The Senate Quietly Edits Obamacare

The Sen­ate quietly passed a bill that would over­turn the Af­ford­able Care Act’s ex­pan­sion of the small-group in­sur­ance mar­ket on Thursday—and it did so with sur­pris­ingly little fan­fare.

The le­gis­la­tion, passed by voice vote, gets rid of the ACA’s re­quire­ment that states in­crease the defin­i­tion of their small-group mar­ket from em­ploy­ers with 50 or few­er em­ploy­ees to 100 or few­er by Jan. 1, 2016. The change would have sub­jec­ted many small and mid­sized busi­nesses to dif­fer­ent rules. Among those was the re­quire­ment for cer­tain es­sen­tial health be­ne­fits to be covered, which is not re­quired in the large-group mar­ket.

The House passed the bill by a voice vote on Monday.

The bill is one of only a hand­ful of stand-alone changes to the ACA that have suc­cess­fully headed for the pres­id­ent’s desk. And this one was able to do so with none of the usu­al drama that ac­com­pan­ies any men­tion of the law.

“While the Af­ford­able Care Act con­tin­ues to di­vide Con­gress, today we’ve made real pro­gress to­wards im­prov­ing this law,” wrote Sen. Jeanne Shaheen in a state­ment after the bill’s pas­sage. “This le­gis­la­tion will make a help­ful ad­just­ment to the Af­ford­able Care Act for small and mid-size busi­nesses by lim­it­ing po­ten­tial premi­um in­creases and let­ting the states de­term­ine what’s best for their mar­ket. This bill is a win for busi­nesses across this coun­try, a win for bi­par­tis­an­ship and I’m very pleased it’s headed to the Pres­id­ent’s desk.”

Shaheen au­thored the Sen­ate ver­sion of the meas­ure with Re­pub­lic­an Sen. Tim Scott. The bill al­lows in­di­vidu­al states to de­cide wheth­er to change their small-group defin­i­tion.

“I look for­ward to Pres­id­ent Obama quickly sign­ing this meas­ure be­cause it is vi­tal that we main­tain the cur­rent defin­i­tion of a small group mar­ket and give states the flex­ib­il­ity to ex­pand the size of group mar­kets if the con­di­tions in their state ne­ces­sit­ate the change,” Scott said in the state­ment.

As re­cently as this week, sen­at­ors had said the bill would need to go through the Health, Edu­ca­tion, Labor, and Pen­sions Com­mit­tee be­fore it could be brought to the Sen­ate floor for a vote, des­pite the loom­ing dead­line for the change to take af­fect.

Law­makers op­posed the defin­i­tion change on the ground that it could in­crease premi­ums for mid­sized em­ploy­ers, lead­ing them to self-in­sure and there­fore rais­ing premi­ums even fur­ther for those re­main­ing in the risk pool. Sev­er­al groups rep­res­ent­ing small and mid­sized busi­nesses were ad­voc­at­ing for its re­peal.

“We com­mend Con­gress for passing this bi­par­tis­an le­gis­la­tion to pro­tect small and mid­sized em­ploy­ers, their em­ploy­ees, and their fam­il­ies from high­er health in­sur­ance premi­ums,” said Alissa Fox, a seni­or vice pres­id­ent with the Blue Cross Blue Shield As­so­ci­ation, after the vote.