Download this Paper Open PDF in Browser

Self Insurance for Small Employers Under the Affordable Care Act: Federal and State Regulatory Options

21 Pages Posted: 30 May 2012 Last revised: 28 Jun 2012

Timothy Stoltzfus Jost

Washington and Lee University - School of Law

Mark A. Hall

Wake Forest University - School of Law

Date Written: June 1, 2012

Abstract

As implementation of the Affordable Care Act reshapes the US health insurance market, state and federal policy makers should be prepared to revisit regulation of stop-loss coverage — a form of reinsurance — for small businesses. Aspects of the reform law could motivate small businesses to self-insure, rather than participate in state-regulated markets either inside or outside the new health insurance exchanges. If younger or healthier groups self-insure, premiums for insured plans will rise, perhaps to an extent that could seriously impair the regulated market. State or federal lawmakers can influence small businesses to participate in the regulated market by making it more difficult or costly to obtain stop-loss coverage, which self-funded employers rely on to protect their businesses from catastrophic medical costs incurred by one or more insured workers. Regulators can limit the comprehensiveness of stop-loss coverage, ban stop-loss coverage outright, or regulate it as they do primary coverage. Because the issues are national in scope, and because uncertainty over ERISA preemption complicates state initiative, the federal government should take the lead in determining the proper confines of self-funding in the small-group employer market.

Suggested Citation

Jost, Timothy Stoltzfus and Hall, Mark A., Self Insurance for Small Employers Under the Affordable Care Act: Federal and State Regulatory Options (June 1, 2012). NYU Annual Survey of American Law, Forthcoming; Washington & Lee Legal Studies Paper No. 2012-24. Available at SSRN: https://ssrn.com/abstract=2070883 or http://dx.doi.org/10.2139/ssrn.2070883

Timothy Stoltzfus Jost

Washington and Lee University - School of Law ( email )

Lexington, VA 24450
United States
540-458-8510 (Phone)
540-458-8488 (Fax)

Mark A. Hall (Contact Author)

Wake Forest University - School of Law ( email )

P.O. Box 7206
Winston-Salem, NC 27109
United States
336-716-9807 (Phone)

Paper statistics

Downloads
377
Rank
65,000
Abstract Views
1,590