The federal and state governments must accelerate their work to implement the Affordable Care Act (ACA) in order to ensure that the law is ready for full implementation by Jan. 1, 2014.
Actions by the Department of Health & Human Services (HHS):
Accelerate work to educate small business owners about the ACA, particularly the health insurance exchanges—directly and via business organizations
Continue to support states that have decided to set up their own state exchanges
Rapidly implement federal health insurance exchanges for states that do not set up their own, or federal-state exchange partnerships where states desire this relationship; establish these exchanges following the principles set forth below for state exchanges
Continue to promote the inclusion of CO-OPs in the federal and state exchanges
Support workplace wellness programs that are accessible by small and large businesses
Complete final rulemaking as necessary to ensure full implementation by Jan. 1, 2014
Actions by states that have opted to establish state exchanges:
Accelerate work to educate small business owners about the ACA, particularly the exchanges (both SHOP and individual)—directly and via business organizations
Make sure that small business outreach includes the self-employed
Enact legislation and/or take necessary administrative action to establish and implement the exchange, with these recommended features:
An “active purchaser” model
Meaningful employer and employee choice (mindful not to allow unfettered choice to create undue adverse selection)
A robust role for brokers in the small business (SHOP) exchange
Inclusion of one or more CO-OPs
Capability to facilitate workplace wellness programs (may not be in place on day one)
Capability to provide other “HR” services—e.g. COBRA, Section 125, HSA’s, etc. (may not be in place on day one)
Robust small business and consumer advisory mechanisms
Conform state health insurance laws and regulations to the requirements of the ACA and ensure smooth operation of the exchange
[In all states] Limit the sale of “stop-loss” coverage to self-insured small plans in order to preserve the integrity of the small-group market
Other
Encourage the Department of Labor to issue guidance that states can regulate the sale of “stop-loss” coverage to self-insured small plans in order to ensure an affordable small-group market
Expand and simplify the small employer premium tax credit (e.g.,raising the average wage limit from $50,000 to $75,000). This expansion, coupled with simplifications to the accounting process involved in claiming the credit, can help more small business owners take advantage of the tax credits and combat continued growth in premium costs.