By Dinah Wiley, CCF Consultant
Small business owners and entrepreneurs will have better access to affordable health care plans for themselves and their employees once the Small Business Health Options Program (SHOP) provision of the Affordable Care Act is up and running. This is a great innovation for small businesses as they can pool with other small businesses to negotiate more competitive insurance rates for their employees. Through SHOP, small businesses that previously could not afford to offer health benefits to their employees will be eligible for tax credits to help them offer medical coverage. This is welcome news for immigrant families: immigrants are a significant portion of America’s small business owners and employees and many of them lack health care coverage.
Congress was careful to craft the legislative language so that small business owners would not be overburdened with paperwork. And the regulations allow States flexibility to operate a separate SHOP exchange or to merge their SHOP with their individual market Exchange. But whether merged or separate, the SHOP will work best for small businesses and their employees if it is simple and streamlined, and the proposed Exchange I regulations are not strong enough in that area. For example, the ACA requires verification of immigration status in the individual market only (not the employer-based market), since for employer-sponsored insurance, such verification has already occurred at the workplace upon hire. Therefore, no re-verification by the SHOP is necessary and would unduly burden both the employees and the small business employer.
Because employers will be certifying their workers as qualified employees for purposes of coverage through the SHOP, the SHOP’s role as “middleman” should be confined to certifying qualified employers, and to facilitating relationships between qualified employers and Qualified Health Plans (QHPs). Otherwise, the rules threaten to discourage participation of employers and immigrant families alike.
SHOP is a great innovation that holds immense potential for small businesses and immigrant families. CMS should ensure the regulations don’t overburden business and families with duplicative paperwork and bureaucratic hurdles such as re-verifying eligibility. Let’s streamline the Exchanges and put SHOP and the ACA to work for America’s small businesses and families.
If you are interested in submitting comments to the Exchange proposed regulations, please contact me for more information at childhealth@georgetown.edu. The deadline for comments was recently extended to October 31.
Editor’s Note: This is the second in a series on how to make the Exchanges more welcoming to all children and families. Dinah Wiley is an attorney and a consultant in law, policy and program development. She has special expertise in immigration law and policy and the health care and income security safety net.
