Awhile back I posted a short note regarding the Small Business Health Options Program (SHOP).  This is a plan under the healthcare reform law that creates options for small employers to offer employee health coverage under the new “State Insurance Exchanges” implemented under the Affordable Care Act (health care reform).

Well, this week, the U.S Department of Health and Human Services (HHS) (the federal agency that administers the Affordable Care Act-health care reform) announced a “final rule” covering those State Insurance Exchanges.  The final rule builds upon and incorporates two preliminary rules and a whopping 24,780 comments from the public.  The rule is fairly long, and it covers a variety of issues governing how state exchanges will be run.  I’m still digesting the thing.  Actually I have yet to finish the first course.  Regardless of where I am in this “buffet of delight,” I do offer some salient points:

  • According to HHS, states will have flexibility in designing how the state insurance exchanges will work.  That is, the state exchange in Vermont need not look exactly like the one in Tennessee.
  • The rule governs how the Exchanges will be established and operated; how health insurance plans can participate in the Exchanges; how individuals will be eligible to enroll in the Exchange health plans; and how small business employers will be eligible to participate in the SHOP.
  • For individual “consumers,” the rule states that there will be a stream-lined and “web-based system” for enrollment in qualified health plans through the Exchanges.  Each individual is supposed to be able to use the same application without the need to submit “multiple applications.”
  • On the tech side, the comments to the rule demonstrates a significant, though perhaps anticipated, emphasis on using existing “electronic data sources…to the maximum extent possible” in the Exchanges.  HHS appears to be pushing for the US and states to officially enter the 21st century.
  • The SHOP will begin in 2014.  SHOP is supposed to provide small employers with the ability to choose the level of coverage they will offer to their employees and choices for the employees of qualified health plans enrolled in the Exchanges.  Under SHOP, states will be able to set the size of their small group markets, as well as offer employees different levels of coverage through different participating plans.

Back to the meal, though I think I’ll be eating the leftovers for awhile.  Can you say “one thin mint?”

1 Comment

  1. You sure nailed the issue before the Supreme Court.

    Now the newspapers are analyzing how often the Justices blinked.

    .