Affordable Care Act Marketplace Coverage for the Self-Employed and Small Business Owners
Before the Affordable Care Act (ACA) was enacted in 2010, self-employed workers and small business owners had limited options to purchase affordable, high-quality health coverage. While most Americans obtained health coverage through their jobs, self-employed workers and small business owners often needed to purchase health coverage on their own, in which case quality coverage was expensive and sometimes denied.
The Affordable Care Act established Marketplaces in all states beginning in 2014. Self-employed workers and small business owners, as well as anybody else who does not have other access to affordable health coverage, can purchase it on their own and can qualify for tax credits if their premiums would otherwise be unaffordable as a share of their income.
For ten years now, I've had Google Alerts set up to send me links to stories about the Affordable Care Act using various commonly-used phrases like "health exchanges" and such. Normally these bring up the most recent articles about the law, but last night one of them included a surprising link to a Reuters article from...March 2013:
Washington could wind up running more health exchanges - official
March 14, 2013
...The Obama administration has given 17 of the 50 states conditional approval to set up online exchanges where working families would purchase private plans at subsidized rates. The remaining 33 states will all have federally run markets, at least in the early years of the coming reform era.
But Gary Cohen, who spearheads exchange implementation for the U.S. Department of Health and Human Services, said some of the approved states face hurdles that could require Washington to step in with federal exchanges before open enrollment starts on Oct. 1.
As I explained, every year, the Centers for Medicare & Medicaid (CMS) puts together a bunch of proposed modifications to the implementation details of the ACA. Some are simple clarifications of existing procedures; some are minor tweaks; and some are major changes. Of the major changes, some are positive...and some are negative. In the case of the 2022 NBPP, there are examples of all three...and the major changes are really major. As in, ranging from harmful to likely flat-out illegal.
For 2022, there were several NBPP items which seem either innocuous or are actually good ideas...but there are a couple of pretty questionable ones and a few more which would be outright devastating (there are also a few involving things like Risk Adjustment which I'm not familiar enough with to comment on one way or the other).
UPDATE 12/31/20: The deadline to submit public comments has passed. In the end, there are 320 comments, 243 of which were submitted after I posted this entry. The wording on a random check of some finds that at least a couple dozen appear to have been guided by my own sample comment below, which I'm glad to see.
Now we'll just have to wait and see. Thank you to everyone who helped out!
Last month, I wrote about the annual Notice of Benefit & Payment Parameters for 2022 (NBPP) from the Centers for Medicare & Medicaid (CMS). This is a long, wonky document published each year which includes a bunch of proposed modifications to various aspects of how the ACA is administered and implemented.
Some of the proposed changes each year are pretty much mandatory. Some are completely up to whoever is running CMS/HHS at the time. Some are nominal tweaks; some are major changes.
