Healthcare Issues Facing
Public Employers
WHAT SHOULD YOU BE FAMILIAR WITH?
o Affordable Care Act – On the Radar Screen
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Employer Shared Responsibility
Employer Reporting Requirements
o Cost of the Affordable Care Act
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Fees and Taxes
Predictive Modeling
o 411 Medical Liability
o Future Trends in Healthcare
EMPLOYER SHARED RESPONSIBILITY
o Applies to groups with 50 or more Full Time Equivalent
Employees (FTE)

Employers with 50 to 99 FTEs - Must make an offer to all
qualifying employees starting with the plan year beginning on
or after 1/1/2016
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Employers with 100 or more FTEs - Must make an offer to all
qualifying employees starting with the plan year beginning on
or after 1/1/2015
EMPLOYER SHARED RESPONSIBILITY

Starting in 2015 coverage must be offered to 70% of all full-time
employees, as well as all part-time, seasonal or variable hour
employees averaging 30 or more hours per week (95% in 2016)

Coverage offered must be affordable and provide minimum value
to avoid penalties

Part-time, seasonal and variable hour employees hours must be
tracked to determine if they qualify as full-time status
EMPLOYER SHARED RESPONSIBILITY
Tracking Ongoing (Existing) Employees
Measurement
Period 1
10 Months
Administration
Period
(Employees who were hired before the start of the first measurement period)
Measurement
Period 2
10 months
Admin.
Period
Measurement
Period 2
10 Months
Admin.
Period
Measurement
Period 4
10 Months
Admin.
Period
Stability Period 1
Stability Period 2
Stability Period 3
12 months
12 months
12 months
EMPLOYER SHARED RESPONSIBILITY
January
10 Months
Stability Period 1
12 months
Measurement Period 1
10 Months
March
Measurement Period 2
10 Months
Stability Period 1
12 months
Measurement Period 2
Measurement Period 1
10 Months
August
Admin.
Period
10 Months
Measurement Period 2
Admin.
Period
Measurement Period 1
Admin.
Period
Tracking New Employees
10 Months
Stability Period 1
12 months
EMPLOYER REPORTING REQUIREMENTS
o Effective for the 2015 calendar year, generally filed by
March 31, 2016
o Applies to large employers with 50 or more FTEs.
o Insured Plans

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Carrier will file 6055 reporting
Employer must file 6056 reporting
o Self-Funded Plans
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Employer must file both 6055 and 6056 reporting
EMPLOYER REPORTING REQUIREMENTS
o 6055 Reporting

Information about the entity providing coverage, who’s
enrolled and the months they were enrolled
o 6056 Reporting

Information about the employer offering coverage, who’s
enrolled, information about the coverage and the cost of
the coverage
COMPLIANCE ISSUES
o Determine the risk level?
o Keeping up with changes in the law
o Data versus tracking analysis
o Cost, time and staffing
o Do you have a decision model
prepared?
COST OF THE AFFORDABLE CARE ACT
o What are the costs involved?
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Health insurance tax
Temporary reinsurance tax
PCORI tax
Benefit cost of compliance
2018 Excise Tax
o What provisions will affect you?
o Are you in compliance with the law?
COST OF THE AFFORDABLE CARE ACT
o 2018 Excise Tax (All Employers)

40% tax on “excess benefits” that exceed $10,200 a year for
individuals or $27,500 for families, multiplied by the health cost
adjustment factor and increased by the age and gender excess
premium amount.

Annual limits are increased by $1,650 and $3,450, respectively,
for employees in high-risk professions (e.g., law enforcement,
EMT/paramedics, construction, mining, longshoremen, etc.
COST OF THE AFFORDABLE CARE ACT
o 2018 Excise Tax (All Employers)

Insured Plans - The tax is imposed pro rata on the issuer.

Self-insured group health plan, a health FSA or an HRA - The
tax is paid by the entity that administers benefits under the
plan (the “plan administrator”).
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Self-Administration - The tax is paid by the employer if it acts as
plan administrator to a self-insured group health plan, a health
FSA or an HRA.
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If the employer contributes to an HSA or an Archer MSA, the
employer is responsible for payment of the excise tax, as the
insurer.
COST OF THE AFFORDABLE CARE ACT
Predictive Modeling
COST OF THE AFFORDABLE CARE ACT
2018 Excise Tax
411 MEDICAL LIABILITY
o Iowa Code Chapter 411
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Municipalities must provide and finance medical care for Police
and Fire members when injured in the performance of their
duties
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Municipalities must continue to provide medical coverage for
such injuries and diseases incurred in the performance of their
duties while receiving retirement allowances
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Higher costs due to requirement of medical and prescription
discounts not being able to be paid through medical insurance?
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Solution? (see attached brochure)
FUTURE TRENDS IN HEALTHCARE
Cost Trends – United States - All PPO Plans
Expected trend has averaged 8.1%.
Actual trend (growth) has averaged 5.2%
FUTURE TRENDS IN HEALTHCARE
o Care continues is moving from more costly settings to
retail clinics and mobile health
o Replacement Generation…new knees, hips…etc.
o The federal readmission penalties appear to have
reduced readmissions by nearly 70,000 in 2012
o 17% of employers now offer a high deductible health
plan as the only option for employees
o Higher enrollment due to the ACA will boost benefit
spending
o Employers believe health management is helping to
slow medical trend
FUTURE TRENDS IN HEALTHCARE
o How do you control Costs?
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Cost shifting, incentives for healthy lifestyles
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Spousal surcharge
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Tobacco surcharge
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Tighter utilization management
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Wellness, disease management
(implementation difficulties in public sector)
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Insured to partial self-funding or fully-selffunding
THANK YOU!!
1555 S.E. Delaware Avenue
Suite A
Ankeny, Iowa 50021
1-800-942-4718 or 515-964-5502