The new administration is causing major changes in the benefits industry, with a laser focus on what will become of the Affordable Care Act. Confronted with a litany of new legislation, it’s easy to miss something. Get the download of the new laws you need to know to keep your benefits compliant and get attorney Larry Grudzien’s legal take on what this means for benefits and HR.
Family Ties: Unknotting Controlled Group Attributionsbenefitexpress
Controlled group attributions are a tricky subject for even seasoned HR pros, which can make it tempting to skip over understanding the rules and hope for the best. However, changes in the Affordable Care Act affect controlled groups perhaps more than any other type of business.
This webinar is your one-hour complete guide to the three types of groups, how they interact, and the types of relationships that most affect your compliance strategy.
What Is The Marital Estate Tax Deduction in ConnecticutBarry D Horowitz
Accumulating wealth is the first order of business, but you must also preserve your wealth for the benefit of the next generation and beyond. Learn more about marital estate tax deduction in Connecticut in this presentation.
Family Ties: Unknotting Controlled Group Attributionsbenefitexpress
Controlled group attributions are a tricky subject for even seasoned HR pros, which can make it tempting to skip over understanding the rules and hope for the best. However, changes in the Affordable Care Act affect controlled groups perhaps more than any other type of business.
This webinar is your one-hour complete guide to the three types of groups, how they interact, and the types of relationships that most affect your compliance strategy.
What Is The Marital Estate Tax Deduction in ConnecticutBarry D Horowitz
Accumulating wealth is the first order of business, but you must also preserve your wealth for the benefit of the next generation and beyond. Learn more about marital estate tax deduction in Connecticut in this presentation.
Presentation delivered by Tom Gibney, SVP & Chief Financial Officer, St. Luke's Cornwall Hospital at the marcus evans National Healthcare CFO Summit Fall 2019 in San Diego CA.
This presentation gives a brief idea on how coalition politics is
major driving force behind corruption.It contains facts,graphics,history,etc about the same.Most of the aspects are presented in context of India.
Summary of Southwest California Legislative Council activities during the 2019 California legislative session. Wins and losses for our local business community.
Jennifer Haberkorn: "Clinton vs. Trump: The Future of U.S. Health Care" 10.28.16reportingonhealth
Jennifer Haberkorn's slides from the Center for Health Journalism webinar "Clinton vs. Trump: The Future of U.S. Health Care," 10.26.16
More info: http://www.centerforhealthjournalism.org/content/clinton-vs-trump-future-us-health-care
Alex Sink For Governor of Florida/DEMOCRATjenkan04
Alex Sink on the issues for Governor of Florida
Candidates personal history
Presented by The Highlands Tea Party http://thehighlandsteaparty.com /
Prepared by John Nelson
Outlook for 2017 and Beyond - Five Exposures to Watch in Health CareEpstein Becker Green
Mark Lutes, Chair of the Board of Directors of Epstein Becker Green and a Member of the firm’s Health Care and Life Sciences practice, delivered the attached keynote presentation, "Outlook for 2017 and Beyond - Five Exposures to Watch," at the Healthcare Financial Forum on March 15, 2017.
The Trump Administration’s policies, and decisions made by Congress, will transform how providers deliver care and receive payment for healthcare services. While President Trump’s February 28 speech to Congress offered few details of a White House vision on health care reform, clues as to a potential future are offered in bills under consideration in the House. In this interactive presentation, we will help finance executives predict the top exposures for their organizations in 2017 by reviewing elements of the shift in the payment paradigm, the Washington policy context and its impact on the threats and opportunities facing their organizations, and the outlook for further legislative and regulatory change.
Key exposures that will be covered include:
Executives Orders & Scrutiny of Regulation
Tax Reform Impacting Commercial Health Care Coverage
Medicare Trends
Exchange Population Coverage Changes
Medicaid Expansion Population Financing Changes
http://www.ebglaw.com/events/healthcare-financial-forum-outlook-for-2017-and-beyond-five-exposures-to-watch/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Grace-Marie Turner, President of the Galen Institute, discusses her organization's efforts to built a competitive marketplace for patient-centric care. Watch the full presentation here: http://video.hint.com/grace-marie-turner-promoting-patient-centered
Presentation delivered by Tom Gibney, SVP & Chief Financial Officer, St. Luke's Cornwall Hospital at the marcus evans National Healthcare CFO Summit Fall 2019 in San Diego CA.
This presentation gives a brief idea on how coalition politics is
major driving force behind corruption.It contains facts,graphics,history,etc about the same.Most of the aspects are presented in context of India.
Summary of Southwest California Legislative Council activities during the 2019 California legislative session. Wins and losses for our local business community.
Jennifer Haberkorn: "Clinton vs. Trump: The Future of U.S. Health Care" 10.28.16reportingonhealth
Jennifer Haberkorn's slides from the Center for Health Journalism webinar "Clinton vs. Trump: The Future of U.S. Health Care," 10.26.16
More info: http://www.centerforhealthjournalism.org/content/clinton-vs-trump-future-us-health-care
Alex Sink For Governor of Florida/DEMOCRATjenkan04
Alex Sink on the issues for Governor of Florida
Candidates personal history
Presented by The Highlands Tea Party http://thehighlandsteaparty.com /
Prepared by John Nelson
Outlook for 2017 and Beyond - Five Exposures to Watch in Health CareEpstein Becker Green
Mark Lutes, Chair of the Board of Directors of Epstein Becker Green and a Member of the firm’s Health Care and Life Sciences practice, delivered the attached keynote presentation, "Outlook for 2017 and Beyond - Five Exposures to Watch," at the Healthcare Financial Forum on March 15, 2017.
The Trump Administration’s policies, and decisions made by Congress, will transform how providers deliver care and receive payment for healthcare services. While President Trump’s February 28 speech to Congress offered few details of a White House vision on health care reform, clues as to a potential future are offered in bills under consideration in the House. In this interactive presentation, we will help finance executives predict the top exposures for their organizations in 2017 by reviewing elements of the shift in the payment paradigm, the Washington policy context and its impact on the threats and opportunities facing their organizations, and the outlook for further legislative and regulatory change.
Key exposures that will be covered include:
Executives Orders & Scrutiny of Regulation
Tax Reform Impacting Commercial Health Care Coverage
Medicare Trends
Exchange Population Coverage Changes
Medicaid Expansion Population Financing Changes
http://www.ebglaw.com/events/healthcare-financial-forum-outlook-for-2017-and-beyond-five-exposures-to-watch/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Grace-Marie Turner, President of the Galen Institute, discusses her organization's efforts to built a competitive marketplace for patient-centric care. Watch the full presentation here: http://video.hint.com/grace-marie-turner-promoting-patient-centered
Affordable Care Act Summary Provisions of the act are phased.docxnettletondevon
Affordable Care Act Summary
Provisions of the act are phased in over ten years.
2010
National temporary high risk pool for those denied coverage.
>82,000 previously uninsured persons gained coverage including more than 250 in Nebraska
Young adults up to 26 y.o. covered under parents’ plans.
>3 million previously uninsured young adults covered, including 18,000 in Nebraska
No lifetime or annual limits on coverage
105 million people benefit, including 700,000 in Nebraska
No denial by insurers of children for pre-existing conditions
No co-payments for preventive care
10-12 million have accessed preventive care, including approximately 360,000 in Nebraska
Tax credits for small employers (<25 employees) to provide health care coverage.
An estimated 360,000 small businesses with 2 million employees benefited in 2011
$250 rebate for Medicare beneficiaries in Part D coverage gap (doughnut hole)
4 million seniors benefited in 2010 including 26,072 in Nebraska
Scholarships and loan forgiveness programs for health professionals choosing primary care
Primary care & other health professions training grants
A number of grants have been made to Nebraska institutions
Comparative Effectiveness Research Grants
Prevention Research and Service Grants
A number of these grants have also been made to Nebraska institutions.
2011
Grants to employ and train primary care nurse practitioners
No co-pay for Medicare preventive services including comprehensive risk assessment and prevention plan
In 2011, an estimated 32.5 million people with traditional Medicare or Medicare Advantage received one
or more preventive benefits free of charge. In 2012 alone, >25 million people with traditional Medicare,
including nearly ~250,000 in Nebraska, have received at least one preventive service at no cost to
them.
Requires insurers to maintain Medical loss ratios or 80 (small group) or 85% (large group). Provides for states
to review and approve premium rate increases
12.8 million subscribers received insurance rebates totaling >$1 billion, including $4.8 million for 22,500
Nebraska families. Insurance rate reviews have saved consumers another $1 billion in premium costs.
50% discount on brand name prescriptions filled during Part D coverage gap
Since inception 5.4 million seniors have saved $4.1 billion; in Nebraska seniors have saved $27.5
million since 2010 because of donut hole rebates or discounts.
10% Medicare & Medicaid bonus for primary care physicians and general surgeons in shortage areas
Increase Medicare payments to hospitals in low cost areas
Increased funding for Community Health Centers
Nebraska Community Health Centers have received >$19 million in additional funding
2012
Bonus payments to high quality Medicare Advantage plans
Incentive Medicare and Medicaid payments to Accountable Care Organizations that demonstrate quality and
efficiency. ACOs have been demonstrated to lower annual health c.
NCET Biz Cafe | Valerie Clark, Conundrum of US Healthcare | Sept 2017Archersan
Do you know how new health insurance laws will affect you and your family? Probably not. We totally get it.
In fact, our modern healthcare system has become so complicated, most people don’t understand it — even in its most basic forms.
But the September Tech Café will help, as Valerie Clark, president of insurance brokerage firm Clark & Associates, discusses “The Conundrum of the U.S. Healthcare System.”
Clark’s firm specializes in the development of creative health insurance plans for employer groups of all sizes, so she is perfectly equipped to lead this informative, frank and non-partisan discussion about the challenges and possible solutions to the serious issues that all Americans are facing today.
In this presentation, Clark will:
· Talk about how we got where we are with healthcare, where we’re going, and most importantly, how will it affect you and your family?
· Address major law changes and how they have affected access to and the cost of care over the past several decades.
· Explore the history and evolution of the U.S. health insurance marketplace, and the public healthcare programs that cover those who are without private health insurance.
So join us in The Basement for Tech Café. Go to the historic post office in downtown Reno, then head downstairs. Listen, learn, enter to win raffle prizes — and answer your pressing health insurance questions.
1) Discuss what seems to be the current posture of the Trump Administration and Republican Party leadership relative to expected health care policy changes.
2) Identify key distinctions between the Affordable Care Act (ACA aka ObamaCare) and the American Health Care Act (AHCA aka TrumpCare).
3) Recognize key strategies for future success regardless of changes to US healthcare policy and law.
Dr. Pam Silberman, President and CEO of the N.C. Institute of Medicine, provides an overview of the Affordable Care Act in North Carolina as part of a NCACC Annual Conference workshop on Aug. 24, 2013.
The pending Healthy Ohio 1115 Medicaid waiver would require nearly all non-disabled adults on Ohio Medicaid to pay premiums. If approved by the federal government, the waiver would result in a greater number of uninsured Ohioans as well as increased Medicaid administrative costs and complexity.
Speakers include:
* Tara Britton, Public Policy Fellow, The Center for Community Solutions
* Nita Carter, Project Director, UHCAN Ohio
This presentation covers national legislative update and state updates specific to employers headquartered in Oregon, Washington, and Montanta. Additionally, we will address recent events including the potential impact of the new tax plan on employee benefits, EEOC wellness rules updates and updates to the ACA.
For further information, please contact The Partners Group:
https://www.tpgrp.com/contact-partner...
For over 35 years The Partners Group has been serving the financial and insurance needs of employers, medical professionals, and successful individuals with services including employee benefits and business consulting, retirement planning, investment services, commercial and individual insurance. We have built our business from the ground up to ensure we are a thriving organization for the next 35 years. Although we have developed a national network and reputation, you can count on our local commitment and service. We deliver through the hard work of over 140 teammates, who tirelessly provide results greater than the sum of our parts. The Partners Group has offices in Portland, Lake Oswego, and Bend OR; Bellevue, WA; and Bozeman, MT. https://www.tpgrp.com
Subscribe to our email list for additional helpful tips:
https://www.tpgrp.com/subscribe/
HR Webinar: The Affordable Care Act Turns 10 Years Old: Where to From Here?Ascentis
Happy Birthday, ACA! Ten years ago, on March 23, 2010, the ACA was signed into law. Adding an unprecedented level of consumer protections and minimum quality standards to the health insurance Americans use, the law was and remains controversial to this day. In fact, the rate of uninsured nonelderly Americans dropped from a high of 17.8% in 2010, to 10.0% in 2016. The cancelation of the individual mandate, among other factors, has started to reverse that trend, with increases in the uninsured rates in 2017 and 2018. As the ACA celebrates its tenth birthday, it has something else to celebrate: its highest approval rate since public opinion polls began tracking it: 55% favorable opinion vs. just 37% unfavorable opinion.
As an HR professional, always busy with a hundred other people priorities at your company, it is hard to keep up with the ever-changing laws in the health insurance industry, and specifically, the ACA. With the law predicted to head to the Supreme Court soon for the third review of its fundamental constitutionality, receiving real-time updates becomes even more important. See what has changed in the ACA, looking at where it started to where it is now in this webinar!
goes thru new healthcare law (PPACA) by section. all information is correct and factual to best of my research. gives great background education on economics of healthcare and covers how massachusetts and europe/canada are doing w/ "reforms". I am against this law, but most information is just plain fact.
Similar to Regulation GPS: Re-routing Health & Welfare Plans (20)
Webinar: Mid-Year Election Changes for Cafeteria Plansbenefitexpress
Let's talk about cafeteria plans. When can participants make election changes?
While cafeteria plans can be a great option for employees wishing to pick and choose benefits based on cost, when and how to facilitate election changes outside of open enrollment can be tricky to navigate for employers. As the use of cafeteria plans continue to grow, we take a deeper look at the rules and regulations of these plans, particularly as they pertain to mid-year election changes.
COVID-19 Health & Welfare: Compliance for Employersbenefitexpress
As part of our continuing ERISA Compliance series, we covered such compliance topics and more in our April 9th webinar discussing COVID-19 and updates from the IRS and DOL concerning the Families First Coronavirus Response Act.
Plan Sponsor Webinar: Navigating COVID-19 for Employersbenefitexpress
In this webinar, we take a deeper look into how the novel coronavirus is not only affecting the way we live, but changing the way we work. From remote work environments, FMLA, contract agreements and more, we discuss how to navigate the changing workforce during this time of uncertainty, and answer questions to help you make the best decisions for the health and safety of your employees.
Medicare & Employer Health Coverage - a Coordination Conversationbenefitexpress
Let's talk about Medicare and Employer Health Coverage. The rules on coordinating Medicare and employer coverage can be complex. How it complements other programs (such as COBRA, HSAs and the ACA) are also areas of question for both employees and their employers.
Part of our ERISA Compliance Series, this webinar is hosted by ERISA Attorney Larry Grudzien and moderated by chief marketing officer Julia Goebel. This webinar will discuss the top wage and hour issues that may be unknowingly lurking within your company.
The Affordable Care Act touches the lives of most Americans. In fact, nearly 21 million will be at risk if Obamacare is struck down, and may even lose health insurance completely if the law is ruled unconstitutional. This webinar will discuss what the outcome may be if ACA is repealed.
Watch our free one-hour webinar reviewing the rules for the new Individual Coverage HRA and the new Excepted Benefit HRA (ICHRA and EBHRA).
In June 2019, Treasury, DOL and HHS released final regulations that are effective for plan years beginning on or after January 1, 2020. These regulations created two new HRAs, Individual Coverage HRAs (ICHRA) and Excepted Benefit HRAs (EBHRA).
These new HRAs will be subject to ERISA and COBRA, but will not be subject to the nondiscrimination rules under Code Section 105(h). Any employer can offer these new HRAs to their employees. They can be offered to common law employees, but cannot be offered to self-employed individuals, partners and more than 2% S-Corporation shareholders.
Facilitated by ERISA attorney Larry Grudzien, and moderated by Chief Marketing Officer Julia Goebel, this webinar will cover the following:
-Why are these new HRAs so important?
-Which employees can be included or excluded
-What documentation is needed to be completed by employers to adopt them
-What reporting and disclosure requirements must be met
-What types of expenses can be reimbursed
-The pros and cons of establishing and participating in these new HRAs for employers
In today's multi-generational workforce, health and wellness benefits are weighted equally with salary expectations. This is why it's important for small and large businesses alike to embrace health and wellness benefits to recruit top talent as well as retain valued employees.
While offering these benefits has been shown to improve employee engagement and productivity, it comes with some challenges. This webinar reviews common questions human resources professionals confront when offering health and welfare benefits to employees.
Facilitated by ERISA attorney Larry Grudzien, this webinar covers the following:
- Questions Surrounding Tax
- Reporting Disclosures
- ERISA, COBRA & FMLA
- Workers Compensation
- Affordable Care Act (ACA)
Benefits are a critical piece of an employee compensation package, with health care benefits reigning most important. Whether you're already offering these benefits or considering adding them to your benefits offerings, view our webinar to learn more and remain competitive in the talent marketplace.
How to Administer Wellness Programs in Today's Regulatory Environmentbenefitexpress
Are you struggling to make sense of the recent legislative updates surrounding employer sponsored wellness programs? Perhaps you are trying to decide whether to continue with current wellness plans, modify your plans without guidance from the EEOC, postpone new wellness programs or discontinue them all together.
It’s a complicated landscape ripe with several options for “next steps” for employees and plan sponsors of wellness plans in 2019 — with perhaps the biggest barrier of all being that employers cannot measure the risk of wellness plans at this time.
To help guide you through this maze of options, watch our one-hour webinar on-demand to learn what rules remain after the EEOC’s regulations were found invalid and what rules have to be met in 2019 in order to offer a valid wellness program.
How to administer wellness programs in today's regulatory environment
This webinar covers:
Requirements under HIPAA
Requirements under the Internal Revenue Code
Requirements under ERISA
Requirements under GINA
Requirements under ADA
Requirements under ACA
HIPAA Training: Privacy Review and Audit Survival Guidebenefitexpress
HIPAA Privacy Overview for Employers. Review a helpful checklist of requirements an employer must adopt to stay compliant with HIPAA and to survive an audit by Health and Human Services (HHS).
Webinar | Texas vs. United States - The Repeal of ACA?benefitexpress
Recently a Federal District Court held in Texas, et al. v. United States of America, et al. that the individual mandate in the Patient Protection and Affordable Care Act (ACA) is unconstitutional, and that the other provisions in the ACA are invalid because they are inseverable from the individual mandate.
Our ACA compliance webinar reviews:
- What the Federal District Court decided.
- The basis for the decision.
- The impact of the decision.
- What may happen over the next months or year.
- What Congress may do to address the situation.
Healthcare Check-in: The Latest Developments in Health and Welfare Plansbenefitexpress
We work in an exciting industry – which means quick changes are the norm, and adaptability is a necessity. Keep your compliance plans up to date with a download of all legislative changes since our last update webinar. This webinar covered legislation that's passed in the last six months, what's on the way, and what it means for your organization.
Webinar | From Analysis to Action: How Personalization Can Lower Employer Cos...benefitexpress
Personalization is everywhere – from Amazon to Spotify, and is now the expectation for consumers. Personalization in benefits elections is also the new normal, thanks to decision support tools and data analytics. Modern decision support tools draw on data points including demographics, preferences and medical need, all highly relevant towards personalization ... as opposed to the "one-size fits all" modeler of the past that relied on strict business rules.
Using data to advise clients can be a game changer for a broker. With analytics, you can quantify your benefit plan suggestions based on hard evidence, and advise based on unbiased data versus mere opinion. But where does this data come from? And how do you know which data to use?
This webinar shows how decision support tools can provide data to simplify health benefit decisions, allowing employees to feel more confident in their decisions, leading to lower costs for employers and client retention for brokers as a result.
In this webinar, brokers will learn how decision support analytics can reinforce their role as a trusted adviser by:
• Helping employer clients understand which health plans and programs are being used and which ones are the most cost-effective
• Minimizing the number of employees who are over-insured or under-insured, helping to save on annual and long-term costs for healthcare premiums, leading to better client retention over time
• Supporting healthy employee behaviors, resulting in lower health care expenses overall
FSAs can do some heavy lifting for your benefits plan – they allow employees to save pretax dollars for healthcare costs without the price tag of other financial wellness initiatives.
However, many HR professionals lack a deep understanding of the compliance requirements to offer and administer a well-rounded program for their employees. Engage your employees with a financial wellness benefit that works.
Key webinar takeaways:
- How different types of FSAs interact with benefit plans as a whole
- FSA and reimbursement limits for 2018
- Legal implications of offering an FSA to employees
- Best practices for administering a successful FSA benefit plan
Webinar | COBRA Pitfalls: Common Mistakes and How to Avoid Thembenefitexpress
Leaving the organization isn't the end of the benefits cycle for employees. This webinar focuses on how to avoid one of the most common compliance pitfalls in benefits ... COBRA administration.
Some of the top takeaways were:
• The basics of successful COBRA administration
• Required notices associated with COBRA coverage
• How Medicare interacts with COBRA for employees and dependents
• Penalties for noncompliance
Smooth and successful off-boarding of departing employees is as important as well-planned on-boarding of new hires. Log on to your roadmap for a smooth ride into COBRA compliance.
Webinar | Clients Calling “Mayday”? Design a Benefits Technology Strategy to ...benefitexpress
Benefits administration can be a delicate, and even difficult balancing act for employers. From managing costs and administrative demands, to maintaining compliance, and integrating with workforce wellness plans, it’s not surprising that three in four employers called “mayday” and turned to benefits administration outsourcing in 2017. With the administrative difficulty level rising, and advisory competition increasing, it is now critical to become the partner of choice to relieve this distress. But how?
Join Scott Evans, chief product officer at benefitexpress, this May Day, as he guides benefits advisers through the top considerations for building, buying or borrowing benefits administration technology solutions to offer clients. If you and your clients have benefits technology questions, Scott has answers.
Webinar takeaways include:
• How to assess your readiness: learn and identify the benefits administration business model that is right for you
• Key criteria for evaluating potential benefits technology partners, plus a valuable checklist
• How to create a benefits technology strategy for your business which is seen as an imperative – not a “value-add” – by your clients
• Tips for staying competitive in a changing market, using your solutions portfolio
Webinar | Training the Technique: Advanced ERISA Compliancebenefitexpress
If your organization offers any form of retirement plan, chances are you have questions about ERISA. This advanced compliance training will go beyond the basics of the requirements of the Employee Retirement Income Security Act of 1974.
Attend our one-hour training to learn:
- Which employers are affected by ERISA regulations
- Which benefits plans are subject to ERISA
- What documentation employers must provide to prove
compliance
- Penalties for noncompliance
ERISA attorney Larry Grudzien will share industry inside knowledge to help participants ensure total compliance with ERISA regulations.
Webinar | Training the Technique: Advanced ERISA Compliance
Regulation GPS: Re-routing Health & Welfare Plans
1. • Awesome Content
Supporting material
Supporting material
• Awesome Content
Copyright 2016 – Not to be reproduced without express permission of Benefit Express Services, LLC 1
Sample Topic
Sample image
3. • Current state of ACA
• Repeal of ACA and Trumpcare
• What could happen in the future?
Copyright 2016 – Not to be reproduced without express permission of Benefit Express Services, LLC 3
Agenda
5. Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 5
The Healthcare Coverage Landscape as of 2009
6. Goals:
• Increase the number of Americans with health insurance
Health care costs are #1 reason for bankruptcy
• 1 ER visit averages $1,265
• 1 broken foot averages $16,000
• Cancer treatment averages $30,000 per year
Some can’t afford health insurance & some jobs don’t provide health insurance
Some choose not to buy insurance
Some want to buy insurance but companies won’t sell it to them
• Lower the cost of healthcare on a per person basis with cost controls
• ACA Links:
http://www2.iona.edu/faculty/rjantzen/eco380/obamacarelinks.html
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 6
Patient Protection & Affordable Care Act
7. Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 7
The Three-Legged Stool
8. • Guaranteed Issue: Carriers must sell to everyone regardless of
medical condition, age, pre-existing conditions, etc (and in fact
can no longer even ask about medical history at all)
• Community Rating: Carriers cannot charge people different
rates for the same policy based on any factors other than age
(within a 3:1 ratio), location (rating area) and whether they
smoke (50% surcharge)
• Qualified Health Plans (QHP): All plans sold have to meet ACA
standards, including at least 60% AV, all 10 Essential Health
Benefits, etc. (i.e., they have to be real healthcare policies)
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 8
The Three-Legged Stool: Leg 1
9. QHP Actuarial Value: All QHPs have to cover at least 60% of healthcare
costs. Available in 4 “Metal Levels”:
• BRONZE: 60% AV (low premiums, high deductible)
• SILVER: 70% AV (mid-range premiums, mid-range deductible)*
• GOLD: 80% AV (higher premiums, low deductible)
• PLATINUM: 90% AV (highest premiums, no deductible)
• Catastrophic: 50% AV, very low premiums, insanely high deductibles, only
available if you’re under 30 or other rare exceptions
*(Silver plans are the only ones eligible for Cost Sharing Reduction assistance)
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 9
The Three-Legged Stool: Leg 1
10. • Individual Mandate: Everyone (with exceptions) has to have an ACA-
compliant healthcare policy for at least 9 months of the year or they
have to pay a tax penalty of:
$695.00/adult ($347.50/child) or
2.5% of household income (whichever is greater)
maximum of $2,085/family or the avg. annual premium for a Bronze plan
• Penalty is by month (6 mo. uncovered = ½ penalty, etc.)
• Exceptions made for various reasons (expatriate, hardship, domestic
violence victim, natural disaster, etc.)
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 10
The Three-Legged Stool: Leg 2
11. • Tax Credits (aka Subsidies): Two types, both based on income relative
to the Federal Poverty Level (FPL):
• Advance Premium Tax Credits (APTC): Income between 100-400%
FPL ($12K - $48K individual; $24.6K - $98.4K for a family of 4)
Subsidies increase as benchmark premiums/deductible increase (premium
goes up 20%? Subsidy goes up ~20%)
Subsidies vary by rating area:
• Avg. premium in Louisville KY $229/month
• Avg. premium in Anchorage Alaska: $994/month
• Cost Sharing Reduction (CSR): Income between 100-250% FPL
($12K - $30K individual, $24.6K - $61.5K family of 4)
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 11
The Three-Legged Stool: Leg 3
12. • Expands Medicaid eligibility to everyone up to 138% FPL ($16.6K/ yr for
individual) regardless of pre-ACA eligibility
• 31 states + DC expanded; 19 states (all GOP held) still refusing
• 2.6 million people caught in Medicaid Gap: Don’t qualify for Medicaid, but earn
too little to qualify for ACA tax credits
• October 2013: 57.4 million enrolled in Medicaid
• October 2016: 74.4 million enrolled in Medicaid
• Net increase of 17.0 million
• 13.0 million of that due to ACA expansion (+special from NY)
• 3-4 million via “Woodworkers”…people who were already eligible for Medicaid
pre-ACA but either didn’t know it or were reluctant to until the ACA went into
effect.
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 12
Medicaid Expansion
13. • No Annual or Lifetime limits on coverage for anyone
(individual market and group market)
• All plans (group & individual) must meet minimum
coverage requirements
• Young adults can stay on parents’ plans until 26 (group &
individual)
• Closes Medicare Part D donut hole
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 13
Other ACA Provisions
14. Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 14
The Healthcare Coverage Landscape as of 2017
15. Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 15
Eligibility for ACA Coverage Among Non-
elderly Uninsured as of 2016
16. • Lowers overall healthcare costs by providing insurance for millions and
making preventive care which will reduce expensive ER visits.
• It increases access to health care by expanding Medicaid.
• Increases access to health care by disallowing exclusions for pre-existing
conditions, keeping <26 year old kids insured, eliminating limits on coverage,
mandating minimum benefit set, providing exchanges with tax credits and
subsidies for small.
• It doesn’t change the budget deficit even though the number of government
subsidized enrollees is increasing because cost controls, shifting the burden to
employers, insurers and other and higher taxes defray the extra costs.
• It ties Medicare MD fees to quality measures in the future.
• Mandates implementation of computerized patient records for health care
providers (w/ some subsidies).
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 16
Pros of Affordable Care Act
17. • Won’t decrease health care costs
• If employers opt to pay fine, govt. subsidies to cover employees will soar
• Increased taxes on high incomes leads to fewer jobs, production, savings
• Huge expansion of government into private sector yielding less choice &
freedom
• Individual mandate is loss of freedom
• Mandatory community rating will increase uninsured by choice
• Cuts to Medicare MCOs will decrease choice for seniors & decrease
efficiency
• Even today more than half of Americans want it repealed.
Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 17
Conservative Objections
18. • Medicaid:
Medicaid Gap (2.6M): 19 states haven’t expanded (blame GOP)
Dr./Hospital reimbursement too low (~40% of private rates)
Feds cover 90-95% of expansion Medicaid funding but only 50-75% of traditional
Medicaid; states constantly raiding their share or messing w/ program
requirements/coverage
• Group coverage:
Employer mandate ironically encourages “Job Lock” while also adding a bunch of
paperwork for tracking employees (but also provides partial funding for exchange
subsidies/Medicaid expansion)
Ineligible due to ESI offer (4.5M): Employer plans glitch allows Catastrophic (Lead)
plans “left on the table” to disqualify employees for individual exchange tax credits
• Risk Corridor Funding
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Legitimate Problems w/the ACA
19. • Undocumented immigrants (5.4M):
ACA doesn’t allow undocumented immigrants onto Medicaid or ACA exchanges even
at full price (unsubsidized). CA nearly passed state law to allow it but rescinded after
Trump took office.
• Medicaid/CHIP eligible (6.4M):
Outreach, outreach, outreach…and obstruction by GOP officials at state level
(remember, most of these are eligible for trad. Medicaid)
• Tax credit eligible/income ineligible (8.3M):
APTC too skimpy (400% FPL cut-off, not generous enough 300-400%)
CSR too skimpy (250% FPL cut-off, not generous enough 200-250%)
ESI ineligibility allows skinny plans to be considered “compliant”
Family Glitch: If 1 member on employee-only ESI, others don’t qualify for exchange
subsidies (~3M people)
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Legitimate Problems w/the ACA
21. Copyright 2017 – Not to be reproduced without express permission of Benefit Express Services, LLC 21
CBO estimated that repealing the ACA would increase the
federal deficit by ~$145 billion between 2017 and 2025
-60
-40
-20
0
20
40
60
80
100
120
2017 2018 2019 2020 2021 2022 2023 2024 2025
Impact of ACA Repeal on Federal Deficit, in Billions
22. Reasons for unfavorable
opinion include:
• Concerns about cost of
coverage
• Perception that law gives
government too big a role
Source: Kaiser Health Tracking Poll,
October 27, 2016
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Despite the insurance gains and deficit impact,
public is divided on view of the law
45% 45%
10%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Favorable Unfavorable Don't Know
Given what you know about the
health law, do you have a generally
favorable or generally unfavorable
view of it?
23. As Congress looks to reform or replace the ACA
policymakers may wish to avoid adverse consequences,
such as:
• Coverage loss among the 20 million people who have gained
insurance
• Return to an era of pre-existing conditions exclusions and denial of
coverage
• Deficit increases stemming from repeal of ACA’s revenue-generating
provisions
• Continued premium increases in the individual market
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Consequences
24. • Defunds Planned Parenthood ($530 million/year…40% of
their total budget)
• Defunds Medicaid Expansion (starting in 2020, via
attrition…no new enrollees, current ones can’t come back
once they leave.
• Defunds Cost Sharing Reductions (CSR) completely
starting in 2020.
• Changes non-ACA Medicaid to Block Grants (kicks more off
later)
• Changes Tax Credits (APTC) from income-based to age-
based ($2,000 for younger --> $4,000 for older enrollees)
• Tax credits no longer increase to match premium hikes, nor
do they vary by geography/rating area
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What’s in Trumpcare?
25. • Changes age band from 3:1 to 5:1 (older enrollees can be charge 5x
as much as younger)
• Eliminates the minimum 60% AV (Bronze) requirement – junk plans
• $100 billion over 9 years to states for High Risk Pools, Reinsurance
programs, etc (part of this is effectively replacing money they stole
from the Risk Corridor program)
• Changes Mandate penalty to a 30%, 1-yr premium surcharge for not
maintaining continuous coverage…w/penalty going to carrier, not IRS
• Wipes out over half the revenue to fund ACA…including 3.8%
investment tax on rich people & 0.9% Medicare payroll tax. Replaces
with…not much.
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What’s in Trumpcare?
26. • This would give top 1% avg. $33,000 tax cut; top 0.1%
avg. $197,000 tax cut; and top 400 richest Americans an
average tax cut of $7 million.
• Repeal ACA Mandates standards for health plans and
premiums and subsidies until 2020
• Retains private market rules
• Retain health insurance marketplaces
• Encourages use of Health Savings Accounts
• Individual Mandate eliminated effective January 1,2016
• Employer mandate penalty reduced to zero effective
January 1, 2016
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What’s in Trumpcare?
27. • 14 million lose coverage in 2018
• Another 10 million lose coverage by 2026 (24 million total)
• Just about all losing coverage would be low-income (Medicaid/elderly/etc.)
• By 2026, total uninsured would be ~52 million (up from current 28 million)
• Age-based tax credits would actually be somewhat better for some in the
middle class (300-600% FPL), but devastating to low-income/elderly.
• Premiums would increase by an additional 15-20% per year thru 2020; would
then gradually decrease to ~10% lower than current projections by
2026…mainly due to forcing 50-64 year-olds off coverage completely.
• Deductibles would increase even more in 2 ways: a) Lower AV requirements;
b) CSR assistance cut off for lower-income enrollees
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CBO Score?
29. • Fix the “Family Glitch”: Other family members should qualify for APTC/ CSR even
if someone in the family is covered by ESI.
• Fix the “Skinny Plan Glitch”: Require ESI policies to be at least Bronze strength
(preferably Silver) before employees are ineligible for APTC/CSR
• Restore Risk Corridor funding (& extend it indefinitely). The money is legally owed
to the carriers anyway, and the program works just fin for Medicare Part D).
• Guarantee CSR Payments. House GOP brought a lawsuit charging CSR
payments are unconstitutional even though they’re legally mandated. Case
pending; sword of Damocles causing monthly uncertainty.
• Require all Individual Market plans be offered on the exchanges (better yet,
exclusively on-exchange, as DC has done for 4 years). Less confusion, no
income-based cherry-picking, easier tracking of enrollment trends.
• Beef up Individual Mandate Penalty (Unlikely)
• Beef up the tax credits (both APTC & CSR)
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Fix the ACA’s Problems?
30. • Individual tax relief for everyone, regardless of where they work, to
purchase their own insurance
• Replace tax deduction for employer contribution with tax credit for
individual purchase
• No barriers to interstate insurance sales
• Allow employers to convert from defined benefit to defined contribution
plans
• Move Medicare to defined contribution plan & allow Medicare plans to opt
out
• Promote new group purchasing based on organization memberships &
associations
• More consumer-directed options like health savings accounts & flex plans
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Conservative Reforms
31. • Extend rational pre-existing condition provisions in individual plans
rewarding responsible behavior
• Equal payment for traditional Medicare & MCO Medicare
• Encourage states to set up high-risk pools and consumer based
reforms
• Provide Medicaid insurees with opt out to private insurance
• Increase fraud & abuse efforts in Medicaid
• Encourage private savings and private long term care insurance to
solve long term care needs
• Stop new tax increases and promote tax cuts to expand private
insurance coverage
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Conservative Reforms
32. • States could apply for federal waivers from several
coverage requirements that President Barack Obama's
2010 health care law imposes on insurers.
• Waivers from an Affordable Care Act provision that obliges
insurers to cover "essential health benefits," including
mental health, maternity and substance abuse services
• The current version of the GOP legislation would erase
that coverage requirement but would let states re-impose it
on their own.
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New Republican Proposals
33. Let states seek an exemption to the law's requirement that
insurers must offer coverage to people with serious
diseases
Patients with high-cost conditions like metastatic cancer and
AIDS would not be segregated in a separate insurance pool,
but their insurers could receive extra payments, as the
government would cover a share of claims exceeding a level
specified by federal health officials.
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New Republican Proposals
34. Stop cost-sharing subsidies
• In addition to subsidized insurance premiums, the ACA provides financial
assistance for deductibles and copayments to consumers with modest
incomes.
• House Republicans have challenged the constitutionality of aid payments,
estimated at $7 billion this year.
Tweak insurance benefits
• The ACA requires insurers to cover ten categories of "essential health
benefits," from prevention to prescriptions, maternity to mental health.
• While broad categories are written into law, key specifics are spelled out in
regulations and guidance.
• The administration could propose changes.
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Other Administrative Actions
35. Remake Medicaid
• Alongside subsidized private insurance for people who
don't have job-based coverage, the ACA expanded
Medicaid to serve millions more low-income adults.
• With the repeal effort stalled, some of the 19 states that
have refused the expansion may come forward.
• That gives the Trump administration an opportunity to
steer an important program in a different direction.
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Other Administrative Actions
36. Wink on insurance penalty
• Tax penalties on people who remain uninsured are the
most unpopular part of the Obama-era law.
• The Trump administration has already eased enforcement.
• The IRS scrapped a plan to hold up tax returns of people
who fail to indicate if they have coverage.
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Other Administrative Actions
37. • Employer Mandate – 2017, 2018, or 2019
• Individual Mandate – 2016, or 2017
• Reporting (1094 1095) – 2018?
• Nondiscrimination rules – gone
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Possible Changes: Health Care Reform
38. • Cadillac Tax – gone
• Essential Health Benefits –small plan market?
• Preexisting Conditions – return?
• Expansion of Medicaid – gone
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Possible Changes: Health Care Reform
39. • Dependent Age 26 – stay
• Marketplace – stay
• Full-time Employee definition – gone
• Health FSA Limitation – gone
• Free standing HRAs – come back
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Possible Changes: Health Care Reform
40. Other Welfare Benefits
• Eliminate the expansion of Form 5500 reporting
• Wellness rules – changed
• Contraceptive Coverage – gone
• Gender transition services – gone
Individual Income Tax
• Allow the deduction of individual premium
• Limit or eliminate deductions
• Eliminate credits to broaden tax base
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Possible Changes
41. • Repeal or replace DOL final overtime rules
• Slow Increases minimum wage
• Delay any pay equity and equal employment opportunity
issues
• Leave Paid Leave to state and local
• Lessen enforcement of Independent contractors and the
gig economy
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Possible Changes: Worker Protections
42. Employer-sponsored healthcare
• Mandates may stay in place for 2017 or 2018
• Reporting in place for 2016, but for 2017 or 2018?
• HSAs and HRAs may be favored
Retirement income
• Reporting and fiduciary rule may change
• Limits may change
• Roth may not be favored
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Employer Next Steps
44. Larry Grudzien
Attorney at Law
(708) 717-9638
larry@larrygrudzien.com
www.larrygrudzien.com
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Contact Information
44