1. SHOP Exchanges: The Basics
Timothy Stoltzfus Jost
Washington and Lee University College of Law

2. SHOP Exchanges
Exchanges to make coverage more accessible and affordable to small businesses
Should increase the market power of small businesses and choice for small businesses and their employees
Proposed regulations take a practical approach to implementation and offer flexibility to employers

3. SHOP Exchanges
Must exist in each state (either as state or federal exchanges)
May be separate or combined with individual exchange
Individual and small group risk pools may be combined or kept separate

4. Which Employers May Participate?
Serves small employers (1-100, or, at state option, 1-50 until 2016)
States may expand to larger employers beginning in 2017
Proposed regulations would not cover businesses without employees

5. SHOP Exchanges: Proposed Regulation Options
Required: employer choice of actuarial value tier, employee choice of qualified health plan (QHP)
States can offer employers options:
(1) employees can choose any QHP offered in the SHOP in any tier;
(2) employers select specific tiers from which an employee may choose a QHP;
(3) employers select specific QHPs from different tiers of coverage from which an employee may choose a QHP; or
(4) employers to select a single QHP to offer employees.

6. SHOP Exchanges: Proposed Regulations
Rolling enrollment for employers, but upon enrollment locked into one year periods (and premiums locked in)
Must offer exchange coverage to all employees
Exchange must provide aggregate bill
Employers must notify exchange about employee change of status
Employers with multiple worksites can offer access to single exchange or to exchanges where employees located