Published on March 5, 2014
Healthcare Reform & Small Business John J. Sarno, Esq. Employers Association of New Jersey www.eanj.org 1
Points to Cover: • • • • • Personal Mandate Insurance Reforms Health Insurance Marketplace Market Dynamics Small Employer Options 2
Patient Protection & Affordable Care Act March 23, 2014 A New Era for America 3
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. 4
Insurance Reform 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) 5
“Free” Preventive Care No Co-Pays No Out-Of-Pockets No Deductibles 6
The Marketplace, Prices and Subsidies – N.J. 34,751 enrollment – Dec., 2013 29 plans within 4 categories Platinum Gold Silver – benchmark plan (70% of healthcare costs) Bronze October – December, 2013 4 of 5 enrollments eligible for subsidy 54% - women 46% - men 7
About 500,000 New Jerseyans are eligible to purchase a healthcare plan on the Health Insurance Marketplace Most work full-or part-time for a small employer About 80% will be eligible for a subsidy 525,000 undocumented workers in N.J. not eligible 8
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 employer • About half of small employers offer healthcare 9
Burden of Benefit • No requirement for employers to offer healthcare • No penalty for small employers • Healthcare plans must conform to ACA 10
New Jersey Health Reform (1992) Individual and Small Group Pools Guaranteed – Issue No-Preexisting Condition Exclusion Modified Community Rating Medical Loss Ratio (80%) Standardized Plans/Coverages 75% Coverage (25 or more hours) 11
Employer-Plan Crisis Premiums have grown 4-times faster than wages since 1999. Average employee contribution has gone up 200% since 2000. Out-of-pocket and co-payments have gone up 115% since 2000. 12
Health Care Inflation Employer-Sponsored Plans (per employee) 2010 $7,300 2000 $15,000 (family) $3,500 $6,200 (family) 13
A Looming Challenge Health Care Inflation 1. Premiums have grown 4-times faster than wages since 1999. In NJ, 5 times faster. 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. 14
NJ Marketplace Carriers Horizon Blue Cross AmeriHealth Health Republic of NJ 15
Questions? Thank You 17
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