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A controversial small business health insurance bill became law in North Carolina on Oct. 1. However, as the 2020 employer health-insurance enrollment period nears, implementation of Senate Bill 86 is stuck in limbo with most, if not all, of the proposed association health plans likely not available for next year. SB86 permits small businesses to use associations, such as chambers of commerce, to obtain health-care plans.

The uncertainty comes as health insurers, advocacy groups and state legislators are fielding inquiries about how small businesses can sign up for an AHP. Supporters estimate that about 110,000 North Carolinians, or about 1% of the population, could benefit from signing up for an AHP. NC Realtors said about 6,000 of its 45,000 members could qualify. "SB86 has the provision for North Carolina AHPs to wait for the federal lawsuit against the new Trump (administration) federal AHP rules before making an AHP effective in North Carolina, said Hughes Waren Jr., chairman of the N.C. Association of Health Underwriters' General Assembly action committee.

The bill was promoted as loosening the requirements for AHPs in N.C. in response to federal Labor Department changes made in June 2018 under the Trump administration. There are 24, mostly Republican-leaning, states offering some form of an AHP. However, on March 28, a federal District Court judge struck down the final U.S. Labor Department ruling. Labor officials filed an appeal April 26. On April 29, U.S. Labor said it would not enforce violations stemming from good faith reliance on the AHP rule's validity, as long as businesses in an AHP meet their responsibilities to pay health-benefit claims as promised. "There are still pending legal challenges to the federal law that this state law is based on," Blue Cross Blue Shield N.C. spokesman Austin Vevurka said Monday. "Currently, a federal court has taken issue with associations based on geography and associations that contain sole proprietors."

The state health underwriters association, representing more than 3,000 insurance agents, brokers and consultants, released a statement in August in which it encouraged Democratic Gov. Roy Cooper to sign the bill. Cooper allowed the bill to become law without his signature Aug. 25.

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