Setting the record straight on health law’s delayed small business features

John Arensmeyer

John Arensmeyer

This memo was originally issued on April 4, 2013:

The Department of Health and Human Services’ proposal to delay critical requirements for small business health insurance exchanges in some states is a disappointment to Small Business Majority and millions of small businesses. It’s a letdown to small business owners and their employees looking forward to robust, competitive exchanges in 2014. We hope this proposal is recognized as counterproductive and is abandoned.

That said, there’s a tremendous amount of misinformation circulating about what the rule would actually mean. We want to set the record straight.

What the Rule Would Do

The proposed rule would delay two features of small business exchanges in some states until 2015. It would not delay opening of the exchanges themselves. Exchanges will still open Jan. 1, 2014.

The rule would mean that in some states, two features of the exchange won’t be implemented: 1) employee choice and 2) premium aggregation. These are wonky healthcare terms, but the impact their delay would have is fairly straightforward. Stalling employee choice means small employers will have to wait until 2015 to be able to offer workers an array of health plans to choose from. Delaying premium aggregation means an administrative function that would simplify the payment process for employers also won’t be available for a year. The two features are linked—premium aggregation is not needed without employee choice.

The Facts

Exchanges still open; small businesses still have more than one plan option

What the rule would not do—despite a multitude of reports saying otherwise—is strip small businesses of any coverage choice whatsoever, essentially forcing all small business employers and their workers into one health plan.

Indeed, word on the street is that all small businesses that enroll in exchanges will have access to only one plan. Some reports have even gone as far as saying this plan will be government-run. Neither one of these is true.

Multiple private plans still available

Whether the rule is finalized or not, come 2014, two things will be true: there will be a full array of private health plans offered through the small business exchanges, and employers will be able to choose a plan from them. Their employees can then decide whether to enroll in it. This is essentially how the small group market works right now. What the rule means is that employees themselves will not have a menu of plans to choose from until 2015—which is a new benefit the law provides for small businesses.

Only applies to certain states

It’s also important to note the rule requires only states that have federally facilitated exchanges to delay these features a year. Federally facilitated exchanges are those created by the federal government in states that haven’t chosen to create them on their own. The 17 states implementing their own exchanges can still extend employee choice and premium aggregation to their customers starting in 2014. Nearly 40% of small businesses in this country do business in the 17 states implementing their own exchanges. That means there will be employee choice among health plans for those businesses next year—if their states choose to give it to them.

No impact on self-employed

What’s more, delaying this rule does not impact America’s 22 million self-employed individuals, nearly 30% of whom are uninsured. As planned, these entrepreneurs will still be able to purchase insurance through the individual exchanges in 2014—a huge boon to owners who have struggled to purchase affordable insurance for decades.

The Bottom Line

While certainly disappointing, delaying employee choice and premium aggregation is not the end of the world. Starting next year, small employers will still be able to pool their buying power in the exchanges, giving them the kind of clout large businesses currently enjoy. They’ll still get administrative help and, in many places, will have more choices of plans than they currently do. All the original features of exchanges will go into effect in 2015.

Small Business Majority has been talking to real small businesses across the country since the law was passed three years ago. We know they like the features of the exchange that could be delayed, along with other key provisions including: 1) being able to pool their buying power; 2) the Medical Loss Ratio provision requiring insurers to spend 80% of premium dollars on care; 3) the preexisting condition ban; and 4) the small business healthcare tax credit, which in 2014 will only be available to small business owners who purchase coverage through an exchange. Our national opinion polling further underscores their support for these features.

We hope the proposed rule isn’t finalized, because small businesses nationwide are looking forward to employee choice and premium aggregation. Nevertheless, these features will still be in the exchanges in 2015—albeit a year late.

Supreme Court Decision a Victory for Small Businesses Looking for Relief from High Healthcare Costs

John Arensmeyer

John Arensmeyer

Statement originally issued on June 28, 2012:

The U.S. Supreme Court’s ruling today upholding the Affordable Care Act is a victory for small business owners who have struggled with the excessively high cost of health insurance for decades. The Affordable Care Act tackles small business owners’ top priorities when it comes to healthcare reform: cost and accessibility. The law will significantly rein in costs while providing more health coverage options for entrepreneurs.

Our opinion polling has found that small businesses support the law, believe healthcare reform is needed to fix the economy and they support key provisions, particularly the healthcare exchanges and tax credits. Many components of the law, including rate review and the Medical Loss Ratio provision, have already resulted in lower premium costs for small employers. It also help ends “job lock,” where a prospective entrepreneur who has a preexisting medical condition cannot leave their job, launch a new company or help grow the economy because they are locked in their job for health benefits. And in 2014 the law calls for health insurance exchanges to be set up in every state, which will do even more to curb costs and boost choice. State lawmakers who have blocked implementation must now step up to the plate and work with local small businesses to establish these new competitive marketplaces.

The political circus that has surrounded this law for the past two years hasn’t done anything to help small business owners struggling with high costs. Today’s ruling lets us get back to what’s important: implementing the law and getting small business owners the financial relief they’ve been waiting for.

Plurality of Small Business Owners Want Healthcare Law Upheld; Only One-Third Want it Overturned

John Arensmeyer

John Arensmeyer

Originally released June 14, 2012:

A plurality (50 percent) of small business owners want the healthcare reform law upheld—either as is or with minor changes—while only one-third want the Supreme Court to overturn it, according to opinion polling released today by Small Business Majority. However, after learning more about the law, a clear majority (56 percent) want it kept intact with, at most, only minor changes.

The Supreme Court is expected to hand down its decision any day in the case against the Affordable Care Act, filed by the National Federation of Independent Business (NFIB) and state attorneys general. The polling of 800 small business owners in eight states (Florida, Illinois, Louisiana, Michigan, Missouri, New York, Texas and Virginia) found that once small business owners learn more about the law, their support for keeping it intact—either as is or with minor changes—rises to 56 percent, while opposition falls to just 28 percent.

Contrary to popular belief, small business owners do not want the high court to throw out the Affordable Care Act. They see this law as helping everyone have coverage and bringing down healthcare costs—something that has been one of their top concerns for years. We hope Supreme Court justices understand how important this law is to small businesses who need relief from high healthcare costs.

Key provisions of the law also have strong small business support, including one of the most crucial components for small businesses—the health insurance exchanges. The Affordable Care Act calls for exchanges—online marketplaces where small businesses can pool their buying power when purchasing coverage—to be up and running in every state by 2014. Sixty-six percent of owners say they would use their state exchange or consider using it to provide their employees with health benefits. The majority of entrepreneurs find potential features of the exchange very appealing, including employee choice (76 percent), the exchange educating employees about plans (74 percent), and the exchange providing plans that offer prevention and wellness programs (77 percent). Additionally, a strong majority (66 percent) of small businesses support their state applying for federal funds to set one up.

“Small businesses have been at the center of this lawsuit, and everything I hear is that they want it overturned. That’s not true for me, and it obviously isn’t true for the majority of my fellow entrepreneurs,” said Mark Hodesh, owner of Downtown Home and Garden in Ann Arbor, Mich. “I sincerely hope our Supreme Court justices listen to what real small businesses are saying about this law, not what a select few are saying for us, and that they uphold it. Going back to the status quo would be unthinkable.”

Other key findings from the poll:

  • 55 percent of small businesses who support upholding the law believe it should be kept because we need to make sure everyone has health coverage; more than one-third say it’s because it will make it easier to purchase insurance
  • 72 percent support the medical loss ratio requirement, where insurers are required to spend at least 80 percent of premiums on healthcare claims and quality improvement efforts
  • 65 percent support “rate review,” where state regulators are allowed to review and approve or reject insurers’ increases they deem excessive
  • 78 percent support prohibiting insurers from denying coverage based on preexisting conditions
  • 69 percent support preventing insurance companies from basing insurance rates on health status; 73 percent support preventing insurers from charging women higher rates than men
  • 69 percent favor allowing young people up to age 26 to stay on their parents’ plans
  • 55 percent of small business owners provide insurance to at least some of their employees, but of those who don’t offer it, 70 percent say it’s because they can’t afford it
  • Of small businesses who do offer benefits, respondents said the two most compelling reasons to offer were that they had a responsibility to offer (47 percent) and because it helps retain good employees (47 percent)
  • Of the small businesses who qualify for a tax credit under the law, but were not taking advantage of it, nearly half (46 percent) said they weren’t using it because they were not aware it existed
  • Nearly half of all small businesses (49 percent) said they’d be more likely to offer insurance if they qualified for a tax credit and the same percentage said they’d be more likely to purchase insurance through an exchange if they could receive a tax credit
  • 51 percent of small businesses are interested in establishing a workplace wellness program

To read the full report go online to http://www.smallbusinessmajority.org/small-business-research/healthcare/small-business-owners-views-on-aca.php

Tax Credit Report: 7 in 10 Small Businesses Eligible for Combined $15.4 Billion in Healthcare Tax Credits

Huffington Post

Since the enactment of federal health care reform, hundreds of thousands of small business owners across the country have been able to claim a tax credit for offering their employees health benefits — and millions more are eligible, according to a report released today by advocacy group Small Business Majority and consumer group Families USA. For tax year 2011, seven in 10 small businesses with 25 or fewer employees are eligible for the credit.

But most striking is that the majority of entrepreneurs don’t even know this credit exists.

American small businesses employ millions of workers and create 65 percent of all net new jobs. They can be found in every pocket of the country, driving growth in metropolitan cities, suburban settings and rural towns. Small businesses hold an iconic position in the American consciousness — a position that sometimes makes it easy to forget how much they struggle to achieve that deserved recognition.

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New Report: Tax Credits Could Help up to 3.2 Million Small Businesses Provide Health Coverage for Their 19 Million Workers

John Arensmeyer

John Arensmeyer

Original statement issued May 9, 2012:

More than 19 million U.S. workers are employed by the 3.2 million small businesses eligible for $15 billion in tax credits in the federal healthcare reform, according to a new report released today. The tax credit helps small businesses pay for health coverage for their employees. A major obstacle to coverage, the report notes, is that many small business owners are unaware of these tax credits because of the noisy—and often misleading—debate over healthcare reform.

The tax credit program is outlined in a report released today by Small Business Majority and the consumer group Families USA. The report contains detailed information on the number of eligible employers and employees in each state whom the program could benefit. It also includes the total dollar amount of tax credits that could be provided to businesses in each state.

In general, businesses that offer health coverage and employ fewer than 25 full-time middle-class workers are now eligible to receive a tax credit of up to 35 percent of the cost of premiums for their workers. In 2014, the size of the credit will increase to cover up to half of the cost of health insurance provided to workers.

The tax credit was included in the Affordable Care Act to help the smallest businesses offer coverage—those who traditionally have the most difficult time doing so. In 2011, only 71 percent of small businesses with 10 to 24 workers offered coverage to their workers; among small businesses with fewer than 10 workers, only 48 percent offered coverage. By contrast, 99 percent of businesses with 200 or more workers offered coverage.

The following are among the key findings of the report, titled “Good Business Sense,” about small business employers. (The report itself also contains state-specific data.)

  • More than 3.2 million small businesses (70.1 percent of businesses with fewer than 25 workers) are eligible for tax credits to help with the cost of health insurance coverage for their workers for the 2011 tax year.
  • More than 1.3 million small businesses are eligible to receive the maximum tax credit when they file their 2011 taxes.
  • More than two in five (40.3 percent of) small businesses eligible for a tax credit are eligible to receive the maximum tax credit when they file their 2011 taxes.

The following are key report findings about U.S. workers. (The report itself also contains state specific data.)

  • Nearly 19.3 million Americans are employed by a small business that is eligible for a tax credit for 2011.
  • Of these workers, nearly 5.8 million are employed by a small business that is eligible for the maximum credit.
  • The total value of tax credits available to eligible small businesses for 2011 is more than $15.4 billion, an average of $800 per worker.
  • The total value of tax credits available to small businesses eligible for the maximum credit is more than $6.1 billion, an average of $1,066 per worker.

The report also contains state-specific data by race and ethnicity on the number of workers who can benefit from the tax credits. As the report makes clear, however, workers and employers can only begin to benefit when they become aware of the tax credit program.

Among small businesses with low-wage workers, the likelihood of offering coverage is even lower. As a result, lower-wage workers employed by small businesses are much more likely to be uninsured than other working Americans.

We know from our opinion polling that small businesses want to offer their employees coverage but many of them can’t afford it. The tax credits will make it easier for small businesses to offer coverage, which makes their businesses more competitive and boosts their ability to create jobs and drive economic growth.

“Small businesses seeking to provide health coverage for their employees have traditionally faced health insurance premiums that are significantly higher than those for large businesses,” said Ron Pollack, executive director of Families USA. These high premiums are due to higher administrative costs and premiums per employee in the small group insurance market, he said.

“The tax credit program, a provision of the Affordable Care Act, now makes it possible for small business to compete with large employers,” Pollack said. “This is great news for these small companies, who can now offer health benefits when competing for talent in the job market. Just as importantly, it’s great for workers and their families who will now have access to affordable health care.”

“We also know from our polling that the majority of small businesses don’t know these credits exist to help them,” Arensmeyer said. “The best way to serve small business owners is to educate them about this provision so they can participate in and benefit from it.”

Families USA and Small Business Majority contracted with The Lewin Group to develop the estimates used in the report. The full report, “Good Business Sense: The Small Business Health Care Tax Credit in the Affordable Care Act,” is available at http://www.smallbusinessmajority.org/small-business-research/downloads/050912_Small_Business_Healthcare_Tax_Credit.pdf.