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Insurers seek delay to midsize group ACA changes

Expanding small business definition would price out customers, payers say

Insurers want to delay an Affordable Care Act provision that requiries them to change their benefit and pricing policies for small business plans, alleging those changes would drastically increase costs, reported the Wall Street Journal.

As of Jan. 1, 2016, the ACA would change the definition of small business to include companies employing more than 50 workers. The employer mandate currently applies to businesses with more than 100 employees. The new definition would expand the small business market, which would mean that more of insurers' individual and small group plans would have to be priced the same for all consumers, regardless of their existing medical conditions, the Journal said.

Insurers claim that, by expanding the small business market, premiums will increase for many consumers, as they won't be able to purchase low-cost plans any more, according to the Journal.

Although insurers already received a two-year reprieve from compliance, as FierceHealthPayer previously reported, they seek another delay.

"Allowing states to keep the current definition of a small group will allow businesses to keep what they have and keep healthcare benefits affordable and accessible for the millions of workers and their families who depend on them," Alissa Fox, senior vice president of the Office of Policy and Representation for the Blue Cross Blue Shield Association, told the Journal.

So far, insurers are making some headway; about 24 state insurance commissioners have announced that insurers can delay compliance with the rule changes.

If the changes do go into effect next year, one option for insurers could be extending contracts with midsize companies beyond the standard 12-month term so that the changes don't go into effect until later in 2016. That could "build a time cushion" for insurers and employers to comply with the new requirements, Paul Nachtwey, vice president of Ohio-based insurance brokerage Todd Associates Inc., told the Journal.

To learn more:
- read the Wall Street Journal article

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