If you offer group health services to companies with up to 100 employees, you have a window of opportunity to expand and change your practice, so it will keep growing through an era of health care reform.

This window is scheduled to last until Jan. 1, 2014, the start date mandated in the Patient Protection and Affordable Care Act (PPACA) for state health insurance exchanges. Experts who have studied the small-group health insurance market believe that unless the law changes, a majority of these groups will either join state exchanges or encourage employees to seek personal coverage through them. 

They believe this because:

  • Small-group health insurance premiums keep soaring.

  • Starting in 2014, most middle-income and lower-income individuals who participate in exchanges will be eligible for federal health insurance subsidies. (Small groups will not be eligible for subsidies.)
  • A few states – Massachusetts, Utah, Indiana and New York – already have experience with exchanges. Many other are gearing-up staffing and structures for exchanges during 2011, so they will be ready for pilots in 2012-13 and roll-out in 2014.
  • For companies employing less than 50 employees, the law includes no disincentives for encouraging individual participation in exchanges.
  • Companies with up to 100 employees may be able to choose another option created by PPACA, a national or state Small Business Health Option (SHOP) regulated by the federal government. Companies with fewer than 50 FTEs can qualify for a basic tax credit if they pay at least 60% of health insurance premiums, and a bonus tax credit is they pay more. Individuals who enroll in SHOPs will be free to choose their own health insurance carriers and plans from a menu.
  • Despite challenges and criticism, especially over the "individual mandate," there has not yet been much interest in rolling back state exchanges or SHOPs. These concepts seem to be better than the "status quo" for just about everyone involved – health insurance companies, employers and employees. However, perhaps they are not better for you, the professional who has diligently met the benefit needs of small groups.

Three Options for Capturing the Opportunity

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