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Patient Protection and Affordable Care Act ("ACA"): Now What? 2012

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Kristin Nealey Meier of Ryan, Swanson & Cleveland PLLC's presentation on Patient Protection and Affordable Care Act

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Patient Protection and Affordable Care Act ("ACA"): Now What? 2012

  1. 1. The Patient Protection and Affordable Care Act (“ACA”): Now What? Kristin Nealey Meier
  2. 2. The Supreme Court Ruled… 2©2012 by Ryan, Swanson & Cleveland, PLLC
  3. 3. The Supreme Court Ruled… (cont.) 3©2012 by Ryan, Swanson & Cleveland, PLLC
  4. 4. The Supreme Court Ruled… (cont.) 4©2012 by Ryan, Swanson & Cleveland, PLLC
  5. 5. 5 What Happens in 2014?  Individual mandate  Assistance for low-income  Employers: provide coverage or penalty  State Exchanges ©2012 by Ryan, Swanson & Cleveland, PLLC
  6. 6. 6 What are the Employer Requirements? 1. Offer Coverage or Pay Fine – “Pay or Play” 2. Minimum Essential Health Benefits Package ©2012 by Ryan, Swanson & Cleveland, PLLC
  7. 7. 7 “Pay or Play” If you employed less than 50 full-time (or equivalent) employees, no fine.  Can offer coverage  Can send to exchanges ©2012 by Ryan, Swanson & Cleveland, PLLC
  8. 8. 8 “Pay or Play” (cont.) If you employed an average of 50 full-time (or equivalent), non-seasonal employees, must offer health coverage that covers at least 60% of costs and meets: “MINIMUM ESSENTIAL COVERAGE REQUIREMENTS” OR PAY A FINE $$$$$$$* $2000/full time employee after first 30. ©2012 by Ryan, Swanson & Cleveland, PLLC
  9. 9. 9 “Pay or Play” (cont.) For example, if you have 50 employees, don’t offer coverage, you pay $2000 x (50-30) = $40,000 *If at least one of your employees receives a tax credit for health insurance ©2012 by Ryan, Swanson & Cleveland, PLLC
  10. 10. 10 “Pay or Play” (cont.) If you employed an average of 50 full-time (or equivalent), non-seasonal employees and offer health coverage that meets: “MINIMUM ESSENTIAL COVERAGE REQUIREMENTS” AND One employee accesses a tax subsidy or cost-reduction benefit for health insurance, YOU PAY A FINE $$$$$$$* $3000/full time employee who accesses subsidy/cost/benefit. ©2012 by Ryan, Swanson & Cleveland, PLLC
  11. 11. 11 Coverage under any of the following:  Certain government programs (i.e. Medicare, Medicaid);  Coverage under an employer-sponsored plan;  Plans in the individual market within a State;  Grandfathered health plan coverage; or  Other coverage recognized by HHS. What are Minimum Essential Health Benefits? ©2012 by Ryan, Swanson & Cleveland, PLLC
  12. 12. NOT Minimum Essential Health Benefits If You Only Offer:  Accident, or disability income insurance;  Coverage issued as supplement to liability insurance;  Liability Insurance, including general liability insurance and automobile liability insurance;  Workers’ compensation or equivalent;  Automobile medical payment insurance;  Credit-only insurance;  Coverage for on-site medical clinics; and  Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits. 12©2012 by Ryan, Swanson & Cleveland, PLLC
  13. 13. 13 Washington State Exchange ©2012 by Ryan, Swanson & Cleveland, PLLC
  14. 14. 14 Washington State Exchange (cont.)  From the website:  As part of national health reform, Washington State will soon have an easily accessible, central marketplace for individuals, families and small businesses to buy health insurance. This online one- stop-shop will be called a Health Benefit Exchange. ©2012 by Ryan, Swanson & Cleveland, PLLC
  15. 15. Washington State Exchange (cont.)  Through the Exchange, Washingtonians will be able to:  Make apples-to-apples comparisons between health plans that meet national and state standards  Check qualifications for tax credits or cheaper co-pays and deductibles  Get help choosing and enrolling in a health plan that: • Fits your personal health needs • Has your choice of doctors 15©2012 by Ryan, Swanson & Cleveland, PLLC
  16. 16. 16 Washington State Exchange (cont.)  Is on pace to establish the exchange by fall 2013  Has conducted analysis and chosen the benchmark plans around which to form the exchange:  http://www.hca.wa.gov/hbe/documents /HBE_Policy_EHB_Milliman_Analysis. pdf ©2012 by Ryan, Swanson & Cleveland, PLLC
  17. 17. Will the ACA survive?  2012 Election 17©2012 by Ryan, Swanson & Cleveland, PLLC
  18. 18. What About in Washington? (cont.)  Both Inslee and McKenna want to rein in healthcare costs  McKenna wants to promote health savings accounts and managed care HMOs like Group Health  Inslee wants to promote preventive care and managing chronic conditions  McKenna supports the new state Health Benefit Exchange  Presumably Inslee also supports the new state Health Benefit Exchange because he supports the ACA in its entirety 18©2012 by Ryan, Swanson & Cleveland, PLLC
  19. 19. 19 Resources (Links provided on your USB key, or online at www.ryanswansonlaw.com)  Washington State Exchange, including policy briefs  Department of Labor  National Association of Insurance Commissioners  U.S. Chamber of Commerce  Small Business Majority  National Business Group on Health  U.S. Small Business Association ©2012 by Ryan, Swanson & Cleveland, PLLC
  20. 20. Questions? Kristin Nealey Meier Ryan, Swanson & Cleveland kmeier@ryanlaw.com (206) 654-2293

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