Small Employer Perspectives On The Affordable Care Act’s Premiums, SHOP Exchanges, And Self-Insurance

Key Provisions of the Patient Protection and Affordable Care Act (ACA): A Systematic Review and Presentation of Early Research Findings

“…Gabel et al. () surveyed small firms and found the majority favored several SHOP features. However, participation in SHOP is lower than expected due to a number of challenges (GAO ).…”

“…As of June 2014, 18 statebased SHOP marketplaces enrolled 76,000 individuals from 12,000 small employers, and premiums for SHOP plans were similar to those for other small-group plans (GAO 2014b). Gabel et al (2013) surveyed small firms and found the majority favored several SHOP features. However, participation in SHOP is lower than expected due to a number of challenges (GAO 2014b).…”

State insurance mandates and off-label use of chemotherapy

“…We may similarly expect to see same-signed but smaller effects among self-insured plans as among fully insured plans. The large employers contributing data to MarketScan are mostly self-insured, while the health plans contribute MarketScan data in a more diverse mix of large and small employers (Miller K. (Truven MarketScan), 2015), which as a group are proportionally more likely to be fully insured (Gabel, Whitmore, Pickreign, Satorius, & Stromberg, 2013). For these reasons, we would expect that state laws would influence utilization for patients in both the health plan data 13 The probability weights we use are specific to each state-year and are constructed as the ratio of the incident cancer patients among the working-age population or number of employer-sponsored insurance enrollees in a given state-year, over the number of Marketscan chemotherapy patients in our sample in that stateyear.…”

DOES LIMITING ALLOWABLE RATING VARIATION IN THE SMALL GROUP HEALTH INSURANCE MARKET AFFECT EMPLOYER SELF‐INSURANCE?

“…There has, therefore, been considerable speculation that the ACA's adjusted community rating regulations may result in an increase in selective self‐insurance among employers in the small group market with relatively healthier workers and, in turn, concern about the possible implications for adverse selection into the fully insured small group market with resulting higher premiums (Lucia, Monahan, and Corlette, ; Weaver and Mathews, ). Such concerns have been exacerbated by a recent estimate that 65 percent of small group employers that offer insurance coverage are expected to face premium increases due to the ACA's rating regulations (Centers for Medicare and Medicaid Services Office of the Actuary, ), qualitative evidence suggesting increased consideration of self‐insurance among small employers (Yee, Christianson, and Ginsburg, ; Gabel et al, ), and anecdotal reports of increased marketing of self‐insurance and related products to smaller employers (Hall, ; Farr, ). Furthermore, increased rates of self‐insurance among smaller employers could have potentially problematic implications for these self‐insured businesses and their workers if enrollees incur high claims and employers do not have adequate reserves or reinsurance to pay them.…”