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 /()*+,.     P$  0` 33̙ff` 3f3f` ___>?" dd@$?lKZ@ d tA@lK3` n?" dd@   @@``PP     @ ` `pB`B` )n(   " Z4(agֳgֳ ?P a T Click to edit Master title style! !@ # Z`gֳgֳ ?@ a RClick to edit Master text styles Second Level Third Level Fourth Level Fifth Level!     SN ' ZA11ȜȜ?hebbbbB ) 3 rDԔ11ȜȜ?deT  <޽h? ? 33̙ff Default DesignK  0 0' ( X   " Z3`gֳgֳ ??- a T Click to edit Master title style! ! # T'`gֳgֳ ?` `  ` W#Click to edit Master subtitle style$ $N ' ZA11ȜȜ?N ^($m3333T  <޽h? ? 33̙ffV 0 P f(  p  01 ?vh     64  M>    X*   6  Z >   Z*   6˳  e]    X*   6Db  <>   Z*:   Tf 1 ? :   RClick to edit Master text styles Second level Third level Fourth level Fifth level!     SH  0޽hx? ? ̙3380___PPT10.U@n/ 0( D$\ H  0޽hx ? ̙3380___PPT10.U 0L0  D(    C `" ?-<$ 0 a l  C ܸ`# ` `  ` H  0޽h ? 33̙ff  0 `PJ(     Tx] gֳgֳ?Pp00 Z(    TZ gֳgֳ? O` Z  6   # l] gֳgֳ? ?mxc LSource: AHRQ, MEPS Insurance Component, 2002. Private sector workers only.M M r  S 0^ "P  `  P0 BA U?#A U  H  0޽h ? 33̙ff3  0 $g( ֳ $ $ NE gֳgֳ?P @0 Z( r $ S @ "P    $0 BA S?# S  ? $  f8 gֳgֳ? ?a/ [Source: Estimated from AHRQ, MEPS Insurance Component, 2002. Private sector workers only.\ \ H $ 0޽h ? 33̙ffG  0 ((  (r ( S \ "    (0 BA W?# H W  ? (  fx{ gֳgֳ? ?a/ [Source: Estimated from AHRQ, MEPS Insurance Component, 2002. Private sector workers only.\ \ H ( 0޽h ? 33̙ff  0 f^ P(  P P N@@ gֳgֳ?P@ X  l  P C A "P   l  P C A #@   H P 0޽h ? 333̙ff  0 8$( ֳ 8r 8 S dO "P   r 8 S R #@   H 8 0޽h ? 33̙ff  0 S(  r  S Y "P    0 BA m?#z m    Tt[ 1? ONo employee contribution for:0   f i gֳgֳ? ?a/: LSource: AHRQ, MEPS Insurance Component, 2002. Private sector workers only.M M H  0޽h ? 33̙ffG  0  (  r  S ! "P    0 BA g?#? g  ?   f# gֳgֳ? ?a/ [Source: Estimated from AHRQ, MEPS Insurance Component, 2002. Private sector workers only.\ \ H  0޽h ? 33̙ffd  0  0(  r  S x "P   x  c $y #&    r  S hz #    H  0޽h ? 33̙ff   0 @$(  r  S  "P   r  S ̾ #@   H  0޽h ? 33̙ff   0 P$(  r  S $ "   r  S  #   H  0޽h ? 33̙ffv   0 &` (  r  S  "P  ` r  S  #@     ZH 1?I|X Guaranteed renewal Group-to-individual portability for some But: No guaranteed issue No individual-to-individual portability No affordability protectionsJB lK3Y  BYH  0޽h ? 33̙ff   0 p$(  r  S  "P  ` r  S  #   H  0޽h ? 33̙ff   0 $(  r  S 7a"P  a r  S  `#@ ` H  0޽h ? 33̙ff 0 t4( ?@@ tX t C vh   ` t T^|1 ? D  ` To maximize group size and minimize premiums, small employers: offer one plan, restrict options, and pay a larger share (or all) of the premium in order to have enough employees in a plan to achieve a reasonable product from an insurer.H t 0޽hx ? ̙33b 0 "@x( ̃@p@ xX x C vh    x TM 1 ? D   ~HSmall-Group and Individual Coverage: presentation by Deborah Chollet, Senior Fellow, Mathematica Policy Research, Inc., to the Citizens Health Care Working Group.V DH x 0޽hx ? ̙33;  0 p|( ̃@p@ |X | C vh   | | T h|1 ? D  | WCMost firms are small but most workers are employed by large firms.H | 0޽hx ? ̙33s 0 3+( (@X@ X  C vh   |+  T n|1 ? D  | {Small firms are less likely to offer coverage, but for those that do, workers are more likely to be eligible and to enroll.H  0޽hx ? ̙33L  0  ( P 0 X  C vh   |  T(u|1 ? D  | hTSmall businesses (1-50 employees) represent a small portion of the insurance market.H  0޽hx ? ̙33 0 '( ̃@p@ X  C vh   |  T{|1 ? D  | Average premiums per benefit paid are higher for small firms. Many states have very few primary insurers; Maryland, for instance, has only three. The profit for insurance companies is more limited in the small group market.H  0޽hx ? ̙33X 0 h(  X  C vh   |  S |  :  | jVSmall companies have premiums that are about 25% higher than those of large companies.H  0޽hx ? ̙3380___PPT10.V8 0 H(  X  C vh   |  S |  :  | J6Small firms are exempted from some federal regulations, but often states do not exempt these firms from State-level regulation. Small businesses are exempt from Federal COBRA and required maternity coverage; however, States have created some  mini-COBRA requirements. States have mandated some benefits; some states have mandated mental health parity; Hawaii has mandated that employers must provide coverage. H  0޽hx ? ̙3380___PPT10.V ' 0 ~(  X  C vh   |~  S >|  :  | Has insurance regulation raised the cost of small-group coverage? The requirement that insurance companies must issue health policies ( guaranteed issue ) has reduced small-group coverage. Community rating has had no demonstrated effect on costs of coverage.H  0޽hx ? ̙3380___PPT10.V'| 0 zr (  X  C vh   |r  S $|  :  | The number of individuals who are seeking health care coverage on their own ( individual market ) is small, only about 7% of total plan market. Basic characteristics of this market are: it is small; underwriting is aggressive (loss risks to the insurance companies are reduced by inflating premiums for individuals perceived to raise the likelihood of insurance claims being submitted); it is expensive; and it is unstable; it shrinks rapidly when employer coverage expands. Substandard coverage is frequent.H  0޽hx ? ̙3380___PPT10.V9e2 0 5-(  X  C vh   |-  S |  :  | In the individual market, HIPAA solved few problems: it provided guaranteed renewal and group-to-individual portability for some; but, there is no guaranteed issue (the insurer can deny coverage to an individual), no individual-to-individual portability (if person moves to another plan, no assured transfer), and no affordability protections. Rates in the individual market are high; there can be long waiting periods for individuals.H  0޽hx ? ̙3380___PPT10.V0H 0 {s (  X  C vh   |s  S |  :  | Some states have tried to address insurability and affordability. 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