Myth vs. Fact: Myth #2: My State Isn’t Setting Up a Marketplace So The Affordable Care Act Doesn’t Affect Me
by Meredith K. Olafson, Community Moderator
- Created: May 22, 2013, 1:37 am
- Updated: May 22, 2013, 1:37 am
As a business owner, it’s important to understand how the Affordable Care Act may affect your business. However, with so many misconceptions about how the Affordable Care Act works, this can be difficult.
As part of our ongoing blog series, “Myth vs. Fact: The Affordable Care Act and Small Business,” this week we’re debunking another common myth: If my business is located in a state that isn’t establishing a state-based Marketplace, the Affordable Care Act doesn’t have any impact on me.
Fact: Every state will have an Affordable Insurance Exchange, or Marketplace, beginning in January 2014. States have the option of running their own Marketplace, partnering with the U.S. Department of Health and Human Services (HHS) to partially run the Marketplace, or opting for a Marketplace run by HHS.
More than half of states have decided to run all or part of their Marketplaces in 2014. Specifically, seventeen states and the District of Columbia have chosen to establish their own Marketplace and, seven additional states have opted to partner with the federal government to establish a Marketplace. States have the opportunity to choose to run more of their Marketplaces in each year following 2014.
Will the insurance options be different in a state-based Marketplace versus a federally-facilitated Marketplace?
We don’t expect there to be a difference since the Small Business Health Options Program (SHOP), which is part of the new Marketplace, will operate in all states. Small employers in all states will be able to compare a range of insurance options for their employees based on price, benefits, quality, and other criteria that may be important to them. This is true whether a business is exploring options for coverage in a state-based Marketplace or a federally-facilitated Marketplace. Also, every health insurance plan in the new Marketplace will offer coverage of “essential health benefits” like hospitalizations, doctor services, prescription drugs, rehabilitation and mental health services, pregnancy, and newborn care. Some employers may even be eligible for tax credits for their premium contributions.
In 2014, employers will be able to choose a plan, from a variety of Marketplace options, to offer their employees. In states like California in 2014 and in all states starting in 2015, employers will be able to choose a variety of plans to offer to their employees—empowering each employee to choose the plan that best suits his or her needs.
Although we have heard some claims that the opening of the SHOP marketplaces will be delayed, this is not the case—these marketplaces will open for enrollment, as planned, on the first of October.
You can learn more about the Marketplaces by visiting www.HealthCare.gov. Business owners should continue to check back between now and October 1, 2013 (when enrollment opens) to see the status of the SHOP Marketplace and coverage options in their state.
To view all state-based Marketplace websites, visit http://www.healthcare.gov/marketplace/about/state-marketplace/index.html.
Small businesses can also sign up for email and text alerts at www.signup.healthcare.gov to stay connected with the latest information about the Marketplace in their area.
About the Author
Meredith K. Olafson is Senior Policy Advisor for the U.S. Small Business Administration where she oversees the agency's education and outreach efforts around health care and the Affordable Care Act.
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This blog is provided for informational purposes only and is not intended as legal or tax advice. Readers should consult their legal or tax professionals to discuss how these matters relate to their individual business circumstances.