The Obama administration is delaying the start of a key piece of the Affordable Care Act. Workers in small businesses will have to wait an additional year to be able to choose from more than one plan in the marketplaces that start next January.
The delay — first proposed in regulations issued last month and confirmed earlier this week — is the first acknowledgment by the administration that it won't be able to meet the tight timetable it has set to get these health exchanges up and running by October 1, when enrollment is set to begin.
The delay has disappointed some backers of the law.
"A major selling point of the small business exchange is that small business owners will be able to simply select a particular level of coverage that they want their employees to have, and then their employees will have the ability to choose from multiple plans within that level of coverage," says John Arensmeyer, CEO of the advocacy group Small Business Majority.
Without a menu that includes multiple plans, he says, the exchanges "will be less attractive."
The change won't affect the options for individuals in the health exchanges. While most people refer to the exchanges as a single entity, there are actually two separate pools: one for individuals and another one for employees of small firms.
Individuals will have a choice of plans from the start. But insurers complained about not having enough time to set up competing plans for the small business exchange, formally known as the Small Business Health Options Program, or SHOP.
As a result, the Department of Health and Human Services said Monday, "We have proposed that in 2014, a SHOP may elect to have businesses choose one plan to offer employees, and in 2015 employees will be able to choose from the full range of plans in the Marketplace."
That's basically the way most small business health insurance works now — the boss chooses a health plan for all the employees.
But the delay is not necessarily a bad thing, says Jay Angoff. He's a former Obama health official and Missouri Insurance Commissioner now back in the private sector. He says when the exchanges begin offering multiple plans is less important than whether they do what they were designed for. Angoff says he's all for giving the government more time to make sure that the plans compete to offer the best coverage at the lowest possible price.
"And I do think if it results in the exchanges using their bargaining power, establishing a competitive bidding process, that it's a good thing, not a bad thing," he says. "Because it will give the exchanges more time to set up a process which will force insurance companies either to charge reasonable rates or not sell through the exchanges at all."
Joel Ario, who helped set up the health exchange program at HHS and has also since returned to the private sector, says he won't be surprised if opponents of the law see the delay as the first indication that the Department of Health and Human Services won't be able to meet its deadlines. But he doesn't think that's the case.
"I think it shows that the agency is going to focus on the must-do's," he says. "and the nice-to-have's will have to in some cases wait. And this is one of those 'it- would-be-nice-to-have-but-not-essential' for 2014."
Small businesses that support the law will still have a reason to join when the exchanges first go live next year. If they do, they could be eligible for new tax credits that can lower the cost of providing coverage.
And there is already a push for the administration to try to reverse its decision to delay the choice feature. But this definitely represents another bump for a law that has already seen some rough roads.
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