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Most state and local governments provide employer-sponsored healthcare benefits to their retirees. In recent years, the Affordable Care Act and accounting changes adopted by the Governmental Accounting Standards Board have introduced new choices and challenges for public employers. As state and local governments look to reduce their unfunded retiree healthcare obligations, some have created dedicated trusts to take advantage of the immediate accounting benefits and the long-term savings that prefunding offers, while others have chosen to shift retirees onto the newly available public exchanges. In light of the new regulatory requirements and the evolving case law on plan modification, this article reviews the changes to the form and financing of retiree health benefits. The analysis suggests that in the long term, the expanded access to health insurance through the public exchanges, the federal subsidies upheld by King v. Burwell, and the prefunding efforts spurred by the new accounting rules should leave participants and taxpayers with greater clarity about the security and the cost of post-employment benefits.