Learn more about the new administration's efforts to repeal the Affordable Care Act. The focus of this presentation will be: -Review current efforts of repeal and replacement -Discuss the processes that may be used for repeal -Understand the timing of when things can change -Review impacts to employer-sponsored coverage

1. ACA Repeal Efforts
April 12,2017

2. PAGE
©Copyright | IXSolutions
Why Repeal?
April12, 2017
1
 Insurancemarketsarecollapsing
 1/3 of U.S. countieshaveonly1 insurerofferingExchange plans
 18outof23Co-Opshavefailed
 Ona “rescuemission”tosavetheindividualmarketfromtotalcollapse
 Premiumsanddeductiblesaresoaring
 25%averagepremiumincreaseforExchange plans
 New kind of uninsured, those buying plans with high premiums and deductibles,
prohibitingaccesstocare
 Increasesnotisolatedtoindividualmarket
 $1trillionin newtaxes,mostlyfallingonfamiliesandjob creators
Source: Obamacare RepealandReplace Policy Briefand Resources

3. PAGE
©Copyright | IXSolutions
RepublicanObjectives
April 12, 2017
2
 Federalderegulation
 More controltostates
 Freemarketstodrivehealthcareinnovation
 Interstatecommerceforhealthcare
 Accesstomoretypesofcoverage
 Eliminatehealthcaretaxes
 HSAexpansion

4. PAGE
©Copyright | IXSolutions
AmericanHealthCareAct(AHCA)
April 12, 2017
3
 The billwhich wouldrepealand replacesignificantpartsoftheACA
 EliminatesIndividualandEmployerMandates
 EliminatesmostACA-imposedtaxes
 Changetaxcreditsintheindividualmarkettobe primarilybasedon age
 ChangesMedicaidfunding
 Expands andimprovesHSAsand FSAs
 Whydoes theAHCAjustfocuson the“financials”oftheACA?

5. PAGE
©Copyright | IXSolutions
115th Congress
April 12, 2017
4
 238currentRepublicanHousemembers
 Need218votesforrepeal
 52currentRepublicanSenators
 Need60votesforrepeal

6. PAGE
©Copyright | IXSolutions
BudgetReconciliation
April 12, 2017
5
 Reconciliationbills can bepassedwithsimplemajorityintheSenate
 Congress can repeal items that impact federal spending and revenues through the
reconciliationprocess
 Onlyneed51Senatevotes(which Republicanshave)
 Full repeal of ACA, or the repeal of certain ACA provisions, would require some bipartisan
support

7. PAGE
©Copyright | IXSolutions
BacktotheAHCA….
April 12, 2017
6
 Was scheduledforaHousevoteon March23,2017
 Coincidentally,the7 yearanniversaryoftheACAbecominglaw
 WhiteHouseissuesultimatumtoRepublicans
 PasstheAHCAormoveon tootheragendaitems
 HouseSpeakerPaul RyaninformsWhiteHouse notenoughvotestopass
 Votedelayeduntilthefollowingday;then
 Houseeventuallypullsthebill

8. PAGE
©Copyright | IXSolutions
What’sthe Issue?
April 12, 2017
7
Republicans
vs.
Democrats General Public Republicans

9. PAGE
©Copyright | IXSolutions
InternalPartyConflict
April 12, 2017
8
 ConservativeRepublicans
 AHCAdidn’trepealenough
 AHCAdidn’trepealprovisionsfastenough
 ModerateRepublicans
 Concernedoverchanges toMedicaid funding
 By working with Conservatives votes are lost from Moderates, and by working with
ModeratesvotesarelostfromConservatives

10. PAGE
©Copyright | IXSolutions
RepealEfforts on “SpringBreak”
April 12, 2017
9
 Lastweek,Republicanleadersheld closeddoor meetingswithModerateandConservative
members
 Goalwastoworkonabill thatRepublicanscan pass
 Nodealwasreached,butprogresswasbelievedtohavebeenmade
 CongressisnowonitsSpringrecessuntilApril24th

11. PAGE
©Copyright | IXSolutions
NextStepsfor Republicans
April 12, 2017
10
 Resumeeffortstopassarepealbill
 UsetaxreformtorepealACAtaxprovisions
 IssueagencyregulatoryguidancewhichimpactstheACA
 Draftseparate,stand-alonelegislationtochangeone itemata time
 Donothing

12. PAGE
©Copyright | IXSolutions
ResumingEfforts
April 12, 2017
11
 Talksofrepealareexpectedtocontinue,but….
 Timingisbecomingabigissue
 June 21, 2017 is the deadline for insurance companies to decide if they will participate in the
Exchanges
 This dateincludesa 7week extension
 Plandesignsand ratesmustbefiledby thisdate
 Absent change, or if uncertainty exists, it will impact rates and which companies
participateintheExchanges
 2018isa mid-termelectionyear

13. PAGE
©Copyright | IXSolutions
Tax Reform
April 12, 2017
12
 AnotherbigagendaitemforRepublicans
 20directandindirecttaxesareincluded intheACA,such as:
 Healthinsurertax
 Medicaldevicetax
 Pharmaceuticalmanufacturertax
 Medicaretaxon highincomeearners
 Throughtaxreform,ACA-relatedtaxprovisionscould berepealed

14. PAGE
©Copyright | IXSolutions
AgencyGuidance
April 12, 2017
13
 ChiefRegulatoryAgencies
 DepartmentofHealthandHumanServices(HHS)
 DepartmentofLabor(DoL)
 DepartmentofTreasury(DoT)
 Collectivelyreferredtoasthe“tri-agencies”
 Tri-agenciescan’tpasslaws,buttheydo regulateandenforcelaws

15. PAGE
©Copyright | IXSolutions
DoTGuidance
April 12, 2017
14
 TheIndividualMandateisstillthelaw, but….
 DoT (IRS) announces that federal income tax returns will be processed even if insurance status is
omitted
 Under the Obama administration, tax returns would be rejected unless you attested to having
insurance,paida penalty,orclaimed anexemption

16. PAGE
©Copyright | IXSolutions
HHS Guidance
April 12, 2017
15
 GuidanceissuedattemptstostabilizeExchanges and IndividualMarket
 Shortenlengthofopenenrollmentperiod
 Morepre-verificationforspecial enrollmentperiods
 Reduceabusesofgraceperiodforlatepremiumpayments
 Allowmoreplandesignstoachievemetallictierstatus

17. PAGE
©Copyright | IXSolutions
SeparateLegislation(one example)
April 12, 2017
16
 HealthSavingsActof2017
 Introducedby MarcoRubioandOrrinHatch
 Increasescontributionlimits
 MakesmoreplansHSA-eligible
 Increasesthetypesofeligiblemedicalexpenses
 AllowssomecarryoverfromFSA/HRAtoanHSA
 Eliminatecertainglitchesunder currentHSArules

18. PAGE
©Copyright | IXSolutions
Do Nothing!
April 12, 2017
17
 "Thebestthingwecando,politically speaking,isletObamacareexplode“
 Trump’scomment afterAHCArepealbill couldn’tgetenoughvotestopass
 GeneralbeliefbyRepublicansinsurancemarketswill collapse ifnothingisdone
 Iftrue,thisshouldigniterepeal/replaceefforts;and
 It could bring Democrats to the table to work on a bill (meaning they could do
morethanchange budget-relateditemsiftheycouldget60 Senatevotes)

19. PAGE
©Copyright | IXSolutions
Future ofRepeal
April 12, 2017
18
 Uncertaintyseemstobetheonly thingcertain
 Whatchanges?
 Timingofchange(s)unclearifrepealdoesoccur
 Method(s)ofrepealeffortsalsounclear
 Repeal efforts would likely come withreplacement provisions, but whatthose provisions are
won’tbeknownuntila bill ispassed

20. PAGE
©Copyright | IXSolutions
Future ofthe ACA
April 12, 2017
19
 ACAcontinuestobe thelawoftheland
 IndividualandEmployer Mandatescontinuetoexist
 Bronze,Silver,Gold, andPlatinumplans arestillyour options
 Exchanges continuetooperateandprovidesubsidiestoeligibleindividuals

21. PAGE
©Copyright | IXSolutions
IndividualMarket
April 12, 2017
20
 Experiencinga greatdealofvolatility
 Choiceisgoingdownandpremiumsaregoingup
 Somecountiesorstatesmaynothaveanyoptionsin2018withoutgovernmentintervention

22. PAGE
©Copyright | IXSolutions
Employer Market
April 12, 2017
21
 More stablethantheindividualmarket
 Moreplanoptionsavailable
 Largernetworkplans available
 Premiumincreasestrendingmuch lowerthanindividualmarket
 In some instances, you may be able to implement a group health plan with just one employee on
theplan
 Qualified Small Employer Health Reimbursement Arrangements (QSEHRAs) also now an option
as ofJanuary1,2017

23. PAGE
©Copyright | IXSolutions
Questions?
April 12, 2017
22
888-239-4408
info@ixshealth.com
www.ixshealth.com/cba