Myth vs. Fact #2

Myth vs. Fact: Myth #2: My State Isn’t Setting Up a Marketplace So The Affordable Care Act Doesn’t Affect Me

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.

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