1. Federal Health Care Reform Implementation Update Elizabeth Hall, Vice President, Federal Affairs

2. 2 Public Policy Platform

3. 3 Federal Environment 2012 Timeline February 2012: Expiration of Payroll Tax Cut and SGR Fix June 2012– Supreme Court Decision August 2012— Payment of MLR Rebates November 6 2012— General Election November/ December 2012 – Continuing Resolution Expires December 2012 - Expiration of Bush Tax Cuts January 2013 – Sequestration Implemented January 2013 – Presidential Inauguration (if R wins)

4. 4 Note: This presentation is not intended to advise you on how to comply with PPACA or its related regulations. This presentation is not intended to offer legal advice. For specific questions, please consult with your counsel or benefits advisor. Topics for Today Implementation Updates ▪Supreme Court ▪Exchanges ▪Essential Health Benefits Political Environment

5. 5 Issue: Anti-Injunction Act

6. 6 Issue: Individual Mandate Constitutionality Is the individual mandate constitutional: Commerce Clause – Can Congress force engagement in commerce/regulate “inactivity”? Necessary and Proper Clause 6

7. 7 Issue: Medicaid Expansion Is the Medicaid Expansion Constitutional? Is the Federal Government coercing states to expand Medicaid benefits? 7

8. 8 Issue: Severability Is the individual mandate severable? The law includes no “severability clause” If the law finds a portion of the legislation unconstitutional, what portion of the law must stand or fall? 8

9. 9 Exchange Enabling Legislation CT VT * Represents legislative activity as of 1/19/12, not compliance with ACA. No regular 2012 session: MT, NV, ND and TX Source: Blue Cross and Blue Shield Association, January 19, 2012 HI AK WV MA RI WA OR NV MT CO NE SD ND KS AZ NM OK WI IA MO IL MI OH TN MS LA AL GA SC NC PA NJ ME UT ID KY IN AR CA FL MD MN NY VA WY TX Pending bill: 12 Failed 2012: 1 Enacted: 13 Executive Order: 7 DE NH Study Law: 3 DC Failed 2012 + planning ongoing No Bill + planning ongoing: 12

10. 10 Exchange Timeline - 2012 State Legislative Sessions—Typically Run First Half of Year HHS Indicates States Must Select EHB Benchmark Plan by Q3 of 2012 State Applications for Exchange Certification due to HHS in Q3 of 2012 States Must Demonstrate to HHS by End of Year 2012 that they are Positioned to Operate an Exchange in 2014 to Avoid Federal Fallback

11. 11 Essential Health Benefits Key Provisions in the Legislation  HHS to define essential health benefits (Institute of Medicine to provide guidance)  However, benefits shall include the following categories: 1.Ambulatory patient services 6. Mental health and substance abuse disorder services 2.Emergency services7. Rehabilitative and habilitative services and devices 3.Hospitalization 8. Laboratory services 4.Maternity and newborn care 9. Preventive and wellness services & chronic disease mgt. 5.Prescription drugs10. Pediatric services, including oral and vision care  Scope equal to “typical employer plan”

12. 12 Essential Health Benefits Bulletin HHS Gives States Four Options: 1.The largest plan by enrollment in any of the three largest small group products in the state 2.One of top 3 state employee plans in the state 3.One of top 3 national Federal Employees Health Benefit Program plans in the state 4.The top HMO Commercial plan in the state

13. 13 Top Small Group Plans in Any of the 3 Largest Products Anthem products are among the top 3 SG products in most states per HHS Web Portal StateFirst*SecondThird CAKaiser SG HMOAnthem PPO COUnited Choice PlusKaiser HMORocky Mountain PPO (Anthem) CTOxford PPOConnectiCare HMOBlue Care HMO (Anthem) GABCBS Healthcare Plan of GA POSBCBS Healthcare of GA HMOAetna HMO INAnthem PPOAnthem LumenosUnited Choice Plus KYAnthem PPOAnthem LumenosHumana PPO MEAnthem PPOAetna PPOAnthem Lumenos MOBlue Access Choice PPO (Anthem)United Choice PlusMercy Health Plans PPO NHHMO Blue New England (Anthem)Matthew Thorne Blue (Anthem)Access Blue New England (Anthem) NVRocky Mountain PPO (Anthem)Health Plan of NV POSHealth Plan of NV HMO NYOxford Health EPOPrism EPO (Empire BCBS)Oxford HMO OHAnthem PPOMed Mutual of OH Super Med.Anthem Lumenos VAAnthem Health Plans of VA PPOAnthem Health Keepers HMOOptima Vantage HMO WIUnited Choice PlusCompcare POS (Anthem)Medical Associates HMO

14. 14 Note: This presentation is not intended to advise you on how to comply with PPACA or its related regulations. This presentation is not intended to offer legal advice. For specific questions, please consult with your counsel or benefits advisor. Topics for Today Implementation Updates ▪Supreme Court ▪Exchanges ▪Essential Health Benefits Political Environment

15. 15 Political Environment 15 2012 Elections, President Obama, Congress and Health Care Reform

16. 16 2012 Presidential Election: The Path to 270 Electoral Votes 16 Source: Real Clear Politics

17. 17 Americans See Country Headed in the Wrong Direction 17 Source: NBC News/Wall Street Journal Survey, Jan. 24 th, 2012 1,000 Am

18. 18 President Obama Approval Ratings 18 Source: New York Times/CBS News Poll, Jan. 19 th, 2012

19. 19 Republican Base Unimpressed with Party’s Candidates 19 Source: Pew Research Center More Republican and Republican-leaning registered voters say the GOP field is only fair or poor (52%) than did so in early January (44%). At about this point four years ago, 68% of Republican and GOP- leaning voters rated the field as excellent or good.

20. 20 Obama vs. Romney Presidential Matchup A USA TODAY/Gallup Swing States Poll from Jan. 28th found that registered voters in 12 key swing states are evenly split between Barack Obama and Mitt Romney in their 2012 presidential election preferences. ▪Obama and Romney have also been statistically tied in each of five polls conducted among swing state registered voters dating back to August 20 Source: Gallup USA/Today Poll

21. 21 Battle for the House of Representatives 21 Map Source: Real Clear Politics Current House: 242 Republicans & 193 Democrats  Democrats Need to Win 25 New Seats to Flip House  50 Seats are Considered Slight Lean/Toss-Ups Republican Held Seats Democrat Held Seats  GOP Currently Holds 28 of those Seats  Democrats Holds 22 of those Seats  Magic Number: 218 Seats are needed for House Majority

22. 22 Congressional Approval Ratings 22 Source:: Real Clear Politics

23. 23 Battle for the Senate 23 Map Source: Real Clear Politics Current Senate: 53 Democrats & 47 Republicans  GOP Need to Win 4 New Seat to Re-Gain Control of Senate  8 Senate Races this Election Cycle are Considered Toss-Ups  6 of those Toss-Up Senate Races are Currently Controlled by Democrats Majority  Magic Number: 51Seats are needed for Senate

24. 24 Key Battleground Senate Races Up-Close Four Most Competitive Senate Races Massachusetts Florida Nevada Virginia 24

25. 25 Massachusetts Senate Race Senator Scott Brown (R-Incumbent) Elizabeth Warren (D) 25 Scott Brown won this seat in a special election against a weak opponent Moderate voting record and bipartisan appeal President Obama won Massachusetts with 62 percent of the vote in 2008 54 percent of the state’s voters are registered independents Latest poll had both candidates in statistical tie Viewed as liberal star who plays well to the deep blue party base in state Harvard law professor, oversaw TARP and established the Consumer Financial Protection Bureau.

26. 26 Florida Senate Race Senator Bill Nelson (D-Incumbent) Congressman Connie Mack (R) *Likely Republican Nominee* 26 Has been Senator since 2000 Only Democrat to hold state-wide office in a increasingly conservative state Nelson currently has a huge fundraising advantage Latest poll had candidates in statistical tie Fits the conservative trending of the electorate Father was two term Florida Senator Still needs to survive a bruising primary race

27. 27 Nevada Senate Race Senator Dean Heller (R-Incumbent) Congresswoman Shelley Berkley (D) 27 Appointed to the Senate last year Former Congressman and Secretary of State Large Hispanic population and large influx of new voters Polls have both candidates in statistical dead heat Largely unknown outside her Vegas area district Has represented Clark County (Las Vegas) since 1998 Nevada economy has been devastated by the recession and the drag of President Obama could hurt Berkley’s chances

28. 28 Virginia Senate Race Former Senator George Allen (R) Former Gov. Tim Caine (D) 28 Former Governor and Senator Strong possibility that the current Gov. Bob McDonnell could be picked as Romney’s running mate Polls have both candidates in statistical tie Chosen to run with President Obama’s message Former Governor and DNC Chair Once a solidly republican state, the voter demographics have shifted to become more favorable to democrats

29. 29 Public Remains Largely Split On ACA FavorableUnfavorable Don’t know/Refused ACA signed into law on March 23, 2010 Source: Kaiser Family Foundation Health Tracking Polls 201020112012

30. 30 Republican Opposition to ACA Far More Intense Than Democratic Support Very favorableSomewhat favorableSomewhat unfavorableVery unfavorable Total Democrats Independents Republicans Source: Kaiser Family Foundation Health Tracking Poll, conducted January 12-17, 2012

31. 31 Next Steps What happens next? What does it mean to you?

32. Questions?