Think you'd be safe if ACA provisions were repealed because you have Employer-Sponsored Insurance? Guess again.

About 90% of my focus here at is on the two biggest sections of the ACA: The Individual Market (3-legged stool, exchanges, subsidies, etc.) and Medicaid expansion. I tend not to write much about Medicare, "traditional" Medicaid or the Employer-Sponsored Insurance (ESI) market, which mainly consists of the Large Group Market (companies with 50 employees or more) and the Small Group Market (companies with fewer than 50 employees). As it happens, the ESI market covers nearly half the U.S. population (roughly 155 million Americans, give or take).

Under the ACA, individual market policies have to include the following "Blue Leg" provisions to be considered ACA-compliant:

  • Guaranteed Issue
  • Community Rating
  • 10 Essential Health Benefits
  • 60% Minimum Actuarial Value
  • No Annual or Lifetime Benefits Cap
  • A list of Free Preventative Services

Small Group policies are legally required to cover all six of the above provisions, so if the first two are crossed off, the roughly 13.5 million people enrolled in them would be in just as much danger of seeing their coverage turn to crap as the ~15 million or so on the individual market would.

As for the large group market, four of the six bullets above apply; the ones which don't are, according to Wesley Sanders, the list of 10 EHBs and the 60% minimum AV requirement (he says it actually does apply, sort of, but is calculated differently).

In other words, while repeal of the ACA wouldn't be quite as devastating to the Large Group Market as the Individual market, it would still be substantial:

Small groups would go back to underwriting so their rates would be more variable (lower for healthy, higher for sick). Pre-Ex for up to a year would return for those coming to ESI without prior continuous coverage.

— Wesley Sanders (@wcsanders) June 12, 2018

The premium rating provisions wouldn’t be impacted, but the pre-ex protections of the ACA extended to large groups and I believe Sessions is arguing all of 42 USC 300gg should be invalidated which would include the large group protections

— Wesley Sanders (@wcsanders) June 12, 2018

Sanders points out that thanks to HIPAA, there's some pre-existing condition coverage for people who maintain continuous coverage after leaving their employer (via COBRA or whatever), but the bottom line is that very few people are guaranteed to work at the same company until they turn 65, and there's plenty of people who will experience a gap in coverage for one reason or another.

Repeal the ACA (or substantial portions of it like the Guaranteed Issue and Community Rating rules, as are currently threatened by the idiotic #TexasFoldEm lawsuit which has been brought by...surprise! 20 Republican Attorneys General and Governors) and it's not just 15 million people at's about 2/3 of the country. is a website run by a friend of mine. It focuses specifically on the employer market, and the impact of the ACA on it. I strongly invite those with Employer-Based Coverage to check it out and share their stories:

Today, 156 million Americans with insurance through their employers benefit from three little known provisions that were implemented when the ACA took effect in September 2010.

  • 1) No lifetime or annual limits: Plans are prohibited from limiting the lifetime dollar value of benefits and annual limits are banned completely.
  • 2) Dependents under age 26: Plans must allow adult children under age 26 to enroll in a parent’s plan.
  • 3) Guaranteed issue: A policy is offered to any eligible applicant without regard to health status (you can't be denied coverage because you are currently sick or have been sick before).

Before September 2010, millions of Americans who thought they were covered by their employers' insurance plans were denied insurance, denied treatment or forced to file for bankruptcy.

I'm sharing their stories.

156 million Americans have employer sponsored insurance (ESI) but for some reason, most aren't at all afraid about how an ACA "Obamacare" repeal will impact them.

They should be.

Hit the "Share Your Story" page of this blog and share your story with me. I'll post them weekly here and on Twitter and Facebook.​​