With fewer than one day left in this legislative session and tens of bills to act on, the Senate needs to act with the appropriate urgency and approve House Bill 5013, which expands the board composition of the Connecticut Health Insurance Exchange (The Exchange) by five votes.

This will ensure the voices of small business people and individual consumers are genuinely heard at the table where key decisions about the future availability of affordable, accessible and quality health care coverage are being made. On April 25, the bill cleared the House with a unanimous vote of 146 to 0. However, somehow the Senate can’t see its way to taking up the bill and getting it done. This is troubling.

Under the federal Affordable Care Act, the state Health Insurance Exchange is supposed to operate as a centralized marketplace, where small businesses with fewer than 50 employees can buy insurance. In a recent survey of Connecticut small businesses by Universal Health Care Foundation of Connecticut, almost two-thirds of respondents said they cannot afford to offer their employees health insurance. And 78.8 percent said health plan costs must decrease to make it possible for them to provide coverage. 

To be ready to open for business in January 2014, the exchange board will need to negotiate with insurers to develop a range of insurance plans affordable to small businesses. The small group market is not one insurers have traditionally seen as profitable. The current board membership has the traditional insurance perspective on it, and not that of small businesses struggling to retain and attract good employees so they can build their businesses.

Here are three reasons why it’s urgent that the Exchange board composition be fixed:

Over the coming months, the Exchange board has numerous important decisions to make.  It must decide what benefits it will require insurers to design products around. Affordable coverage must be accompanied by quality health benefits, not a shell insurance plan with high deductibles as a ploy to keep premiums down. 

The board must market the Exchange effectively, and figure out how best to get the word out to small businesses. In the survey mentioned earlier, more than half of the respondents were unaware of the federal tax credit available through the ACA (35percent since the ACA was enacted and 50 percent starting in 2014). The board is hiring staff and has engaged a range of consultants but it is not at all clear that it recognizes small business owners with many responsibilities s to juggle will need assistance to take maximum advantage of the resources available to them through the Exchange. 

Another key decision the board has before it is creating of the standards they will use to qualify health plans to be sold on the Exchange. One such standard small employers would want to weigh in on is how benefits are designed to encourage prevention, improve health outcomes and reduce costs. For instance, eliminating co-pays on certain chronic illness medications to promote people adhering to their regimen makes health sense and is known to control costs. These are just some of the many decisions needed. As the saying goes, “if you’re not at the table, you’re on the menu!” Small businesses in Connecticut must be at the Health Insurance Exchange table.

Kevin Galvin is the chair of Small Business for Healthy Connecticut.