State Decisions on Allowing Mid-Sized Employers to Delay a Move to the Small-Group Insurance Market

By Ashley Williams and Sabrina Corlette

A provision in the Affordable Care Act that could have a strong impact on small and mid-sized employers is starting to draw some public attention. Historically, states have defined their small-group markets as groups of two to 50 employees. However, beginning January 1, 2016, the Affordable Care Act expands the definition of “small employer” to mean a business that employs between two and 100 employees.

Experts fear this change could result in premium increases for some mid-sized employers with between 51 and 100 employees, which are currently included in the large-group market, because they will become newly subject to several small-group market reforms. These include new rating rules such as charging people more for preexisting conditions and the requirement to cover a minimum set of essential health benefits. As a result, some policymakers and others have called for the delay or repeal of this provision.

While it is unlikely that the Obama Administration will unilaterally delay this requirement, it does have a transitional policy for mid-sized employers. Under this policy, states can decide whether to permit mid-sized groups to remain part of the large-group market for up to two more years, and thus be exempt from the small-group market reforms. Not surprisingly, states are dealing with this challenge in different ways.

In a new blog post for the Commonwealth Fund, CHIR researchers Ashley Williams and Sabrina Corlette share the results of a 50-state survey of state decisions regarding this market transition. Read more here.

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