2020 OPEN ENROLLMENT ENDS (most states)

Time: D H M S

North Carolina: GOP Senate expands "Ass" portion of #ShortAssPlans; will Cooper veto?

This happened yesterday:

Senate OKs small business health-care bill
By Richard Craver Winston-Salem Journal

The state Senate gave initial approval Wednesday to a Senate bill that would allow small-business employers to offer an association health-insurance plan, or AHP, that could provide lower premium costs.

Senate Bill 86 received a 40-8 vote on second reading, but an objection to a third reading kept it on the Senate calendar until at least today.

The GOP holds a majority in the NC Senate, but only by 29 to 21, so stopping this there was apparently a lost cause. They also hold a 65 to 54 majority in the state House. I'm not sure whether SB 86 has already been voted on there or not. If it passes both, it would be up to Democratic Governor Roy Cooper to veto the bill.

The bill would loosen the requirements for AHPs in North Carolina in response to federal Labor Department changes made in June by the Trump administration.

The objection was tied to some Democratic legislators’ concerns that the bill was moving too fast and that Republicans were not taking steps to bridge potential coverage caps.

...Critics of AHPs say giving small employers access to the flexibility of larger employers could lead to those plans opting out of providing 10 essential health benefits required in the federal marketplace under the Affordable Care Act.

...SB86 does not include guarantees of the essential benefits. An amendment to add the essential benefits was tabled by a 28-20 vote.

...A statement from the office of Senate leader Phil Berger, R-Rockingha, said that SB86 “requires the same exact coverage as already exists in law for large companies and corporations.”

“Drafters of Obamacare exempted large groups from having to comply with the federal health law’s 10 essential health benefits because they recognized that most large groups already these comprehensive coverage benefits to their employees. Additionally, AHPs do not displace any insurance plans that are already offered on the (federal health insurance) exchanges.”

(sigh) Yes, it's true that most large companies provide fairly comprehensive healthcare benefits, but that's because 1) it's a part of the employee's compensation and 2) they get a fat tax break on their portion of the policy cost. Neither of those are the case with "Associations". It's possible they'll offer comprehensive plans, but the whole point of these policies is that they're supposed to be far less expensive, so the odds are that they'd be stripped down...and since the association itself presumably isn't paying any portion of the premiums for anyone other than the actual association staff, they aren't getting a tax break either.

What’s new in SB86 is that an AHP could be accessed by non-affiliated employers within the same region or metropolitan area, allowing for the crossing of state lines in some instances.

So much for state's rights.

...The bill would allow sole proprietors and the self-employed to enroll, which has attracted the support of groups such as the NC Realtors trade group and NC Chamber.

This is the one part of the bill where I admit to having mixed feelings. The ACA specifically doesn't allow sole proprietors (or husband/wife-only LLCs) to be designated as "small businesses" for purposes of enrolling in small group policies, presumably as a means of preventing the individual market risk pool from being damaged by healthy enrollees fleeing to the small group market. Virginia recently passed an unusual bill which basically bypasses this ACA provision to allow exactly that. However, Virginia's situation was an outlier at the time; unsubsidized individual market premiums in the Charlottesville area were so insanely through the roof that something had to be done to help out those who weren't eligible for ACA exchange subsidies.

...Critics say the bill may allow small employers to cherry-pick industry sectors and regions to attract primarily young healthy individuals, which could leave older and less healthy individuals with more expensive premium options in the federal health-insurance marketplace.

Again, that's exactly what the concern was with the Virginia bill. There's no way of knowing how much of an impact this has on either individual market enrollment, small group enrollment, or premiums on either market until later on this year.