United Hospital Fund
The issue brief examines the impact of an Affordable Care Act provision redefining the small group insurance market as 1–100 employees, in place of the 1–50-employee standard all states currently use. The brief lays out the logistics of this change in New York State and explores its implications for policymakers and for the affected small businesses.
With different premium-setting methodologies applying to the two insurance market segments in New York—community rating and experience rating—a high-level actuarial analysis featured in the brief illustrates how this change might affect the current small group market overall. It also examines how the change might affect premiums for firms with 51–100 employees that will join the new small group market; such firms’ premiums are currently based on the age and gender of their employees and the type of business in which they are engaged. Lastly, it explores the complex options state policymakers face in implementing this new rule.