{"title":"Saving Small Employer Health Insurance","authors":"Amy B. Monahan, D. Schwarcz","doi":"10.2139/SSRN.2138200","DOIUrl":null,"url":null,"abstract":"Health care reform devotes substantial attention to resuscitating the small group health insurance markets that serve employers with fewer than fifty full time employees. Unfortunately, a number of interweaving provisions embedded within the Affordable Care Act create strong incentives that, starting in 2014, will tend to undermine this market and, in the process, increase the fiscal cost of reform. First, small employers with predominantly low-income employees will tend to opt out of the small group market. Second, small employers with mixed-income employees will have strong incentives to offer coverage that is neither technically “affordable” or of “minimum value” in order to preserve the availability of premium and cost-sharing subsidies on the individual market for their low-income employees. Third, small employers with unusually low-risk employees will have strong incentives to self-insure any group plan they do offer in order to avoid cross-subsidizing higher-risk groups. Analyzing these risks collectively, this Article offers a number of recommendations for saving the small group market. For instance, it argues that the SHOP exchanges that are intended to organize the small group market in 2014 must strategically target the weaknesses of self-insurance by offering simple and risk-free coverage options that facilitate employee choice. They must also market this coverage aggressively in light of insurance brokers’ likely financial incentives to push self-insurance on small employers. Additionally, state and federal law makers should explore various possibilities for making small employers both more likely to offer group coverage and, if they do offer group coverage, to do so through SHOP exchanges rather than self-insured plans. Possibilities explored by this Article include amending the terms of the premium and small business tax credits, regulating stop-loss insurance, and imposing various restrictions or penalties that are aimed at preventing churning between the self-insured and small group markets.","PeriodicalId":51610,"journal":{"name":"Iowa Law Review","volume":"98 1","pages":"1935-1989"},"PeriodicalIF":1.0000,"publicationDate":"2012-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"2","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Iowa Law Review","FirstCategoryId":"90","ListUrlMain":"https://doi.org/10.2139/SSRN.2138200","RegionNum":3,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"LAW","Score":null,"Total":0}
引用次数: 2
Abstract
Health care reform devotes substantial attention to resuscitating the small group health insurance markets that serve employers with fewer than fifty full time employees. Unfortunately, a number of interweaving provisions embedded within the Affordable Care Act create strong incentives that, starting in 2014, will tend to undermine this market and, in the process, increase the fiscal cost of reform. First, small employers with predominantly low-income employees will tend to opt out of the small group market. Second, small employers with mixed-income employees will have strong incentives to offer coverage that is neither technically “affordable” or of “minimum value” in order to preserve the availability of premium and cost-sharing subsidies on the individual market for their low-income employees. Third, small employers with unusually low-risk employees will have strong incentives to self-insure any group plan they do offer in order to avoid cross-subsidizing higher-risk groups. Analyzing these risks collectively, this Article offers a number of recommendations for saving the small group market. For instance, it argues that the SHOP exchanges that are intended to organize the small group market in 2014 must strategically target the weaknesses of self-insurance by offering simple and risk-free coverage options that facilitate employee choice. They must also market this coverage aggressively in light of insurance brokers’ likely financial incentives to push self-insurance on small employers. Additionally, state and federal law makers should explore various possibilities for making small employers both more likely to offer group coverage and, if they do offer group coverage, to do so through SHOP exchanges rather than self-insured plans. Possibilities explored by this Article include amending the terms of the premium and small business tax credits, regulating stop-loss insurance, and imposing various restrictions or penalties that are aimed at preventing churning between the self-insured and small group markets.
医疗改革将大量精力投入到重振小型团体健康保险市场上,这些市场为全职雇员少于50人的雇主提供服务。不幸的是,《合理医疗费用法案》(Affordable Care Act)中一些相互交织的条款产生了强大的激励机制,从2014年开始,这些条款往往会破坏这个市场,并在此过程中增加改革的财政成本。首先,以低收入员工为主的小雇主往往会选择退出小团体市场。其次,拥有混合收入雇员的小雇主将有强烈的动机提供既不是技术上“负担得起”的保险,也不是“最低价值”的保险,以便为其低收入雇员在个人市场上保留保费和成本分摊补贴的可用性。第三,拥有低风险员工的小型雇主将有强烈的动机自行投保他们提供的任何团体计划,以避免交叉补贴高风险群体。本文对这些风险进行了综合分析,提出了一些拯救小集团市场的建议。例如,它认为,计划在2014年组织小团体市场的SHOP交易所必须战略性地针对自我保险的弱点,提供简单、无风险的保险选择,方便员工选择。他们还必须积极推销这种保险,因为保险经纪人可能会出于经济动机,向小雇主推销自我保险。此外,州和联邦立法者应该探索各种可能性,使小雇主更有可能提供团体保险,如果他们提供团体保险,通过SHOP交换而不是自我保险计划来实现。本文探讨的可能性包括修改保费和小企业税收抵免的条款,规范止损保险,以及实施各种限制或处罚,旨在防止自我保险和小团体市场之间的动荡。
期刊介绍:
Since its inception in 1915 as the Iowa Law Bulletin, the Iowa Law Review has served as a scholarly legal journal, noting and analyzing developments in the law and suggesting future paths for the law to follow. Since 1935, students have edited and have managed the Law Review, which is published five times annually. The Law Review ranks high among the top “high impact” legal periodicals in the country, and its subscribers include legal practitioners and law libraries throughout the world.