Healthcare exchanges under the Affordable Care Act (ACA) are on every state’s mind as they prepare for 2014, when states will either default to the federal healthcare exchange system or implement their own state-run exchanges. Washington, DC, is opting to launch its own exchange, a plan that has small-staff associations in the District concerned and confused.

ASAE delivered a letter [PDF] last week to the DC City Council and Mayor Vincent Gray in support of preserving the private health insurance market for small employers and individuals in the District. ASAE represents more than 3,000 association professionals and roughly 800 organizations based in Washington, DC—over 82 percent of which have fewer than 50 employees and would be required to enter the DC exchange.

Forcing small employers into the exchange is a risky decision, as costs and other major details have not been finalized.

In the letter, ASAE President and CEO John H. Graham IV, CAE, said the affected associations have expressed concern about the details and costs associated with DC’s exchange, adding that it is critical that the affordable options found in the private market are preserved and that associations be afforded a transition time of at least two years before being required to enter the exchange.

“For many associations, providing insurance is one of their highest budget costs annually,” Graham wrote. “Forcing small employers into the exchange is a risky decision, as costs and other major details have not been finalized. The exchange should be an option for individuals and small businesses in DC, but not a mandate.”

According to the letter, the two-year buffer would allow ensure that the creation of the DC exchange is not disruptive to the healthcare market. “Such a transition time would enable the infrastructure to be tested and the system to be confirmed,” the letter stated. It would also “allow small associations to have the options for insurance coverage that were promised with the passage of the Affordable Care Act.”

ASAE is a member of the Small Employer Alliance for Affordable Healthcare Options, a coalition of more than 170 small employers in Washington, DC, that is working to keep the private market as an option for employers.

Associations have plenty of developments to monitor as regulations continue to roll out and compliance issues arise. And they are watching as states decide whether to set up an exchange or opt into the federal system.

In addition to the District, 17 states so far have declared that they will create state-run marketplaces, while 26 will opt in to the federally facilitated marketplace, according to an interactive map on The Commonwealth Fund’s website. Seven states are working on a partnership marketplace with the federal government.

States that participate in the federal marketplace will have the option to apply to run their own marketplaces in the future, said Kathleen Sebelius, secretary of the Department of Health and Human Services, in blog post last week.

“States will continue to be partners in implementing the healthcare law, and we are committed to providing them with the flexibility, resources, and time they need to deliver the benefits of the Affordable Care Act to the American people,” she said. “2014 is the beginning, not the end.”

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