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The impact of the COVID-19 pandemic and recent federal policies on small business health insurance: views from the market
The impact of the COVID-19 pandemic and recent federal policies on small business health insurance: views from the market
Small business owners have long struggled to provide their workers with health insurance. But, relative to large businesses, they face high and often volatile premiums, a lack of market power for negotiating premiums, and high administrative costs associated with covering a small number of workers. These pressures, along with the high and rising prices for medical services, have contributed to a steady decline in the number of small businesses offering coverage, leaving small business employees more likely to be uninsured. With tens of millions of people employed by small businesses in the United States (SBA 2019), federal and state policymakers have pursued strategies to help small employers purchase and maintain affordable health coverage. These strategies, including insurance market reforms, small business tax credits, Small Business Health Options Program (SHOP) marketplaces under the Affordable Care Act (ACA), and the easing of regulatory standards and facilitation of health reimbursement arrangements, have resulted in a market buffeted by dramatic change. In two previous reports from 2015 and 2017, we examined the effect of federal policy changes on the small-group market in six states (Arkansas, Minnesota, Montana, New Mexico, Pennsylvania, and Vermont) through interviews with market stakeholders, including small employers, insurers, and insurance brokers (Corlette et al. 2017; Lucia et al. 2015). For this brief, we reassess how the COVID19 pandemic and recent federal health insurance policies have affected the small-group market in the same six states.
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