20 1. View one: Keeping my family and myself covered while building a business 2. View two: Helping my employees understand their options 3. View three: Options and obligations as my business grows

21 1. View one: Keeping my family and myself covered while building a business 2. View two: Helping my employees understand their options 3. View three: Options and obligations as my business grows

22 Keeping my family covered Option 1: Private purchase of individual or family coverage through the open market or the marketplace (exchange) without subsidies No more pre existing condition exclusions No individually rated coverage Open enrollment unless qualifying event November 15 th February 15th

23 Keeping my family covered Option 1: Private purchase of individual or family coverage This option is for you if: Family income > 400% FPL ($95,400 for family of 4) You have no employer option

24 Keeping my family covered Option 2: Subsidized Individual / Family coverage through the Marketplace (Exchange) Family income % FPL ($23,850 $95,400) Not eligible for coverage through an employer Family glitch prevents subsidies if: Spousal employer offers any family plan, and Employee only coverage is affordable

25 Keeping my family covered Option 2: Subsidized Individual / Family coverage through the Exchange Next open enrollment starts November 15 th Family cost for benchmark plan (2 nd lowest cost silver) is a fixed percent of income Subsidy is the difference for the benchmark plan

26 Georgia Markets and Premium Variation

27 Variation in Premiums by Region Region Total Silver Premium 40 Year Old Subsidy with $12,000 income Net Costs 10 NW Georgia $245 $225 $20 3 Atlanta $251 $231 $20 12 Middle $300 $280 $20 Georgia 15 SW Georgia $442 $422 $20 1 SW Georgia $482 $462 $20

28 Keeping my family covered Option 3: Group coverage through a spouse More and more employers are charging more for family coverage Family glitch might prompt some employers to drop family option

29 1. View one: Keeping my family and myself covered while building a business 2. View two: Helping my employees understand their options 3. View three: Options and obligations as my business grows

30 Helping My Employees (during start up years) Healthy employees: Are less likely to miss work Are more productive when at work Employers pay wages, not family income Each employee has a different situation

31 Employees have all of your options Purchase coverage on the open market or exchange (marketplace) without subsidies Exchange coverage with subsidies Spousal coverage Medicaid / PeachCare for Kids

32 Children Medicaid Under 1 185% FPL 1 to 5 133% FPL % FPL Georgia Medicaid & PeachCare for Kids Children PeachCare Above Medicaid and below 235% FPL Pregnant women under 200% FPL

33 1. View one: Keeping my family and myself covered while building a business 2. View two: Helping my employees understand their options 3. View three: Options and obligations as my business grows

34 Why Offer Health Insurance? Healthy employees are better Benefits drive recruitment and retention Risk pools stabilize premiums Group purchasing reduces administrative costs Purchasing expertise in HR Tax subsidies for employer sponsored insurance (ESI) under ACA Tax preference for ESI

35 Why Employers Don t Offer ESI Some workers don t value it at or above its cost Young Temporary Worker turnover not costly Fear of the complexity and cost

36 Employer Implications Depend upon Number of Workers (FTEs) <25 Employees <50 Employees >50 Employees >200 Employees

37 Tax Credits <25 Employees Full Credits <10 FTEs Wages < $25,000 Phased out credits 10 to 24 FTEs Wages to $50,000 Credit as share of premium: : 50% max

38 Tax Credits 2014: Examples <25 Employees Number of FTEs Average Annual Wages ($ s) Employer payments for Health Insurance Tax Credit 10 $25,000 $60,000 $30, $25,000 $90,000 $20, $25,000 $144,000 $2, $40,000 $60,000 $12, $40,000 $90,000 $2, $40,000 $144,000 0

39 SHOP Marketplace (Exchange) Purchasing <50 Employees Certify, price and rate plans Standardized benefit information Administer small business tax credits

40 Pay or Play >50 Employees Penalties if full time workers obtains subsidized coverage $2,000 per full time worker (exclude first 30) if no coverage offered $3,000 per worker obtaining the subsidy if coverage offered that is not sufficiently generous High cost sharing High employee premiums

41 Employer Must: >200 Employees Auto enroll new workers Employee only Lowest cost plan Employee can still opt out or change selection

42 Obligations: Small Employers & ACA No obligation to offer until you have 50 full time equivalents (FTEs) Delayed until 2016 for 50 FTEs Starts 2015 for 100 FTEs Mix of full and part time employees equivalent to having 50 full time employees

43 Important Employer Considerations Almost all firms with more than 100 employees already offer coverage Likely impact very small Marginal effect most relevant for firms right at 50 employees Counting non traditional worker hours (adjunct professors, employees with call, airline personnel) could affect certain types of employees

44 How Has it Gone So Far? Glass Half Full Improved web site First enrollment period objectives met Continued positive outlook for the ACA on the deficit (CBO report) Job lock is eliminated Improved health of the labor force Glass Half Empty True enrollment not yet known Cliffs create incentives Reduction in labor supply Marginal impact on labor demand Instability, uncertainty, rule changes Increase premiums Communication challenges

45 GHPC Health Reform Resources and Tools: care reform Leading through Health Reform (PowerPoint Presentation) Policy Briefs: An Overview of Health Reform State Implications of Health Reform in Georgia Implications of Health Reform for Community Based Organizations The Impact of Health Reform on Health Care Providers Health Reform Implications for Employers The Supreme Court Ruling on the Affordable Care Act: What will it mean for Georgians? Health Insurance Exchanges ACA Funding for Georgia Community Health The Role of Georgia s Safety Net Providers in the Health Insurance Marketplace The Little Blue Book, a health glossary Leading through Health System Change: A Public Health Opportunity Planning Tool

46 Additional Resources: U.S. Dept. of Health and Human Services Health Care Site and Marketplace Enrollment Federal Poverty Level Guidelines PeachCare for Kids Georgia Medicaid Congressional Budget Office Bipartisan Policy Center Trust for America s Health Commonwealth Fund Kaiser Family Foundation Robert Wood Johnson Foundation National Conference of State Legislatures National Governors Association Association of State and Territorial Health Officials National Association of County and City Health Officials

47 Thank you! Patricia Ketsche, Ph.D. Associate Professor, Robinson College of Business Fellow, Georgia Health Policy Center Georgia State University

Lynn A. Blewett, Ph.D. Professor, University of Minnesota

Lynn A. Blewett, Ph.D. Professor, University of Minnesota Lynn A. Blewett, Ph.D. Professor, University of Minnesota Westlake Forum III Healthcare Reform in China and the US: Similarities, Differences and Challenges Emory University, Atlanta, GA April 10-12, 2011

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