Vulnerable to what?

Premium increases.

Individuals and fully insured small groups (2-50 employees) are generally in pools. While the claims experience of pools varies, this (and last) year have seen flat premiums in the individual market, and 5-12% increases for most small groups.

But, if you have > 50 employees, you lose most of that pooling. That’s fine with 500 lives or more; i.e., there’s generally enough premium to cover the risk.

Consider however the case of ABC Mechanical Contracting. They have just 8 employees on a health plan but, 45 employees on three different union plans, making their Average Total Number of Employees (ATNE) 50+. So, ABC is getting a budget busting 27% premium increase (from $85,315 to $108,350). Is that fair? I mean, their premium doesn’t even cover the cost of one by-pass surgery!

As originally written, the ACA expanded the definition of small group  to 100 lives. That was reversed when then President Obama signed the PACE Act in October, 2015. I wasn’t convinced then that was the right call, and it still seems problematic. (Revisit both sides of the question HERE.)

I can say, ABC would like  ATNE to go AWOL.

ASAP!