Final SBC Rules GOP Readies for King Decision

Final SBC Rules GOP Readies for King Decision

Our Thinking / Healthcare /

Final SBC Rules GOP Readies for King Decision
Calendar17 June 2015

Just-issued final rules for health plans' summary of benefits and coverage (SBC) clarify and modify this ACA disclosure requirement. The revisions largely incorporate guidance issued in recent years and contain few changes from the December 2014 proposed rules. Most plans must follow the revised rules starting with this fall's open enrollment for the 2016 plan year. The SBC templates and other model materials will remain the same through the 2016 plan year.

Beginning in 2016, the ACA expands the small group market from employers with 2 to 50 employees to include mid-sized employers – those with 51-100 employees – in insured, nongrandfathered plans. To date, 34 states have issued guidance allowing mid-sized employers to remain in the large-group market for up to two years, according to a new Commonwealth Fund analysis. The report includes a map identifying state decisions.

With just days or weeks remaining until an expected Supreme Court decision in King v. Burwell, Republican lawmakers are offering contingency plans and working behind the scenes to ready a response if the Supreme Court invalidates subsidies in the 34 federally facilitated exchanges. It’s not clear whether or when Republicans might coalesce around a single bill, but many of the proposals to date share key principles. These include providing transitional or temporary financial assistance for those who would lose subsidies, giving states the ability to opt out of many ACA requirements and to regulate their own insurance markets, and repealing the individual and employer mandates. GOP leaders probably won’t finalize and release details of a plan unless the Court rules in favor of King. And even if they largely agree on policy, enacting a King fix won’t be easy given what’s likely to be a messy legislative process and highly charged negotiations with congressional Democrats and President Obama.

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