Small-group market rules change may be GOP's best chance to alter ACA

In the wake of the Supreme Court's ruling to uphold federal Affordable Care Act subsidies, Republicans have labored to decide on their next move to repeal or at least chip away at the ACA.

This fall, it looks as though their best bet for a "fix" for the healthcare reform law may be legislation that overturns the expansion of the small-group insurance market, according to the National Journal.

Time is of the essence, as the ACA requires states to expand the definition of their small-group market to include employers with 100 or fewer employers by Jan 1. Previously, the designation had only included employers with 50 or fewer employees, but the ACA included the expansion provision to make the market more stable and attractive to insurers.

The strategy of overturning the expansion has a degree of bipartisan support: The Senate version of a bill to repeal it has 27 cosponsors, including six Democrats, and the House version has 207 cosponsors, including 29 Democrats.

Further, the implementation of the current policy could cause a "big disruption" in the small-group market, Tim Jost, a health law professor at Washington and Lee University, tells the NJ, adding that he doubts President Barack Obama would be opposed to a shift in the law.

Indeed, "it is probably one of the most realistic changes [to the ACA] at this point that we can see," Katie Mahoney, the U.S. Chamber of Commerce's executive director for health policy, told the publication.

Still, some Republicans aren't likely to settle for anything less than a full ACA repeal, the article points out, and any measures to repeal the small-group market expansion mandate are likely to see opposition from Democrats who initially supported the expansion, such as Senate Minority Whip Dick Durbin.

Republican presidential candidates have started to outline their own strategies for repealing and replacing the ACA, but none are likely to guarantee protections for people with pre-existing conditions or match the ACA's ability to expand coverage, the L.A. Times notes in a recent opinion piece. However, their plans do have the benefit of decreasing regulation and reducing federal spending.

To learn more:
- read the NJ article
- here's the L.A. Times piece

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