µ l o z } µ ^ o W u o } Ç v ( ] / µ d } t Z · W } i ] } v À X o ] Ç í ò ô D ] o o ] } v...
Transcript of µ l o z } µ ^ o W u o } Ç v ( ] / µ d } t Z · W } i ] } v À X o ] Ç í ò ô D ] o o ] } v...
Buckle Your Seatbelts: Employee Benefit Issues To WatchJames Slotnick, JDAVP, Government Relations
May 22nd, 2019
17 states, led by California, filed a motion to intervene
Argument
Supreme Court has twice found ACA to be constitutional
Individual mandate tax is still in place
ACA heading back to the Supreme Court?
3
Texas v. United States
U.S. Government
Argument
Individual mandate and underwriting prohibitions should be ended
Remainder of law should remain
Last week Government decided to agree with Texas’ argument
19 states have joined Texas in this lawsuit
Argument
2012: ACA constitutional because individual mandate is a tax
2017: Individual mandate tax reduced to zero
Therefore entire ACA is unconstitutional
ACA heading back to the Supreme Court?
4
THREE POSSIBLE OUTCOMES
1. entire law is upheld
2. entire law ruled unconstitutional
3. Individual mandate / underwriting protections unconstitutional
What happens next?• ACA continues “as is” during the
appeal• Appeal to be heard by three 5th Circuit
judges• Appeal could then be heard “en banc”
by 5th circuit• Appeal could then be heard by
Supreme Court
Drug prices: American Patients’ First⎻ Eliminate “gag clauses” – Patients Right To Know Act
⎻ Disclose drug prices in direct to consumer advertisements
⎻ PBM Rebates
⎻ Eliminate “Balance Billing”
⎻ Examine foreign “price controls” that impact US consumers
6
“Medicare For All” legislation
7
Goal of covering all Americans under a government-run health insurance program
• Would end the current employer-sponsored health insurance system
• Under the plan, consumers would not be liable for any out-of-pocket spending on copays or emergency room visits, only on prescription drugs
• The plan is estimated to cost $30+ trillion and paid for in part by:
‒ 2.2% income tax
‒ 6.2% levy on employers
Bill had 15 co-sponsors in the Senate including:
• Senator Gillibrand (NY)• Senator Harris (CA)• Senator Warren (MA)• Senator Booker (NJ)
Other issues to watch…
• Paid Family & Medical LeaveMore discussion on the federal level, action on the state level• California, DC (2020), New Jersey, New York, Rhode Island, Massachusetts
(2021), and Washington (2020)• Anticipate that Connecticut, Maine, Oregon, and Vermont could pass
legislation in 2019
Could FAMILY Act pass House in 2019• New program run by Social Security entitling every working American to 12
weeks of paid family and medical leave @ 60% of their salary
8
State PFML Laws Vary State # weeks leave Max Combined Medical &
FamilyAmount of benefit.
CA 6 weeks family52 weeks medical
52 weeks 60-70% wages depending on income (Max. $1,173/week)
MA 12 weeks family20 weeks medical
26 weeks 80% wages up to SWAWW & 50% thereafter (Max. $850/week)
NJ 6 weeks family26 weeks medical
66% wages (Max. $637/week)
NY 8 -12 weeks family (increasing annually from 2018 to 2021)26 weeks medical
26 weeks Medical: 50% wages up to max. $170/week Family: 50% - 66% (increasing annually from 2018-2021) up to a max of $652.96
RI 4 weeks family30 weeks medical
60% wages (Max. $833/week)
WA 12 weeks family12 weeks medicalExtra 2 weeks pregnancy-related
16 weeks(18 weeks if pregnancy related)
90% of wages up to SWAWW & 50% thereafter (Max.$1,000/week)
9
21
10
25
1215
24
8
21
2014 2016 2018 2020
Democratic seats Republican seats
Senate seats in play, by election year
Republicans gained 9 seats Democrats gained 2 seats ?????
What to watch for in mid-terms
Source: Cook Political Report.
Republicans gained 2 seats
2020 Senate Races
12
OH
WVVA
PA
NY
ME
NC
SC
GA
TN
KY
IN
MI
WI
MN
IL
LATX
OK
ID
NV
OR
WA
CA
AZ
NM
CO
WY
MT ND
SD
IA
UT
FL
AR
MO
MS AL
NE
KS
AK
States to watch:
• Alabama
• Colorado
• Iowa
• Maine
■ Democrat Incumbent ■ Republican Incumbent
2020 dates to remember
• February 3: Iowa caucuses
• February 11: New Hampshire primaries
• February 15: Nevada Democratic caucus
• February 22: South Carolina Democratic caucus
• March 3: “Super Tuesday”
13
Summary
• 2019 is another important year for ACA
• Employee Benefits issues continue to evolve
• 2020 elections are around the corner
14
Projections vs. reality
16
5.4 2.6 12014 8 Million vs. 9 Million
8.8 2.8 2.42015 11.6 Million vs. 14 Million
9.6 3.1 10.32016 12.7 Million vs. 23 Million
9.2 3 12.82017 12.2 Million vs. 25 Million
8.7 3 14.32018 11.7 Million vs. 26 Million
TBD vs. 26 Million2019
With Premium Tax Credits Without Premium Tax Credits CBO Projected Enrollees
6
6
6
A “two-tier” pricing model
17
$629
$115
All Consumers
With Premium Tax Credits
Without Premium Tax Credits
25% Of Exchange Enrollees
75% Of Exchange Enrollees
Source: CMS
A “two-tier” pricing model
18
$232
$629
2014 Rates 2018 Rates
Average Premium Without Premium Tax Credits
Source: Center For Medicare Services