ACA Impact on

Retiree Systems
Christina Nyquist
Vice President,
Head of Regulatory Affairs
January 28, 2014

ACA Impact on Retiree Systems

1) Aetna Innovations

2) Insurance Rules
3) Changes to Medicare

Aetna Inc.

We are building
the 21st Century Health Care System
Enable ACO-branded
insurance products.
Consultation to
ensure success

Patient health
information exchange
technology

Online tools to help

consumers managed their
health care and wellness

Apps to help
physicians connect
their own data and
information

Consumer tool to
research treatments,
find providers and
make appointments

Clinical decision support

to identify gaps in care
and best practices

Aetnas solution is payor agnostic and

enables virtual integration
Aetna Inc.

ACA Impact on Retiree Systems

1) Aetna Innovations

2) Insurance Rules
3) Changes to Medicare

Aetna Inc.

Key Affordable Care Act Issues for Employers

Issue

Impact

Medical Loss Ratio

Caps investment in HIT, transparency, wellness, ACOs, fraud prevention and other
core innovations at 15% of large group premiums.

Summary of Benefits
and Coverage

The summary of benefits requirement imposes significant administrative burdens

on employers.

Industry estimates are close to $400 million in first two years of implementation.
Constrain ability to explain Tiered Networks and other innovations.

Definition of
Full-time Employee

Employers must offer all full-time employees affordable coverage.

Reporting
Requirements

ACA creates multiple new information tracking and reporting requirements for
employers.

Exchanges

If states expand Exchanges to large group, ACA requires Exchange rating for all
large groups.

Specialty Populations

Expatriate
Mini-med

Aetna Inc.

ACA Impact on Retiree Systems

1) Aetna Innovations

2) Insurance Rules
3) Changes to Medicare

Aetna Inc.

ACA Changes to Medicare

The ACA makes significant cuts to Medicare payments while
linking new payments to quality rating measures
The cost of Medicare and other entitlement programs will
continue to rise
Projected Tax Revenue
Medicare

Medicaid & Other

Health Programs
Social Security

Source: CBO

Aetna Inc.

Number of Enrollees (Millions)

Enrollment in Employer Group Medicare Advantage

(EGWP) Continues to Rise
3.0

Number of Employer Group Medicare Advantage Enrollees,

May 2006 February 2013

2.53

2.32

2.5
2.0

1.83

1.92

Feb 2009

Feb 2010

2.08

1.56
1.5
1.0

1.3
0.96

0.5
0.0
May 2006 Nov 2007

Feb 2008

Feb 2011

Feb 2012

Feb 2013

In February 2013, 18 percent of all MA enrollees or 2.5 million

individuals were in employer group plans.

Source: MedPAC Data Book, June 2013.

Aetna Inc.