1. Healthcare Reform & Small Business
John J. Sarno, Esq.
Employers Association of New Jersey
www.eanj.org
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2. Points to Cover:
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Personal Mandate
Insurance Reforms
Health Insurance Marketplace
Market Dynamics
Small Employer Options
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3. Patient Protection & Affordable Care Act
March 23, 2014
A New Era for America
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4. 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.
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5. Insurance Reform
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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)
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6. “Free” Preventive Care
No Co-Pays
No Out-Of-Pockets
No Deductibles
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7. 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
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8.  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
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9. 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
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10. Burden of Benefit
• No requirement for employers to offer
healthcare
• No penalty for small employers
• Healthcare plans must conform to ACA
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11. 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)
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12. 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.
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13. Health Care Inflation
Employer-Sponsored Plans
(per employee)
2010
$7,300
2000
$15,000 (family)
$3,500
$6,200 (family)
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14. 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.
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15. NJ Marketplace Carriers
Horizon Blue Cross
AmeriHealth
Health Republic of NJ
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17. Questions?
Thank You
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