How charitable of Walmart to be so concerned about the struggling "small employer."
Under the ACA, small employers have the option of buying insurance on their state's exchange.
http://healthaffairs.org/blog/2013/01/17/individual-and-group-coverage-under-the-aca-more-patches-to-the-federal-state-crazy-quilt/
State Exchanges
The ACA seeks to preserve and even enhances the states’ traditional role in regulating health insurance through newly created state health insurance exchanges to assist individuals and small employers to obtain coverage. It was widely assumed that states would prefer to operate their exchanges for their own residents instead of having the federal government do it. Consequently, the ACA contemplates states running most of the exchanges, with the federal government stepping in only when a state is unable or unwilling to do so.
States had until mid-December 2012 to declare their preference and, contrary to initial assumptions about states wanting to maintain control, only 18 plus the District of Columbia decided to establish their own exchanges. To date, HHS has conditionally approved 17 states plus the District of Columbia to operate a state-based exchange. Of that group, only 3 would qualify as politically “Red” states (Idaho, Kentucky and Utah). HHS has yet to rule on Mississippi’s application to run its own exchange.
The remaining 32 states that passed on running their own exchanges must decide by February 15, 2013 whether to partner with the federal government or delegate all exchange responsibilities to HHS. Residents of these (predominantly Red) states will therefore be consigned to federal or federal-state hybrid exchanges. Two early applicants, Arkansas and Delaware, received conditional approval to run a state and federal partnership exchange. The hybrid approach envisions federal transitional assistance during the early years of the exchange, after which the exchange will be run exclusively by the state. In contrast, solely federal exchanges are not transitional and are expected to operate indefinitely, until a state applies to run its own exchange.
The ACA’s reliance on state-based exchanges was designed to maintain state influence over their insurance markets, as they have done under the McCarron-Ferguson Act and the Employee Retirement Income Security Act (ERISA). Wide scale rejection of state authority is thus surprising and ironic. What is immediately apparent is that with regard to state-based expectations, by yielding control of exchanges to the federal government, states punted. The result is an unexpected power shift away from the states and to the federal government.
