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May 16, 2017

Trump to dismantle small-business part of ACA marketplaces

The online health insurance marketplace for small businesses created under the Affordable Care Act will be dismantled, the Trump administration announced Monday.

The Washington Post reported that the federal Department of Health and Human Services will move to end the ACA's Small Business Health Options Program, or SHOP, by 2018. The program was created to give businesses with fewer than 50 employees — and therefore not required to provide health insurance under the ACA — the option of doing so through a "one-stop" online marketplace.

The newspaper reported that federal health officials plan to propose a new federal rule to take effect in January, which would narrow, but not eliminate, the federal website for small-business insurance. Federal officials told the newspaper that the pending change would allow companies to continue going online to apply for government tax credits under the law, but would no longer let them use the Healtcare.gov website to select health plans. Instead, the site would show the names of available insurers and tell companies to deal directly with brokers of the health plans.

A news release issued Monday by the federal Centers for Medicare and Medicaid Services said the change only impacts states, including Maine, that offer the SHOP plans through the federally facilitated ACA health insurance marketplace.

CMS's release downplayed the impact of the change, stating: "Out of the nearly 30 million small businesses in the country, less than 8,000, just 0.1% of small businesses, currently participate in the federally facilitated SHOPs in 33 states, which cover less than 40,000 individuals nationwide. SHOP programs are now defunct and do not provide needed insurance coverage for small businesses."

The Washington Post reported that Kevin Counihan, chief executive of the ACA's HealthCare.gov during the Obama administration, said it's unclear whether the unilateral elimination of SHOP is permitted under the 2010 ACA law.

The law's language is vague on whether the small-business part of the law must mirror the enrollment system for people buying coverage on their own, he said.

Counihan told the Washington Post he found it ironic that the Trump administration "added more steps in the goal of being simpler," pointing out that under the announced change in the SHOP program, businesses would need to use two websites, one to check whether they qualify for ACA business tax credits and another to work with a broker or an insurer.

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