17-02-14-UHPP ACA Update

Health Reform in Utah
Policy Update for Congressional Staff
February 2017 Jason Stevenson
Utah Health Policy Project
801.433.2299 x23
stevenson@healthpolicyproject.org

84,601
140,612
175,637
-
50,000
100,000
150,000
200,000
250,000
10/31/13
11/30/13
12/31/13
01/31/14
02/28/14
03/31/14
04/30/14
05/31/14
06/30/14
07/31/14
08/31/14
09/30/14
10/31/14
11/30/14
12/31/14
01/31/15
02/28/15
03/31/15
04/30/15
05/31/15
06/30/15
07/31/15
08/31/15
09/30/15
10/31/15
11/30/15
12/31/15
01/31/16
02/29/16
03/31/16
04/30/16
05/31/16
06/30/16
07/31/16
08/31/16
09/30/16
10/31/16
11/30/16
12/31/16
01/31/17
Utah’s sign-ups on healthcare.gov reached 197,187 in 2017
[OE1-a] Health Insurance Marketplace: February EnrollmentReport (Oct. 1, 2013-March 1, 2014), http://aspe.hhs.gov/health/reports/2012/ACA-Research/index.cfm; [OE1-b] Health Insurance Marketplace: November EnrollmentReport (November 13, 2013), For the period: October 1, 20134 - November 2, 2013,
https://aspe.hhs.gov/sites/default/files/pdf/180496/rpt_enrollment.pdf[OE1-c]Health Insurance Marketplace: January Enrollment Report (January 13, 2014), For the period: October 1, 2013 – December 28, 2013, https://aspe.hhs.gov/sites/default/files/pdf/177611/ib_2014jan_enrollment.pdf[OE1-d]Health Insurance Marketplace: February
EnrollmentReport February 12, 2014), For the period: October 1, 2013 – February 1, 2014, https://aspe.hhs.gov/sites/default/files/pdf/177606/ib_2014feb_enrollament.pdf[OE1-e]Health Insurance Marketplace: March EnrollmentReport (March 11, 2014), For the period: October 1, 2013 – March 1, 2014,
https://aspe.hhs.gov/sites/default/files/pdf/76811/ib_2014Mar_enrollAddendum.pdf[OE1-f]Health Insurance Marketplace: SummaryEnrollmentReport: State Profile, (May 1, 2014), https://aspe.hhs.gov/sites/default/files/pdf/93806/ut.pdf
-----------
[OE2-a] Health Insurance Marketplace: December EnrollmentReport, (December 30, 2014), For the period: November 15, 2014 – December 15, 2014, https://aspe.hhs.gov/sites/default/files/pdf/77201/ib_2014Dec_enrollment.pdf[OE2-b] Health Insurance Marketplace: January EnrollmentReport, (January 27, 2015), For the period: November 15,
2014 – January 16, 2015, https://aspe.hhs.gov/sites/default/files/pdf/33826/ib_2015jan_enrollment.pdf[OE2-c]Health Insurance Marketplace: March EnrollmentReport, (March 10, 2015), For the period: November 15, 2014 – February 22, 2015, https://aspe.hhs.gov/sites/default/files/pdf/83656/ib_2015mar_enrollment.pdf; [OE2-d]State-Level
Data from the ASPE January Health Insurance MarketplaceEnrollmentReport For The 2016 Open EnrollmentPeriod; March 31, 2015 Effectuated EnrollmentSnapshot; 15-06-02; http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-06-02.html
-----------
[OE3-a] Health Insurance Marketplace: January EnrollmentReport, (January 7, 2016), For the period: November 1, 2015 – December 26, 2015, https://aspe.hhs.gov/sites/default/files/pdf/167981/MarketPlaceEnrollJan2016.pdf; [OE3-b] Health Insurance MarketplaceOpen EnrollmentSnapshot - Week 11; January 10, 2016 - January 16, 2016
(Released: 1/20/16); Health Insurance MarketplaceOpen EnrollmentSnapshot - Week 13 January 24, 2016-February1, 2016; https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-02-04.html; [OE3-c]Health Insurance Marketplaces 2016 Open EnrollmentPeriod: Final EnrollmentReport (March 11,
2016), For the period: November 1, 2015 – February 1, 2016,
https://aspe.hhs.gov/sites/default/files/pdf/187866/Finalenrollment2016.pdf; [OE3-d] March 31, 2016 EffectuatedEnrollmentSnapshot (Released: June 30, 2016), https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-06-30.html
----------
[OE4] - [2017 Final] Biweekly EnrollmentSnapshot; Weeks 12 through 14; Date 2017-02-03; Weeks 12-14; 11/1/16 thru 1/31/17; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-0203.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending; [2017] Biweekly EnrollmentSnapshot;
Date 2017-01-18; Weeks 10-11; 11/1/16 - 1/14/17; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-18.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending;[2016] Biweekly EnrollmentSnapshot; Date 2017-01-04; Weeks 8-9; 11/1/16 - 12/31/16; Link:
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-04.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending
197,187
Utah’s ACA
enrollment
grew 12.3%
in 2017

Rank State
2016 Open
Enrollment 3
(Final)
2017 Open
Enrollment 4
(Final)
Difference
(#)
Difference
(%)
1 Hawaii 14,564 18,938 4,374 30.0%
2 South Dakota 25,999 29,622 3,623 13.9%
3 Utah 175,637 197,187 21,550 12.3%
4 Oregon 147,109 155,430 8,321 5.7%
5 Wyoming 23,770 24,826 1,056 4.4%
6 New Jersey 288,573 295,067 6,494 2.3%
7 North Dakota 21,604 21,982 378 1.7%
8 Wisconsin 239,034 242,863 3,829 1.6%
9 Nevada 88,145 89,061 916 1.0%
10 Florida 1,742,819 1,760,025 17,206 1.0%
Utah’s marketplace enrollment increased 12.3% this year
Sources: [2017 Final] Biweekly Enrollment Snapshot; Weeks 12 through 14; Date 2017-02-03; Weeks 12-14; 11/1/16 thru 1/31/17; Link:
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-02-
03.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending; [2016 Final] Health Insurance Marketplace Open Enrollment Snapshot - Week 13; Date 2016-02-04;
Week 13; 11/1/15 thru 1/31/16; https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-02-04.html

Sources: [2017 Final] Biweekly Enrollment Snapshot; Weeks 12 through 14; Date 2017-02-03; Weeks 12-14; 11/1/16 thru 1/31/17; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-02
03.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending;[2017] Biweekly Enrollment Snapshot; Date 2017-01-18; Weeks 10-11; 11/1/16 - 1/14/17; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-
18.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending; [2016 Final] Health Insurance Marketplace Open Enrollment Snapshot - Week 13; Date 2016-02-04; Week 13; 11/1/15 thru 1/31/16; https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-
sheets-items/2016-02-04.html; [2016] Biweekly Enrollment Snapshot; Date 2017-01-04; Weeks 8-9; 11/1/16 - 12/31/16; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-
04.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending; [2015] Health Insurance Marketplace Open Enrollment Snapshot - Week 9; December 27, 2015 – January 2, 2016; Link: https://WWW.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-
items/2016-01-06.html; [OE3; 2016] Health Insurance Marketplace Open Enrollment Snapshot - Week 11; Date 2016-01-20; Weeks 10-11; 11/1/15 - 1/16/16; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-01-20.html; [2016]
Biweekly Enrollment Snapshot; Date 2017-01-04; Weeks 8-9; 11/1/16 - 12/31/16; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-01-04.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending; [2015] Health Insurance
Marketplace Open Enrollment Snapshot - Week 9; December 27, 2015 – January 2, 2016; Link: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-01-06.html
43,071
35,534
34,637
8,565
16,014
43,390
54,806
41,245
2,812
8,282
0
10,000
20,000
30,000
40,000
50,000
60,000
Week 4 Week 6 Week 7 Week 9 Week 11 Week 13
OE 3 (2015-16)
OE 4 (2016-17)
New
Administration
Bi-weekly
Enrollment Growth
in Covered Lives
Only 11,000 Utahns signed up for ACA insurance in January 2017
—compared to 24,500 the year before

26.6% 27.7% 27.1%
27.0%
25.3%
23.3%
19.9%
14.6% 15.4% 15.3% 14.5% 14.0%
12.5% 10.5%
9.3% 9.2% 9.3%
8.1% 8.7% 7.8% 6.5%
5%
10%
15%
20%
25%
30%
2009 2010 2011 2012 2013 2014 2015
Under 200% FPL All incomes Above 200% FPL
Since 2009, the uninsured rate for Utahns earning over
+200% of the poverty level declined the most
Period ACA Available
Source: U.S. Census
-28% -30%-25%
Utah Uninsured Rate by Income Level (2009 - 2015)

In 2016, 13 of Utah’s top 20 ZIP codes for
ACA enrollment were outside of Salt Lake
County
Source: 2016 Health Insurance Marketplace Plan Selections by ZIP Code; (Nov. 1, 2015 — Jan. 9, 2016); https://aspe.hhs.gov/basic-report/plan-selections-zip-code-health-insurance-
marketplace-january-2016
RANK CITY SELECTIONS % INCREASE
1 Lehi (84043) 3,501 19%
2 South Jordan (84095) 3,346 12%
3 American Fork (84003) 2,948 17%
4 Pleasant Grove (84062) 2,931 20%
5 St. George (84790) 2,829 10%
6 St. George (84770) 2,742 11%
7 Draper (84020) 2,624 13%
8 Bountiful (84010) 2,455 5%
9 Spanish Fork (84660) 2,377 24%
10 West Valley City (84119) 2,368 3%
11 West Valley City (84120) 2,345 13%
12 Provo (84604) 2,289 22%
13 Herriman (84096) 2,276 20%
14 Clearfield (84015) 2,258 3%
15 Riverton (84065) 2,255 23%
16 Cottonwood Heights (84121) 2,254 6%
17 Orem (84058) 2,196 24%
18 Orem (84057) 2,193 16%
19 Ogden (84404) 2,189 1%
20 Layton (84041) 2,110 12%

14,686
26,765
28,626
2,203
3,650
4,278
-
5,000
10,000
15,000
20,000
25,000
30,000
35,000
2013-14 2014-15 2015-16
Marketplace enrollment in CD1 increased
8% in 2015-16
No
Subsidy
Received
Subsidy
Sources: [2014] Plan Selections by ZIP code in the Health Insurance Marketplace; Date: 2014-09-01; 10/1/2013 thru 4/19/14; https://aspe.hhs.gov/plan-selections-zip-code-health-insurance-marketplace-september-
2014“; [2015B] ASPE 2015 Health Insurance Marketplace Plan Selections by ZIP Code; Date 2015-04-01; (Nov. 15, 2014 — Feb. 22, 2015);
http://aspe.hhs.gov/health/reports/2015/MarketPlaceEnrollment/EnrollmentByZip/rpt_EnrollmentByZip_Apr2015.cfm; [2016] Addendum to the Health Insurance Marketplaces 2016 Open Enrollment Period: Final
Enrollment Report; Date: 2016-03-11; For the period: November 1, 2015 – February 1, 2016; https://aspe.hhs.gov/health-insurance-marketplaces-2016-open-enrollment-period-final-enrollment-report

7% in 2015-16
No
Subsidy
Received
Subsidy
23,108
41,927 44,524
3,466
5,717
6,653
-
10,000
20,000
30,000
40,000
50,000
60,000
2013-14 2014-15 2015-16

13% in 2015-16
No
Subsidy
Received
Subsidy
2013-14 2014-15 2015-16
22,838
42,496
47,5143,426
5,795
7,100
-
10,000
20,000
30,000
40,000
50,000
60,000

10% in 2015-16
No
Subsidy
Received
Subsidy
2013-14 2014-15 2015-16
25,203
45,989
50,110
3,780
6,271
7,488
-
10,000
20,000
30,000
40,000
50,000
60,000
70,000

Marketplace enrollment Utah’s congressional
districts increased an average of 10% in 2015-16
-
10,000
20,000
30,000
40,000
50,000
60,000
UT CD-1
UT CD-2
UT CD-3
UT CD-4
2013-14 2014-15 2015-16

Utah has the nation’s highest percentage (25%)
of children enrolled in ACA coverage
Age
Utah
37 FFM states
10%
10%
16%
16%
20%
27%
1%
25%
12%
19%
16%
12%
15%
< 18
Age 18-25
Age 26-34
Age 35-44
Age 45-54
Age 55-64
Age 65+
56% of Utah
enrollees are
under age 34
Source: Health Insurance Marketplaces 2017 Open Enrollment Period: January Enrollment Report; Date: 1/10/17; For period 11/1/16 to 12/24/16; Weeks 8-9; Link:

85% of Utahns enrolling on healthcare.gov
received a premium subsidy
No subsidy
Received subsidy
Subsidy Status
85%
15%
83%
17%
Utah
37 FFM states

Sliding-scale subsidies make insurance more affordable
The 2016 FPL guidelines are applied to the 2017 Marketplace plans.
These guidelines only apply to the Lower 48 States (Alaska and Hawaii have their own guidelines).
Source: Link: http://familiesusa.org/product/federal-poverty-guidelines
For 2017, a family of four can earn $90,000
a year and receive a premium subsidy
If your income/family size is on this chart, you qualify for a subsidy

ACA subsidies cover 69% of average monthly
premiums for Utah enrollees
Impact of monthly subsidies on
ACA insurance premiums
$187
$84
(69%)
(31%)
Utah Average
Monthly
Premium:
$271
Consumer
Cost
Subsidy
Amount
Subsidy Impact

72% of Utah’s ACA enrollment earns below
250% of the poverty level
31%
22%
19%
9%
8%
Utah
34%
22%
14%
8%
9%
37 FFM states
100% to 150%
151% to 200%
201% to 250%
251% to 300%
Poverty Level
301% to 400%

Over half of re-enrolling marketplace consumers
in Utah switched plans in 2016
Origin of Utah
ACA enrollment
Active vs. Auto status for
re-enrollments
Newly enrolled
Re-enrolled
23%
77%
56%
21%
Active re-enrollment
Auto re-enrollment

The Hernandez Family
Residence: Salt Lake City, Utah
Ages:
Dad : 33
Mom: 29
Kids: 11, 7
Annual income: $26,000
% of poverty level: 109%
Monthly premium: $550
Subsidy pays: $502 per month
The Hernandez’s pay: $48 per month
Primary doctor: $5
Specialist doctor: $15
Emergency room care: $100
Generic drugs: $3
Plan
Details
Deductible: $500
Out-of-pocket maximum: $2,500
Source: https://www.healthcare.gov/see-plans/; Image source: Moodboard
How much does
the Hernandez
family pay for
health insurance?
Kids on
Medicaid
Benchmark
Silver plan
Parent-only
coverage

The Peterson’s pay: $263 per month
Primary doctor: $30
Generic drugs: $10
Plan
Details
Deductible: $6,000
How much does
the Peterson
family pay for
health insurance?
Benchmark
Silver plan
Could pay
$30/month
more for plan
with $2,600
deductible
The Peterson Family
Residence: Draper, UT
Ages:
Dad : 24
Mom: 23
Kid: Newborn

Monthly premium: $1,544
Subsidy pays: $1,210 / month
The Smith’s pay: $333 per month
Primary doctor: $35
Generic drugs: $15
Plan
Details
Deductible: $3,000
How much do
the Smiths pay
for health
insurance?
Benchmark
Silver plan
Subsidy
increased by
$400 per
month over
2016 amount
The Smiths
Residence: Santa Clara, UT
Ages: 62, 60

The Phillips’ pay: $564 per month
Primary doctor: $35
Generic drugs: $15
Plan
Details
Deductible: $7,000
How much do
the Phillips pay
for health
insurance?
Kids covered
by Medicaid
Parents are
caught in the
Utah Medicaid
Coverage Gap
The Phillips Family
Residence: Lindon, Utah
Ages:
Dad : 35
Mom: 33
Kids: 11, 7

The Simonsens’ pay: $945 per month
Primary doctor: $35
Generic drugs: $15
Plan
Details
Deductible: $7,000
How much do
the Simonsen’s
pay for health
insurance?
Benchmark
Silver plan
Plan premium
increased 25%
from 2016
The Simonsen Family
Residence: Alpine, Utah
Ages:
Dad : 44
Mom: 35
Kids: 11, 7

Impact of repealing the ACA on Utah families
Allow discrimination against Utahns with pre-existing conditions—
including denials, waiting periods, and higher premiums
Bring back high-risk pools to segregate sick people
Raise premiums for women and older Utahns [age 40+]
Charge extra for preventive care, well-child checks, autism
screening, immunizations, mammograms, and physical exams
Eliminate essential health benefits—letting insurers skip coverage
for maternity care, cancer, diabetes, mental health, and
emergencies
Impose annual and life-time caps for insurance benefits
Reduce premium subsidies for low- and middle-income families
Create instability and confusion among Utah insurers and decrease
participation in 2018 marketplace
Return prescription drug donut hole for 300,000 Utah seniors

A “continuous coverage” requirement to protect
pre-existing conditions is not adequate

(*) ACA: $162.56 monthly premium after $386.82 monthly subsidy; [Unsubsidized monthly premium for two adults: $549.38]
(**) Repeal: $450 monthly premium ($5,400 annual) offset by $2,400 age-based tax credit ($1,200 per parent)
Total
(P+OPM)
$5,951
$13,000
+119%
Premium
(annual)
$1,951*
$3,000**
+54%
Deductible
(annual)
$1,400
$6,000
+329%
Out-of-
Pocket Max
$4,000
$10,000
+150%
Premium
+ Deductible
$3,351
$9,000
+169%
P+D as % of
income
8.4%
23%
+174%
Repeal
(H.R. 2300)
Difference
Repealing the ACA will increase
the triple the health insurance
costs for the middle-class
Shumway family….
The Shumways
Family of 4
Ages: 32, 32,12, and 10
Income: $40,000
Children on CHIP
ACA
(Benchmark
Silver Plan

The Simonsens
Family of 4
Ages: 32, 32,12, and 10
Income: $120,000
(*) ACA: $862.80 monthly premium with no subsidy
(**) Repeal: $800/month premium ($9,600 annual) offset by $4,200 age-based tax credit; ($1,200 per parent, $900 per child)
Total
(P+OPM)
$24,654
$15,400
-38%
Premium
(annual)
$10,354*
$5,400**
-65%
Deductible
(annual)
$7,000
$6,000
-14%
Out-of-
Pocket Max
$14,300
$10,000
-30%
Premium
+ Deductible
$17,354
$11,400
-34%
P+D as % of
income
14.5%
9.5%
-35%
Repeal
(H.R. 2300)
Difference
Repealing the ACA will
decrease insurance costs by
1/3 for the Simonsen family
ACA
(Benchmark
Silver Plan

Ways to Repair the ACA
• Fix the “family glitch” so that family members priced out of
employer-based coverage can get subsidies to purchase
marketplace insurance
• Add tax credits for consumers on individual market earning more
than 400% of poverty level (i.e. the Simonsen family)
• Increase contribution amounts to health savings accounts (HSAs)
• Create “Copper Plan” with high deductibles, low premiums, and
open to all consumers regardless of age, income
• Allow more small business “association health plans” sponsored
by business and professional organizations
• Allow Medicare to negotiate for prescription drugs
• Allow insurers to sell policies across state lines

2017: 28 Plans2015: 101 Plans 2016: 74 Plans2014: 91 Plans
2 plans
11 plans
11 plans
4 plans
0 plans
Sources: [2014] https://https://insurance.utah.gov/health/Health%20Refrom/ACA_Rate_Individual_20131007_OnExchange.pdf
[2015] Utah – On Exchange Rates (accurate as of 10/15/14) https://insurance.utah.gov/health/Health%20Refrom/2015IndividualOnExchange20141016.pdf
[2016] www.hea;thcare.gov; See Plans and Premiums (October 2015)
Altius Health Plans
Arches
BridgeSpan
Humana
Molina Healthcare
Select Health
6 plans
26 plans
34 plans
24 plans
1 plan
Humana (6)
Molina Healthcare (3)
Select Health (60)
University of Utah (5)
Altius Health Plans
Arches
BridgeSpan
Humana
Molina Healthcare
Select Health
Gold
Silver
Bronze
Catastrophic
Platinum
5 plans
19 plans
27 plans
21 plans
2 plans
5 plans
29 plans
40 plans
27 plans
0 plans
2014-17 Individual Marketplace Comparison
Salt Lake
County
Molina Healthcare (5)
Select Health (18)
University of Utah (5)

3 insurers
2 insurers
1 insurer
In 2017, 95% of Utahns have access to
two or more marketplace insurers
Accessible
Insurers
Utah
Population
(2014)
% of Utah
Population
(2014)
Molina;
SelectHealth;
University of
Utah Health
Plans
2,375,104 80.7%
SelectHealth;
University of
Utah Health
Plans
424,851 14.4%
SelectHealth 142,947 4.9%

In 2017, average premiums for Bronze and Silver plans increased
at lowers rates than 2016, but Gold plans jumped 47%
Source: Utah Dept. of Insurance; 2014-2017 Utah Individual and Small Employer Group Rates for Age 21, Non-Tobacco, Salt Lake County, (as of 9/27/2016)
GoldSilverBronze
1.4%
21%
9%
3.7%
19%
16%
7.4%
19%
47%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
GoldSilverBronzeGoldSilverBronze
2014-15 2015-16 2016-17
Average Monthly Premiums by
Enrollment Period and Metal Tier

90% of Take Care Utah clients chose from the
three least expensive Silver Plans
Source: Utah Dept. of Insurance; 2016, 2017 Utah Individual and Small Employer Group Rates for Age 21, Salt Lake County, Non-Tobacco (as of 9/27/2016)
Family of 5 earning $80,000 a year

What has been going on with employer-based insurance?
Source: Kaiser Family Foundation Employer Health Benefits – 2016 Summary of Findings - http://kff.org/health-costs/report/2016-employer-health-benefits-survey/
Average Annual Health Insurance Premiums and Worker
Contributions For Family Coverage (2006-2016)
Percentage of Firms Offering Health Benefits by Firm Size
(1999-2016)
82% subsidy
71% subsidy

www.takecareutah.org | call 2-1-1
TCU’s trained counselors are ready to help you
understand your new options to find affordable
health care coverage today
Where can Utahns find help
applying for health insurance?

17-02-14-UHPP ACA Update

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