This document provides an overview of TD&P Consulting, Inc. and its founder and CEO Thomas Dawson. It outlines Dawson's experience in healthcare policy, including serving on Capitol Hill and at the Department of Labor. The remainder of the document summarizes key aspects of the Affordable Care Act, including the individual mandate, guaranteed issue requirement, Medicaid expansion, and affordable coverage provisions. It also discusses updates and challenges to the ACA.
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Thomas (Tom) Dawson, Esq., MPH, MA
Founding Partner and CEO
TD&P Consulting, Inc.
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• Thomas (Tom) J. Dawson III, is the founder and
CEO of TD&P Consulting, Inc., a health policy
firm focused on health reform and its impact on
private and public health insurance markets.
• With over 23 years in healthcare policy, Dawson
has served on Capitol Hill, at the Department of
Labor, with non-profits and in the private sector.
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Thomas (Tom) Dawson, Esq., MPH, MA
Founding Partner and CEO
TD&P Consulting, Inc.
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• Dawson acted as the senior health care counsel to the U.S.
House of Representatives Committee on Small Business.
• During his time on the Hill, Dawson also provided
healthcare policy guidance as an advisor to the
Congressional Hispanic Caucus (CHC) Health Care Task
Force and drafted legislation relevant to the health science
industry and small businesses.
• From 2001 to 2007, Dawson served as a Pension Law
Specialist with the U.S. Department of Labor’s Employee
Benefits Security Administration (EBSA).
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ACA Background
• Prior to ACA: a percentage of Americans were
uninsured.
• Purpose: intended to provide increased number of
Americans insurance and decrease cost of healthcare.
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ACA – Important Features
• Individual Mandate
• Guaranteed Issue Requirement
• Medicaid Expansion
• Affordable Coverage
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Individual Mandate
The individual mandate requires that all individuals who are
lawfully present in the United States Obtain some form of
minimum essential coverage, or pay a penalty.
There are only three exemptions to this requirement: (1) the
religious exemption; (ii) individuals not lawfully present in
the United States; and (iii) incarcerated individuals.
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Guaranteed Issue Requirement
The guaranteed issue requirement prohibits denial of coverage
due to preexisting health conditions.
This requirement guarantees access to minimum essential
coverage for all lawfully present individuals.
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Affordable Coverage
• Health coverage must be affordable, which is defined as a
percentage of an employee’s income
• Minimum Essential Coverage (“MEC”)
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Examples of Minimum Essential Coverage
• Qualified Health Plans (QHPs) purchased in and outside the Exchange
• Medicaid / Traditional Medicare / Medicare Advantage (MA)
• Health plans for children (CHIP)
• VA benefits
• Union plans
• Plans offered by employers for their employees
• Plans offered to federal government employees
• Plans for retired persons
• Most health plans for active members of the United States military
(TRICARE)
• Student health plans
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Case Challenge
• National Federation of Independent Business v. Sebelius
• Challenge to ACA individual mandate and Medicaid expansion
• Question: Does Congress have authority under the
consideration to enact legislation with the two provisions.
• Held: Yes, under the authority to “lay and collect Taxes.”
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ACA Update
• The Employer Play or Pay Mandate
• Employers with greater than 50 full-time employees must offer at
least 95% of full time employees insurance coverage to avoid
penalty
• Minimum Essential Coverage penalty increase
• Dependent Coverage
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ACA Update
• Reporting Requirements.
• Health Plan companies required to report Minimum Essential Coverage
data to the IRS. See Section 6055 of ACA.
• Form 1095C – Statement of Employer Provided Health Insurance Offer and
Coverage sent by large employer to all full-time employees.
• Form 1094C – Sent by large employers to the IRS.
