Fewer and fewer small employers are providing health insurance because of the cost.  The cost of health insurance is especially painful for tiny employers who employ fewer than 10 employees.  Benefit mandates and regulatory mandates, such as HIPAA’s guaranteed issue mandate on small employers, apply to state-regulated, fully insured plans.  Large employers who self-insure under ERISA escape all the benefit mandates at the state level and have more flexibility in designing a health care plan for their employees.

Small employers should be allowed to join together across state lines and have the same flexibility that large employers enjoy.