1. Health Care Reform Federal Updates and Priorities Grace Campbell Regional Director, State Advocacy December 5, 2013

2. Important Dates SMTWTFS 1234567 891011121314 15161718192021 22232425262728 293031 DecemberJanuary FebruaryMarch Final day for enrollment to count 1/1/14 SMTWTFS 1234 567891011 12131415161718 19202122232425 262728293031 Coverage begins Budget Conference Committee Reports Congress must approve CR to keep government open SMTWTFS 1 2345678 9101112131415 16171819202122 232425262728 Federal government reaches debt ceiling SMTWTFS 1/2 345678 9101112131415 16171819202122 23242526272829 3031 45 Day Announcement Open Enrollment Ends Last Day to select plan for April 1 Effective Date

3. Proposed Federal ACA Related Legislation Extend Open Enrollment Introduced by Senator Shaheen Potential Impact on 2015 Premiums 1 Year Mandate Delay Introduced by Senators Manchin & Kirk Breaking “The Link” will increase premiums Policy Cancellations Bills in House & Senate Changes rules in middle of the game; impacts 2015 premiums

4. Breaking the Link: States’ Experience Says It All Coverage Disruptions Higher Premiums No Reduction in Uninsured

5. Priority Issues Affordability Health Insurance Tax Public Programs Health Care Cost Roadmap

6. Priority Issue: Affordability “First Rule” of PremiumsNew Benefits = New Costs Changing rules could impact premiums

7. Priority Issue: Affordability – What Plans Are Doing Plans Meeting the Affordability Challenge Head On Constructing Plans to Balance Affordability and Quality Innovative Benefit Design

8. Priority Issue: Health Insurance Tax (HIT) A $100 Billion “Hidden” Tax on Premiums Makes Health Insurance More Expensive…Undermines Goals of Reform 2 Year Delay of HIT Provides Immediate Relief for Families, Employers & Seniors

9. Priority Issue: Medicare Advantage More than 14 Million Americans Enrolled Higher-Quality Care to Seniors Protections Against Out-of-Pocket Costs Overwhelming SatisfactionBut…

10. Priority Issue: Medicare Advantage ACA Cut $200 Billion (and New Health Insurance Tax) Impact on Beneficiaries = Higher Costs, Less Benefits, Loss of Choice Seniors Cannot Afford to Have Program Cut More

11. Priority Issues: What’s Driving Health Care Costs? Medical Liability Fee-for-Service Provider Consolidation Cost Shifting Demographics “Innovation” Bias Lifestyle Choices Cost Opacity

12. Priority Issues: Our Roadmap