Wisdom at Work

1. Wisdom at Work

2. Welcome • Lincoln Human Resource Management Association Presentation • Tuesday, August 11, 2009 • Health Care Reform • 2010 Trends

3. Health Care Reform • Major Health Care Reform Proposals • Senate Finance Committee Policy Options • Senate HELP Committee – Affordable Health Choices Act • House Tri-Committee – America’s Affordable Health Choices Act of 2009 (H.R. 3200) • President Obama – Principals for Health Reform

4. Senate Finance Committee Policy Options • Require all individuals to have health insurance • Create a Health Insurance Exchange through which individuals and small businesses can purchase health coverage, with subsidies available to individuals/families with incomes between 100 and 400% of the federal poverty level ($73,240 for a family of 3 in 2009) • Impose new regulations on the non-group and small group insurance markets • Expand Medicaid and CHIP and offer a temporary Medicare buy-in for the pre-Medicare population

5. Senate HELP Committee – Affordable Health Choices Act • Require individuals to have health insurance • Create state-based American Health Benefit Gateways through which individuals and small business purchase health coverage, with subsidies available to individuals/families with incomes up to 400% of the federal poverty level • Require employers to provide coverage to their employees or pay an annual fee, with exceptions for small employers, and provide certain small employers a credit to offset the costs of providing coverage • Impose new regulations on the individual and small group insurance markets • Expand Medicaid to all individuals with incomes up to the 150% of the federal poverty level

6. House Tri-Committee – America’s Affordable Health Choices Act of 2009 • Require all individuals to have health insurance • Create a Health Insurance Exchange through which individuals and smaller employers can purchase health coverage, with premium and cost-sharing credits available to individuals/families with incomes up to 400% of the federal poverty level. • Public health insurance option • Require employers to provide coverage to employees or pay into a Health Insurance Exchange Trust Fund, with exceptions for certain small employers, and provide certain small employers a credit to offset the costs of providing coverage • Impose new regulations on plans participating in the Exchange and in the small group insurance market • Expand Medicaid to 133% of the poverty level

7. President Obama – Principles for Health Reform • Reduce long-term growth of health care costs for businesses and government • Protect families from bankruptcy or debt because of health care costs • Guarantee choice of doctors and health plans • Invest in prevention and wellness • Improve patient safety and quality care • Assure affordable, quality health coverage for all Americans • Maintain coverage when you change or lose your job • End carriers to coverage for people with pre-existing medical conditions

8. Health Care Reform Implementation • It is anticipated that implementation will take place in 2013

9. Tax Changes Related to Health Insurance • Tax preference for employer-sponsored insurance, health savings accounts, flexible spending accounts, and deductions for medical expenses (Senate Finance) • Impose a minimum tax on individuals without qualifying health care coverage of no more than $750 per year (Senate HELP) • Impose a tax on individuals without acceptable health coverage of 2.5% of modified adjusted gross income (House Tri-Committee) • Surtax imposed at progressive rates on high income individuals

10. Current Update • Many anticipated by now that Congress would have had a proposal completed. • The Finance Committee will go home for the recess without a deal but with a promise to continue negotiating during the break, and with a target date of September 15th for Committee action. • In the House, the Blue Dog Coalition of 52 conservative Democrats put a halt to the Energy & Commerce Committee’s process for 10 days when seven coalotion members refused to proceed without concessions • A public plan that is optional to providers and that negotiates rates

11. Current Update (continued) • Preservation of the role of agents/brokers • Keeping the bill under $1 trillion • Allowing state-based exchanges • There are 50 additional amendments that the Committee intends to address prior to floor debate in the fall. • The Hosue will try to meld all three Committee versions into one bill in anticipation of a full House debate and vote in September, at the earliest • The Blue Dogs have made it clear that the larger coalition of 52 has not signed off an anything and that the compromise was chiefly designed toa llow the Committee process to proceed. • Bottom line: neither the House nor the Senate will be voting as a Chamber on health care reform until the fall.

12. Employer Requirements – Senate Finance Committee • Proposed Option A • Require employers with more than $500,000 in total payroll per year to offer coverage to their employees and contribute at least 50% of the premium or pay an assessment. • A set fee per enrollee per month; or • A tiered penalty calculated as a % of payroll; or • A larger penalty only on firms with annual payroll of more than $1.5 million • Proposed Option B • No employer pay or play requirement

13. Employer Requirements – Senate HELP Committee • Require employers to offer health coverage to their employees and contribute at least 60% of the premium cost or pay $750 for each uninsured full-time employee and $375 for each uninsured part-time employee who is not offered coverage • For employers subject to the assessment, the first 25 workers are exempted • Exempt employers with 25 or fewer employees from the requirement to provide coverage

14. Employer Requirements – House Tri-Committee • Require employers to offer coverage to their employees and contribute at least 72.5% of the premium cost for single coverage and 65% of the premium cost for family coverage of the lowest cost plan that meets the essential benefits package requirements or pay 8% of payroll into the Health Insurance Exchange Trust Fund • Some hardship exemptions for employers that would be negatively affected by job losses as a result of requirement • Eliminate or reduce the pay or play assessment for small employers with annual payroll of less than $400,000 • < $250k: exempt • $250k to $300k: 2% of payroll • $300k to $350k: 4% of payroll • $350k to $400k: 6% of payroll

15. Employer Requirements – House Tri-Committee (continued) • Committee Amendment: would extend the reduction in the pay or play assessment for small employers with annual payroll of less than $750,000 and change the sliding scale • Require employers that offer coverage to automatically enroll into the employer’s lowest cost premium plan any individual who does not elect coverage under the employer plan or does not opt out of such coverage

16. Employer Subsidies – Senate Finance Committee • Provide certain small employers that purchase insurance for their employees with a tax credit. • 50% of the average total premium cost paid by the employer available to employers with 10 or fewer employees and whose employees have average annual wages of less than $20,000. • Phased out as firm size and earnings increased

17. Employer Subsidies – Senate HELP Committee • Provide qualifying small employers with a health options program credit (no more than three consecutive years) • Employers less than 50 employees • Pay an average wage of less than $50,000 • Must pay at least 60% of employee health expenses • Credit is equal to $1,000 for each employee with sinle coverage and $2,000 for family coverage • Bonus payments for each additional 10% of employee health expenses above 60% paid by employer • Temporary reinsurance program for employers providing health insurance coverage to retirees ages 55 to 64. • Reimburse 80% of retiree claims between $15k and $90k. Ends when state Gateway is established.

18. Employer Subsidies – House Tri-Care Committee • Small employers with fewer than 25 employees and average wages of less than $40,000 with a health coverage tax credit • The full credit of 50% of premium costs paid by employers is available to employers with 10 or fewer employees and average annual wages of $20,000 or less • Phases out as firm size and wages increase and not permitted for employees earning more than $80,000 per year. • Reinsurance pool for retirees 55 to 64 on health plan. Payment is 80% of claims between $15k and $90k. $10 billion allocated over 10 years for this program.

19. 2010 Trends • Premium Costs • Average small employer (less than 50 employees) medical premium increases prior to plan changes will range from 10% to 20% • Large employers will see a range of 7% to 15% of overall cost increases prior to plan changes • Reinsurance increases are seeing larger spikes, with range of 15% to 25%

20. 2010 Trends • Utilization • Inpatient hospitalization and emergency room utilization rates are level and at times, dropping • Impact of wellness and health intervention programs • Possible negative impact is the economy in the event individuals not seeking care due to finances • Increases in preventive/routine utilization very common as employers and insurance companies enhance that benefit • Mental health utilization has increased the past year • Economic factors

21. 2010 Trends • Carriers/Providers • Continued consolidation in the Third Part Administrator (TPA) environment • No significant mergers between medical insurance companies expected • Example was Coventry Healthcare purchasing Mutual of Omaha’s medical block recently • Fee schedules with providers using networks stable • Various pockets of discontent/negotiation will happen

22. 2010 Trends • Legislation • Mental Health Parity and Addiction Equity Act of 2008 • Effective in 2010, mental health and substance abuse benefits must be paid same as any other illness (no limitations) • Health plans do not have to offer benefits • Cost impact ranges from .2% to 2% • HIPAA (HITECH Act) • Requires covered entities to take stronger action to secure protected health information • Additional compliance work (no cost changes) • Potential extension of COBRA subsidies

23. Questions? • Thank you for the opportunity to present to the LHRMA! • Brett Sesker FLMI, HIA, ALHC, GBA • Principal, Senior Consultant • 402.964.5451 • bsesker@ssgi.com • Jeff Jorth • Principal • 402.964.5622 • jjorth@ssgi.com

24. Information Sources • The Henry J. Kaiser Family Foundation • Aetna Health Reform Weekly