1. Federal Health Care Update For Public Employers – An Uncertain Future
Anthony Ashenhurst & Anne Mergen

2. Which Public Employers are Covered by the Affordable Care Act?
Public employers with 50 or more employees

3. Small Public Employers
What if a public employer does not have 50 or more employees?
It is not covered, but may be affected
If the public employer provides health insurance, it might have to pay more to cover Essential Health Benefits

4. Large Public Employers
Do “large” (50 or more employee’s) Public Employers Have to Provide Coverage? No
But, if at least one employee applies for and receives a subsidy for insurance through an exchange, then a $2,000 penalty per full time employee applies

5. Affordable Care Act Issues
Premiums Increasing
Insurers Leaving the Marketplace
Six states only have one carrier now: Alabama, Alaska, Oklahoma, South Carolina, Iowa and Wyoming
Iowa’s carrier out of 94 counties (total 99)
Illinois lost 4 for 2017

6. 2017 Rate Increases
The Illinois Department of Insurance average approved rate increase based on metal level average rate increases across the state:
Lowest-cost Bronze plan = 44 percent (60/40)
Lowest-cost Silver plan = 45 percent (70/30)
Second-lowest-cost Silver plan = 43 percent (70/30)
Lowest-cost Gold plan = 55 percent (80/20)

7. Polls Show Public Concern

8. Where the President Stands on Medicaid Expansion
Letter from Secretary Tom Price and CMS Administrator Seema Verma to all Governors
Medicaid has departed from historical mission in covering non-disabled, working age
Easier waiver approvals
Assist low income individual with skills and employment
Move working age non-pregnant, non-disabled to private coverage

9. What comes next?
Repeal
Repeal and Replace
Fix the ACA

10. Impact of Repeal on Municipal Owned Hospitals
Likely to have to provide more uncompensated care
More Emergency Department Visits

11. The Amending the ACA through the “Reconciliation” Process
Reconciliation only for measures that directly affect the budget
The process can:
Eliminate Taxes on the wealthy, insurance companies, and medical companies
Eliminate The individual mandate
Undo the Medicaid expansion
Eliminate financial assistance to insurance companies
Reconciliation cannot:
Eliminate the pre-existing condition rule

12. Policy Proposals American Health Care Act (AHCA)
The House Plan
The “Better Care Reconciliation Act”
The Senate’s Attempt at a Plan
The Cruz-Lee Amendment
“Skinny Repeal”
Problem Solver’s Caucus

13. The “Skinny Repeal” As originally proposed Most taxes would remain
No penalty for failing to buy health insurance
Eliminating the individual mandate
No penalty for employers who don’t provide Health insurance

14. Impact of Policy Proposals
The House AHCA?
The Senate Better Care Plan?
Skinny Repeal
Premiums would likely rise
Fewer people would be covered by insurance

15. The Problem Solver’s Caucus
Created by the House
Includes 43 members
Republicans and Democrats
Goal of stabilizing the individual insurance market

16. Medicaid Likely Changes
Medicaid Expansion
Block grants or Per capita funding
States would choose
Work Requirements
Premiums

17. Questions? What do you think is Next?