The Road to Affordable Care:
Opportunities, Challenges and Successes
in a post-ACA Market
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Disclaimer
The comments here represent my opinion alone, and
are not intended to be representative of the
Washington State Health Exchange Board.
I am speaking today as a consumer and working
families advocate, and not as a Board member.
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Dual Role for Consumer Advocates
Cover the Uninsured Protect Existing Coverage
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Medicaid Enrollment
Exchange Enrollment
Improve Quality
Ensure Affordability &
Access
• Consumer’s Voice
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Watch Employer Behavior
Impact on Market
Identify Threats
Monitor Costs
Evaluate Access
Hours and Pay Cuts
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Employer Penalties in the ACA
Type of Employer Penalty
$$$ Penalty
Employer fails to offer ANY Coverage and $2,000 on all FTEs
at least 1 FTE enrolls and is eligible for
(minus 30 FTEs)
premium tax credit or cost sharing subsidy
Employer offers UNAFFORDABLE
Coverage and 1 or more FTEs enrolls and
gets premium tax credit or cost sharing
subsidy
$3,000 per
employee
receiving coverage
FTE = 30+ hours or more per week
“Unaffordable” = coverage costs more than 9.5% of individual’s income
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Unanticipated Possible Market Changes
Possible scenario: Employers drop group plan,
pay penalty only instead
Timeline
Income
Annual
(4 at 250% FPL) Plan
Premium
Employer
Annual
Cost
Individual Estimated
Cost
Govt
Cost
Pre ACA
$57,625
$14,196
$11,357
$2,839
$0
Post ACA
$57,625
$14,196
$2,000
$4,644
$7,552
Difference
- $9,357 + 1,805 + $7,552
Source: Calculation example borrowed from Gene Mechanic Law, 503.384.2070
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Unanticipated Market Changes Nationally
Example: Employer penalty only applies to employees who work more than
30hrs/week and qualify for the exchange. Penalty does not apply to employers
whose workers qualify for Medicaid.
Source: See handout from the Healthy WA Coalition.
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Changing Market Behavior
Experienced Market Behavior in WA, 2012
(excerpt, top 18)
Source: HCA Report to the Legislature, Employment status of HCA medical assistance clients &
persons with dependents, Nov 2013.
Shared Responsibility was the ACA’s intent
The Affordable Care Act (ACA) was designed to ensure that
employers, individuals, and the government share the
responsibility for health care coverage and cost:
 The ACA requires large employers to pay a penalty to offset
the costs of public subsidies for their workers' healthcare if
their full time employees receive health coverage through Exchanges.
 Big corporations who shift costs to taxpayers by exploiting a
loophole in the ACA, by cutting hours, pay or benefits, move
more low-wage workers to Medicaid, should also have a penalty.
 The assessment could cover the state’s portion of Medicaid,
enhance provider reimbursement rates and invest in Washington’s
safety net programs.
 State-level policy can close this loophole in the ACA.
Other Market Policies that Impact Health
Other employer policies that impact health and health
outcomes for working families:
 Lower income workers more likely to face shift changes,
mandatory overtime, and non-standard hours.
 Despite increased workload for families, no major federal
initiatives have passed to help family/work dynamics.
 Other nations with comparable resources have passed
“work-family reconciliation” acts; The US ranks dead last.
 Of 200 nations studied by UCLA,
180 nations offer guaranteed paid leave to new parents,
175 of them mandate paid annual leave,
162 limit the maximum length of the workweek;
The US offers none of these protections.
Source: New York Times, Stephanie Coontz, Why Gender Equality Stalled, Feb 3, 2013.
Teresa Mosqueda, MPA
Government Affairs Director
WA State Labor Council, AFL-CIO
[email protected]
206-353-5276
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Source: Mirror, Mirror on the Wall, How the Performance of the US Healthcare System Compares Internationally, Commonwealth Fund, June 2014