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political influence in Washington, DC so that self-insurance issues receive their due attention. Absent a complete repeal, the self-insurance marketplace will continue to be under attack by proponents of health care reform who argue that the move by smaller employers to self-insure will create adverse selection in the health care marketplace and threaten the viability of state health care exchange. Finally, the biggest unanswered question is what employers will choose to do in 2014 when the "play or pay" rule becomes effective. As you have likely seen, there have been conflicting conclusions from various consulting organizations, think tanks and other "experts" as to whether employers will drop coverage in favor of paying a penalty, which is presumably cheaper. SIIA's view is that it is premature to draw any definitive conclusions but that developments will need to be closely monitored. Outcome #2 - The Entire Law is Deemed Unconstitutional Obviously if the court deems the entire law unconstitutional the regulatory issues as well as the "play or pay question" referenced above are taken off the table, which could be viewed as a win for the self-insurance industry. That said, it's important to consider the longer view in order to fully evaluate such a significant development. This is because judicial intervention will not signify the end of health care reform, but rather yet another beginning as legislative proposals will start to be floated almost immediately in Congress. The ultimate direction of this legislative process will be shaped by the November elections. Should the Republicans take back the White House and strengthen their position in Congress watch for legislation that will encourage individuals to purchase their own health care insurance instead of getting it through their employers. This will likely be incorporated as part of a larger tax reform discussion and represents a direct threat to the self-insurance marketplace. By contrast, it's probable that election results favoring the Democratic party will prompt the return of "Medicare for All" legislation, which was championed by many on the political left as recently as 2009. Such legislation would threaten the self-insurance marketplace from the other direction. In the more immediate term, self-insured employers and their business partners will need figure out how to unwind their plans from various changes made over the past two years to comply with specific ACA requirements. There are certain to be complications associated with such efforts. Members can count on SIIA to provide critical education in this area should it be necessary. Outcome #3 - One or More Specific Parts of the Law are Deemed Unconstitutional This outcome arguably creates the most uncertainty going forward as a "split decision" ruling will not stop the regulatory process and additional health care reform legislation will be back in play in Congress. And while legislation may initially be targeted to address specific sections of the ACA struck down by the Court (such as the individual mandate), they are certain to be loaded up with extraneous provisions at the request of myriad interest groups. The self-insurance industry should watch for provisions that would prohibit the ability of employers to self-insure based on size. Again, November election results will
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dictate the size, scope and direction of this legislation. Conclusion Over the past three years the discussion and debate about health reform legislation and its subsequent implementation has been extensive. In many cases the "conventional wisdom" has been wrong. Based on this past experience, whatever the Court decides will set in motion a series of future events that cannot be precisely predicted by SIIA or any other organization. SIIA understands this and will continue to take the long view of how such developments may affect self-insured employers and their business partners. This focus will be reflected in the association's government relations activities, informational resources and educational programs on an ongoing basis in effort to ensure that SIIA members are among the best educated and best represented health care reform stakeholders in the country.
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Contact Information: Self-Insurance Institute of America, Inc. Erica Massey 800-851-7789 Contact via Email www.siia.org David Kirby: 410-539-6888
Online Version of Press Release: You can read the online version of this press release at: http://www.pr.com/press-release/419664
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