ABC in October submitted comments on two proposed rulemakings designed to implement provisions in the Patient Protection and Affordable Care Act (PPACA).

One rulemaking lays out requirements for states to establish health care exchanges; requirements for qualified health plans to offer coverage within exchanges; and basic standards that must be met before employers can participate in the Small Business Health Option Program (SHOP). The other addresses a provision that would require all group health plans and health issuers to provide a summary of benefits and coverage and uniform glossary of terms to health insurance shoppers and enrollees upon request and before they buy coverage.

Establishing Health Care Exchanges and Qualified Plans

On Oct. 21 ABC submitted comments to the Department of Health and Human Services (HHS) as part of the Small Business Coalition for Affordable Health Care to provide input on a proposed rule on establishing exchanges and qualified health plans. 
 
In the letter, the coalition emphasized the importance of ensuring flexibility and simplicity in the SHOP so small businesses can easily participate in a manner that works best for employers and employees.  The coalition also called attention to the need for states and HHS to ensure the stability of each state’s exchange, as well as SHOP financing and infrastructure so, as exchanges grow over time, they remain financially viable and able to meet the needs of all participants.

The coalition pointed out that the proposed rule does not address all exchange provisions in PPACA, including failing to define minimum essential health benefits, actuarial value, and other benefit designs. The coalition noted that many small businesses are still attempting to figure out how the new law will impact their ability to offer health insurance to their employees and that it is extremely difficult for small businesses to track and comprehend multiple, incomplete proposed rules.

“As the administration works to develop additional regulations related to the exchanges, one thing is clear – small business owners remain committed to working as partners to develop an insurance marketplace that is simple, efficient and responsive to their needs,” the letter stated. “Potential costs to small businesses must be closely examined as other regulations are proposed.”

Summary of Benefits and Glossary of Terms

ABC, along with 69 other companies and organizations, submitted comments Oct. 21 addressing the notice of proposed rulemaking that would require all health plans and issuers to provide a summary of benefits and coverage and uniform glossary of terms. According to a news release by HHS, the summary of benefits and coverage will include a new, standardized health plan or policy comparison tool for consumers known as “coverage examples,” expected to be similar to the nutrition facts label required for packaged foods.

In the comment letter, ABC and the other groups asked the U.S. Departments of Treasury, Labor and HHS to immediately assure employers that adequate time will be provided for compliance with these provisions. The groups also recommended a simpler approach to implementing the portion of the rules which call for plan participants to obtain “coverage facts labels” on selected health conditions.

In addition, the comments pointed out employers need flexibility not only to meet the requirements expected of them under the new law, but also to continue leading innovation in benefit designs that are highly valued, increase quality and contain costs. The groups noted the importance of structuring the final rules in such a way that the 94 percent of employers with more than 50 employees that currently offer health care coverage can continue to offer such coverage. 

“We urge the final rules be modified so they do not impose unnecessary expenses onto employer-sponsored health coverage,” the comments said. “Our ultimate goal is affordable, quality health care for our employees.”