Setting the record straight on health law’s delayed small business features

The Department of Health and Human Services’ proposal to delay critical requirements for small business health insurance exchanges in some states is a disappointment to Small Business Majority and millions of small businesses. It’s a letdown to small business owners and their employees looking forward to robust, competitive exchanges in 2014. We hope this proposal is recognized as counterproductive and is abandoned. 

That said, there’s a tremendous amount of misinformation circulating about what the rule would actually mean. We want to set the record straight.

What the Rule Would Do
The proposed rule would delay two features of small business exchanges in some states until 2015. It would not delay opening of the exchanges themselves. Exchanges will still open Jan. 1, 2014.

The rule would mean that in some states, two features of the exchange won’t be implemented: 1) employee choice and 2) premium aggregation. These are wonky healthcare terms, but the impact their delay would have is fairly straightforward. Stalling employee choice means small employers will have to wait until 2015 to be able to offer workers an array of health plans to choose from. Delaying premium aggregation means an administrative function that would simplify the payment process for employers also won’t be available for a year. The two features are linked—premium aggregation is not needed without employee choice.

The Facts
Exchanges still open; small businesses still have more than one plan option
What the rule would not do—despite a multitude of reports saying otherwise—is strip small businesses of any coverage choice whatsoever, essentially forcing all small business employers and their workers into one health plan.

Indeed, word on the street is that all small businesses that enroll in exchanges will have access to only one plan. Some reports have even gone as far as saying this plan will be government-run. Neither one of these is true.

Multiple private plans still available
Whether the rule is finalized or not, come 2014, two things will be true: there will be a full array of private health plans offered through the small business exchanges, and employers will be able to choose a plan from them. Their employees can then decide whether to enroll in it. This is essentially how the small group market works right now. What the rule means is that employees themselves will not have a menu of plans to choose from until 2015—which is a new benefit the law provides for small businesses.

Only applies to certain states
It’s also important to note the rule requires only states that have federally facilitated exchanges to delay these features a year. Federally facilitated exchanges are those created by the federal government in states that haven’t chosen to create them on their own. The 17 states implementing their own exchanges can still extend employee choice and premium aggregation to their customers starting in 2014. Nearly 40% of small businesses in this country do business in the 17 states implementing their own exchanges. That means there will be employee choice among health plans for those businesses next year—if their states choose to give it to them.

No impact on self-employed
What’s more, delaying this rule does not impact America’s 22 million self-employed individuals, nearly 30% of whom are uninsured. As planned, these entrepreneurs will still be able to purchase insurance through the individual exchanges in 2014—a huge boon to owners who have struggled to purchase affordable insurance for decades.

The Bottom Line
While certainly disappointing, delaying employee choice and premium aggregation is not the end of the world. Starting next year, small employers will still be able to pool their buying power in the exchanges, giving them the kind of clout large businesses currently enjoy. They’ll still get administrative help and, in many places, will have more choices of plans than they currently do. All the original features of exchanges will go into effect in 2015.

Small Business Majority has been talking to real small businesses across the country since the law was passed three years ago. We know they like the features of the exchange that could be delayed, along with other key provisions including: 1) being able to pool their buying power; 2) the Medical Loss Ratio provision requiring insurers to spend 80% of premium dollars on care; and 3) the preexisting condition ban. Our national opinion polling further underscores this.

We hope the proposed rule isn’t finalized, because small businesses nationwide are looking forward to employee choice and premium aggregation. Nevertheless, these features will still be in the exchanges in 2015—albeit a year late.

John Arensmeyer 
Founder & CEO, Small Business Majority



(This post was originally posted here on the Small Business Majority blog)

Small Business Health Care Consortium Touts Importance of ACA to Illinois Firms

The newly formed Small Business Health Care Consortium (SBHCC) announced today the results of recent Illinois polls regarding the small business provision of the Affordable Care Act and their call for Governor Quinn to establish an Illinois Insurance Exchange with key principle provisions by issuing an executive order.

The polls, conducted in conjunction with the Small Business Majority, found that:

• 63% of Illinois small business owners want to see the Affordable Care Act upheld, with minor or no changes. After learning more about the specifics of the law, support for keeping it as is or with minor changes rose to 68%.
• A 73% majority of small business owners say they would use or consider using the state exchange, and seven out of 10 Illinois small business owners support the state in applying for federal aid under the Affordable Care Act to set one up. 
• A majority of business owners say they’d be likely to purchase health care for their employees through a state exchange because it is the only place they can receive a tax credit beginning in 2014. 64% of those polled said qualifying for the tax credit would make them more likely to provide or continue offering coverage to employees.

(Links: IL ACA Poll Mini Report and ACA Wrapup poll)

Small businesses are the backbone of Illinois’s economy. In 2010, 203,600 businesses in Illinois had 25 or fewer workers, according to the Small Business Majority. The SBHCC, formed earlier this year, represents the voice of small business leaders throughout Illinois on health care reform.

Present SBHCC Steering Committee members include the Illinois Black Chamber of Commerce, Illinois Hispanic Chamber of Commerce, National Association of Women Business Owners – Chicago Chapter, McCormick Chamber of Commerce, Women’s Business Development Center, and small businesses including Old Mexico Restaurant (Rock Island), Gregg Florist (Peoria), Wirehead Technology (Chicago), Second Act Cancer Recovery Boutique (Chicago), MCCE Investments (Springfield), Linda Forman CPA PC (Evanston), and H.A King & Associates (Chicago.)

“Forming the Small Business Health Care Consortium to represent the diversity of small businesses throughout the state is overdue. I am working with the Small Business Health Care Consortium to ensure that all small businesses can afford health insurance,” said Howard Lee of Wire Technology in Chicago, a SBHCC steering committee member.

Another provision of the ACA is the development of a competitive healthcare marketplace, or insurance exchange, in each state. Small businesses want to support our employees and their families by being able to provide them with the quality, affordable healthcare they deserve, but the high costs make it difficult or impossible for many of us to do that. We need a strong marketplace to give us more control, quality choices, and better consumer protections when buying insurance - just like the big guys get.

Pattie Sheehan, Certified Mastectomy Fitter and sole proprietor of Second Act Mastectomy Boutique in Chicago, serves cancer patients and survivors. “Every day I see and hear from women who did not catch their cancer early because they did not have access to healthcare. Women who battle cancer also work at small businesses and that means that they are less likely to have health insurance coverage, just because their employer is small. It is time for the inequality of insurance access to be erased and for the needs of small businesses to be met so that our employees can afford good insurance. That is why I have joined the Steering Committee of the Small Business Health Care Consortium.”

Since 2010 under the ACA, companies with fewer than 25 employees and average employee wages of less than $50,000 can get tax credits for the health insurance they provide their employees. These tax breaks have already lightened the load on small businesses so we can get back to what we do best...creating jobs that will stay here in our communities.

“I am the owner of MCCE Investments and I also own several Subway stores in the Springfield area. The main reason I am spending time on this project, the Small Business Health Care Consortium, is to be sure small business has a voice in the process from the beginning. We have to be sure health care for all Americans is not done on the backs of small business but must be shared by all,” said Mark Burris.

“Contrary to political spin and popular belief, small business owners in Illinois do not want the U.S. Supreme Court to throw out the Affordable Care Act. Illinois small businesses see this law as helping everyone have coverage and bringing down healthcare costs—something that has been one of their top concerns for years. We hope Supreme Court justices understand how important this law is to small businesses who need relief from high healthcare costs,” said Jim Duffett, Executive Director of the Campaign for Better Health Care.

Duffett continued, “Since the General Assembly has abdicated its responsibilities, Governor Quinn needs to step up to the plate and enact an Executive Order to begin the process for an Illinois Marketplace (exchange). Small businesses are committed in taking personal responsibility; it is time for our political leaders to do the same.”

Right now, Illinois could access over $200 million in federal funds to implement the new marketplace. It won't cost the state a penny if we use these federal funds. This past legislative session, the General Assembly took no action on implementing a marketplace in Illinois. This means the federal government will implement one for us, unless Governor Quinn takes immediate action.

David Whitaker, Chair of the Health Committee for the Illinois Black Chamber of Commerce, said “Small businesses are diverse throughout Illinois and yet we all have the same problem when it comes to buying health insurance—it is very difficult and we spend more for it than larger businesses. The Illinois General Assembly failed this past session to enact legislation to establish an Illinois marketplace, or insurance exchange. It is time for action and leadership.”

“The SBHCC is calling on Governor Quinn to sign an executive order to set the standard for this
marketplace and it must include the following principles:

1) No insurance industry representataives on the Governing Board.
2) The right to negotiate rates with insurers - there must be real cost containment measures.
3) The Insurance industry must pay for the Marketplace, not small businesses and consumers.”

Joyce Harant, SBHCC Project Director said, "Small business owners are so busy keeping their businesses operating that they have very little time to navigate what is happening about health care reform. Most of them wish they could afford health insurance for their employees and yet when the rubber meets the road, for many of them the obstacles are too great. My hope is that we can learn the needs of small business owners and, in a collective way, make sure their needs and opinions are heard and become part of the legislation passed in Illinois."

Full statements by small business owners on today's telebriefing are available via Kathleen Duffy. The audio of today's telebriefing is available on the Campaign for Better Health Care's Audio Archive.

A Helping Hand for Small Businesses: Health Insurance Tax Credits

The Affordable Care Act (ACA) established a tax credit to help small businesses provide health insurance for their employees. According to a new study released today from Families USA and the Small Business Majority, 3.2 million small businesses, employing 19.3 million Americans, will benefit from these tax credits. Out of the 198,910 small businesses in Illinois, 137,900 will be eligible for a small business tax credit—that’s 69.3%.

The cost of health insurance is often the prohibitive factor when it comes to coverage for small business employees. Whereas almost all businesses—99 percent—with 200 or more employees offer coverage for their workers, small business have a much lower rate: 71% of businesses with 10-24 workers, and 48% of businesses with fewer than 10 workers offered employee health coverage.

The small business tax credit is an integral part of the ACA – created in order to help small businesses provide coverage for their employees. The credit is designed to provide assistance to the smallest businesses that face the highest premiums. In order to qualify, all businesses must cover at least 50% of each employee’s health insurance.

• Businesses with up to 25 FTEs and average wages of less than $50,000 will receive credits on a sliding scale. To see if your business qualifies, go to the Small Business Majority Tax Calculator here. 

• Businesses with 10 or fewer employees and average wages of less than $25,000 are eligible for the maximum 35% tax credit.. 

• Non-profit businesses are eligible for a 25% refund. In 2014, when health care reform is in full-force, the tax credits will cover up to 50% of small businesses’ health coverage plans, and non-profits will receive a refund up to 35%. 

Unlike individuals, whom the ACA mandates to have coverage, small businesses are not mandated to provide coverage to their employees. However, if a business of 50 or more workers has an employee who receives an individual subsidy to cover the purchase of individual plan insurance, that business will be levied a fee.

What does the small business tax credit mean for Illinois small businesses and their employees? 

1,206,000 Illinoisans are employed at small businesses. Out of that number, 757,300 (62.8%) are employed at businesses that are eligible for a tax credit, making it easier for their employers to provide health coverage for them. Overall, the state will receive $634,615,800 in tax credits, or about $838 per employee, on average.

54,130 (39.3%) of Illinois small businesses will be eligible for the Maximum (35%) credit. 220,400 people will benefit from the maximum credits, or 29.1% of those employed by a small business.

The country suffers from large ethnic and racial disparities in health care, and coverage is no different in small businesses, where a disproportionate number of African American and Latino small business employees are without insurance, as compared to white, non-Latino employees. Many of these workers could benefit from the small business tax credit. In Illinois, 188,090 Latino workers are employed by small businesses. 74.5% (140,040) of those workers will benefit from small business tax credits. 118,310 African American, non-Latino workers are employed at small businesses, of which 78,170 (66.1%) will benefit from tax credits.

As with many other aspects of the Affordable Care Act, the small business tax credit is still underused and unknown. We found in our Neighborhood Stories series last year that many small business owners and chambers of commerce in the South and West Sides of Chicago had not heard of the small business tax credit. The Families USA and Small Business Majority Report released today will help to continue to publicize the availability of the credit.

What does Health Care Reform mean for Small Businesses?

Your Bottom Line: What Healthcare Reform Means for Illinois Small Businesses
March 23, 2012 11:00 AM CDT

This webinar will focus on what the new federal healthcare law, the Affordable Care Act, means for Illinois small businesses. It will include both federal and state provisions to help local small business owners understand how the law will affect them.

We are excited for you to participate because this webinar will have special opening remarks by Marianne Markowitz, Regional Administrator for the U. S. Small Business Administration in Chicago. In addition, valuable information will be provided by ACCION Chicago, the Women's Business Development Center, the Campaign for Better Health Care and the Small Business Majority.

Topics being discussed include:
• Chicago area small business resources
• Small business tax credits— who’s eligible for them and how to claim them
• Illinois health insurance exchange and on going legislation that will directly impact on small businesses access to health insurance
• Prevention and wellness
• Shared responsibility
• Cost containment
• Tools and resources available for small businesses interested in learning more about the law.

Register for the webinar here.
For more information email Joyce Harant or call 309-648-3035.

Healthcare Tax Credits: A Boon To Small Business, Yet Spin-Doctors Oppose

Ever since the Affordable Care Act was passed in 2010, opponents have thrown every attack they can think of against the wall, hoping something will stick. As attempts to repeal the law have failed, some of their arguments have become increasing laughable and, unfortunately, unconscionably reckless. For instance, these opponents now want you to believe that, in essence, small business owners do not want free money -- a mindboggling claim in these economic times.

Opponents, including groups that claim to represent small business, are taking aim at the small business tax credit in the ACA -- a provision allowing businesses with fewer than 25 employees that have average annual wages under $50,000 to get a tax credit of up to 35% of their health insurance costs beginning in tax year 2010. They say small businesses aren't using the credits because they don't provide enough of a benefit.

Poppycock.

I'm a small business owner. I founded ACI Interactive, an award-winning international e-commerce company that, after 10 years, I sold to the nation's leading retirement products company. My current company, Small Business Majority, is a nonpartisan, nonprofit organization that focuses on advocating for small business-friendly policies at the national and state levels. And small business owners like myself have a special name for tax credits: free money.

Politicians and spin-doctors with an ax to grind about healthcare reform argue that my small business colleagues don't like free money. They say these tax credits, which are available until 2017, have no practical utility. That's like claiming that people wouldn't pick up $100 they find on the sidewalk because it's not enough to cover their rent that month. The argument is simply ridiculous, but even more astounding is that some people, likely far removed from the day-to-day reality of running a small business, seem to think it's a valid point.

Let me set the record straight. Small businesses like free money, even if it's available for only a few years or if it comes from a president they don't agree with. And they especially like it when times are tough.

There is a problem, however: small businesses haven't been taking advantage of the tax credits -- not because they're turning their noses up at free money, but because they don't know the credits exist. We polled more than 600 small business owners nationwide and found that 57% weren't aware the credits were available. After learning of the credits, one-third of small business owners who don't currently offer insurance to their employees said they'd be more likely to do so because of them.

The IRS sent postcards to the 4 million small businesses eligible for a credit on their 2010 taxes; according to a report we released last year with Families USA, nearly 84% of all small business in the country would be eligible for a credit. But small business people work 80-hour weeks so it's understandable that they might not know all the details of the healthcare law, especially when those shouting the loudest and purporting to have small businesses' best interests at heart are actively advocating against the credits. That's a disgrace and a disservice to our nation's entrepreneurs who bust their hump every day to make ends meet, pay their employees and turn a profit in their chosen endeavor.

It's clear partisans in Washington care more about scoring political points than helping small business owners. The fact that they're waging their ideological war at the expense of our nation's chief job creators is shameful. Small businesses will help dig us out of this recession. We should be doing everything in our power to help them, no matter what end of the political spectrum we fall on.

John Arensmeyer
Founder and CEO, Small Business Majority
(This post originally appeared on June 8, 2011 in the Huffington Post Small Business America)