TD&P Consulting, Inc.

Practical Employee Benefits for ERISA and NON-ERISA AttorneysSeptember 20, 2016

2

Thomas (Tom) Dawson, Esq., MPH, MA

Founding Partner and CEO

TD&P Consulting, Inc.

2

• Thomas (Tom) J. Dawson III, is the founder

and CEO of TD&P Consulting, Inc., a health

policy firm focused on health reform and its

impact on private and public health insurance

markets.

• With over 23 years in healthcare policy,

Dawson has served on Capitol Hill, at the

Department of Labor, with non-profits and in

the private sector.

3

Thomas (Tom) Dawson, Esq., MPH, MA

Founding Partner and CEO

TD&P Consulting, Inc.

3

• Dawson acted as the senior health care counsel to

the U.S. House of Representatives Committee on

Small Business.

• During his time on the Hill, Dawson also provided

healthcare policy guidance as an advisor to the

Congressional Hispanic Caucus (CHC) Health Care

Task Force and drafted legislation relevant to the

health science industry and small businesses.

• From 2001 to 2007, Dawson served as a Pension

Law Specialist with the U.S. Department of Labor’s

Employee Benefits Security Administration (EBSA).

Affordable Care Act Update

5

ACA Background

• Prior to ACA: a percentage of Americans were

uninsured.

• Purpose: intended to provide increased number

of Americans insurance and decrease cost of

healthcare.

6

ACA – Important Features

• Individual Mandate

• Guaranteed Issue Requirement

• Medicaid Expansion

• Affordable Coverage

7

Individual Mandate

The individual mandate requires that all individuals who are lawfully present in the United States obtain some form of minimum essential coverage, or pay a penalty.

There are only three exemptions to this requirement: (i) the religious exemption; (ii) individuals not lawfully present in the United States; and (iii) incarcerated individuals.

8

Guaranteed Issue Requirement

The guaranteed issue requirement prohibits denial of

coverage due to preexisting health conditions.

This requirement guarantees access to minimum essential

coverage for all lawfully present individuals.

9

Medicaid Expansion

Now covers more people because of increase in economic

threshold level.

10

Affordable Coverage

• Health coverage must be affordable, which is defined as

a percentage of an employee’s income.

• Minimum Essential Coverage (“MEC”).

11

Examples of Minimum Essential Coverage

• Qualified Health Plans (QHPs) purchased in and outside the Exchange

• Medicaid / Traditional Medicare / Medicare Advantage (MA)

• Health plans for children (CHIP)

• VA benefits

• Union plans

• Plans offered by employers for their employees

• Plans offered to federal government employees

• Plans for retired persons

• Most health plans for active members of the United States military (TRICARE)

• Student health plans

12

Case Challenge

• National Federation of Independent Business v.

Sebelius.

• Challenge to ACA individual mandate and Medicaid

expansion.

• Question: Does Congress have authority under the

consideration to enact legislation with the two provisions.

• Held: Yes, under the authority to “lay and collect Taxes.”

13

ACA Update

• The Employer Play or Pay Mandate.

• Employers with greater than 50 full-time employees must offer at least 95% of full time employees insurance coverage to avoid penalty.

• Minimum Essential Coverage penalty increase.

• Dependent Coverage.

14

ACA Update

• Reporting Requirements.

• Health Plan companies required to report Minimum Essential Coverage data to the IRS. See Section 6055 of ACA.

• Form 1095C – Statement of Employer Provided Health Insurance Offer and Coverage sent by large employer to all full-time employees.

• Form 1094C – Sent by large employers to the IRS.

15

ACA Update

• Cadillac Tax

• Imposed on Coverage Providers

• 40% tax

• 2016 Consolidated Appropriations Act delays implementation until

2020

16

ACA Update

• Menu Labeling Requirements

• Chain Restaurants

• Calorie Information on Menu

• Written Information Available Upon Request

17

ACA Update

• Automatic Health Care Enrollment Repeal

• Employers with 200 or more employees

THANK YOU

Contact UsTelephone: 240-670-7982

Visit Our Office:

1400 Spring Street, Suite 500

Silver Spring, MD 20910