Healthcare Reform & Small Business
John J. Sarno, Esq.
Employers Association of New Jersey
Points to Cover:
Health Insurance Marketplace
Small Employer Options
Patient Protection & Affordable Care Act
March 23, 2014
A New Era for America
The Health Insurance Marketplace
Uninsured individuals not eligible for Medicare or
Medicaid will be permitted to purchase insurance
through state Exchanges (purchasing pools).
Individuals will be eligible for subsidies.
Employers with fewer than 100 employees will be
permitted to enroll.
Employer eligibility may be expanded in 2017.
High-risk pool created (2010)
Dependent coverage to age 26 (2010)
Children with pre-existing conditions cannot be denied coverage (2010)
No denial for pre-existing conditions eliminated (2014)
No Charge for annual wellness visit (2014)
Guaranteed issue policy (2014)
Modified community ratio (2014)
80 – 85% medical loss ratio (2014)
Long-term insurance program (2014)
No pre-existing condition exclusions (2014)
“Free” Preventive Care
The Marketplace, Prices and Subsidies – N.J.
34,751 enrollment – Dec., 2013
29 plans within 4 categories
Silver – benchmark plan (70% of healthcare costs)
October – December, 2013
4 of 5 enrollments eligible for subsidy
54% - women
46% - men
About 500,000 New Jerseyans are eligible to
purchase a healthcare plan on the Health
Most work full-or part-time for a small
About 80% will be eligible for a subsidy
525,000 undocumented workers in N.J. not
N.J. Small Group Market
• 95% of N.J. employers (250,000) are “small”
(50 employees or fewer)
• 40% of N.J. workers are employed by small
• About half of small employers offer healthcare
Burden of Benefit
• No requirement for employers to offer
• No penalty for small employers
• Healthcare plans must conform to ACA
New Jersey Health Reform (1992)
Individual and Small Group Pools
Guaranteed – Issue
No-Preexisting Condition Exclusion
Modified Community Rating
Medical Loss Ratio (80%)
75% Coverage (25 or more hours)
Premiums have grown 4-times faster than wages
Average employee contribution has gone up
200% since 2000.
Out-of-pocket and co-payments have gone up
115% since 2000.
Health Care Inflation
A Looming Challenge Health Care Inflation
1. Premiums have grown 4-times faster than wages since 1999. In NJ, 5
2. Average employee contribution has gone up 200% since 2000.
3. Out-of-pocket and co-payments have gone up 115% since 2000.
4. NJ Public Interest Group estimates premiums for New Jersey employers
will double to $24,000 per year by 2016.
5. Premiums in N.J. are third highest in U.S.
NJ Marketplace Carriers
Horizon Blue Cross
Health Republic of NJ