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Thursday, October 12, 2017

Trump Decides to Lower Small Business Health Care Premiums without Congress


The Trump and Republican promise to “Repeal and Replace” the ACA has run into more than one bump in the road. On Thursday President Trump let the nation know that he is aware of the other arrows in his health care quiver. His solution could be accomplished by allowing small business employers to band together thousands of employee lives forming “association health plans” via their trade associations or chambers of commerce, and crossing state lines.

Under the Employee Retirement Income Security Act of 1974 (ERISA) there already are provisions in the law which could allow small businesses to band together to provide healthcare benefits, and even cross state lines. In East Alabama there are currently thousands of employees covered under their employer’s self-insured ERISA plans, administered by Blue Cross/Blue Shield of Alabama, with various forms of stop-loss reinsurance.  Further legislation is not necessary, but regulatory change would speed adoption and expansion of this alternative for East Alabama Small Employers.

The mechanism to accomplish this is the self-insured Multiple Employer Welfare Arrangement (MEWA). MEWAs can be fully insured as well. MEWAs were created under the amendments to the ERISA in 1983 which currently allows employers to form self-insured health plans through their employer business associations, which are re-insured by insurance companies using a stop-loss plan, thereby providing adequate reserves to satisfy state regulators.

There are currently more than 175 self-insured MEWAs across the United States with tens of thousands of small businesses participating. In 2016 there were 9 MEWAs in Alabama listed on the Department of Labor (DOL) site. The problem is that the current law provides for dual regulation of MEWAs, by both the federal DOL and each individual state Department of Insurance, such as Alabama.

The DOL has consistent standards for MEWAs, but each state can have its own unique requirements. Alabama currently has no specific MEWA regulations, but looks at the underlying stop-loss insurance carrier as the state regulated entity. This limits the ability of MEWAs to cross state lines, as they would have to navigate each state’s insurance department requirements.

The 1983 amendments to ERISA provided a mechanism to resolve the problem by giving the Secretary of Labor the ability to adopt a regulation whereby the dual regulatory system can be circumvented. In other words, the DOL can adopt a regulation permitting MEWAs to cross state lines to offer more health insurance options for small businesses. The section of ERISA that provides for this is 29 U.S.C 1144 (b)(6)(B). Thus, legislation will not be required and Secretary of Labor Acosta, who was first to talk Thursday at the White House, already has the authority to do this.

In states, such as Alabama, where there are currently only one or two insurance options, there could be dozens of MEWAs available for small businesses to join, where local providers and employers joined together to solve their own local health care challenges. This could result in numerous lower-cost options for healthcare for small and large employers in East Alabama.


Tommy Eden is a partner working out of the Constangy, Brooks, Smith & Prophete, LLP offices in Opelika, AL and can be contacted at teden@constangy.com or 334-246-2901. Blog at www.alabamaatwork