December 13, 2010 

Office of Consumer Information and Insurance Oversight 

Department of Health and Human Services 

Room 445-G Hubert H. Humphrey Building 

200 Independence Ave. SW 

Washington, DC 20201 

Re: OCIIO-991-IFC, Amendment to the Interim Final Rules for 

Group Health Plans and Health Insurance Coverage Relating to 

Status as a Grandfathered Health Plan Under the Patient 

Protection and Affordable Care Act 

On behalf of the American Society of Association Executives (ASAE), 

we appreciate the opportunity to comment on the recent amendment 

to the Interim Final Rules regarding grandfathered health plans under 

the Patient Protection and Affordable Care Act. ASAE is a section 

501(c)(6) individual membership organization of more than 22,000 

association executives and industry partners representing nearly 

12,000 tax-exempt organizations. Its members manage leading trade 

associations, individual membership societies, and voluntary 

organizations across the United States. 

The proposed amendment, allowing insured plans to change carriers 

and retain grandfather status provided they do not violate other 

factors of the Interim Final Rules, will provide some marginal help to 

small and medium-sized employers. However, this change does not 

address the basic problem facing many small and medium-sized 

associations that do not have the market power of larger employers, 

and that will not have increased access to the insurance market until 

the Exchanges are established in 2014. 

As we pointed out in our previous comments, most of our members 

represent small and medium-sized organizations, and the average 

association has 11 employees. The organizations are often captive to 

a small number of health insurance providers and do not have the 

economic clout of larger enterprises. 
As we also pointed out, most of these organizations will greatly benefit 

from the expanded options for health insurance that will be available 

beginning in 2014 through the Exchanges. The Exchanges will allow 

the small and medium-sized organizations that our members represent 

to benefit from the economics of pooling that is not currently available. 

But this will not occur until 2014. 

Because of this reality, we reiterate our request that small and 

medium-sized employers be allowed to retain grandfathered status 

even if they make cost saving changes to both copayments and cost 

sharing, provided they do not reduce the per-employee amount they 

pay for insurance. This could help these organizations adjust and 

preserve coverage in anticipation of greater reform options beginning 

in 2014. We also request that small and medium-sized employers be 

allowed to change insurance carriers prior to 2014 and have their 

plans treated as grandfathered plans provided that they do not reduce 

the per-employee amount they pay for insurance. 

We note that the Secretary has provided waivers to the grandfather 

rules for numerous employers, including multinational corporations. 

Most of the organizations that our members represent strive to provide 

meaningful and comprehensive health insurance benefits. We are 

asking that you recognize the serious situation facing these 

organizations and grant a blanket waiver for small and medium-sized 

employers to help them maintain health insurance coverage while 

waiting for the eventual benefits of the Exchanges. 

Many of our members have advocated for health care reform, 

particularly to increase options available through market reform and 

the Exchanges. The association community has indicated its 

willingness and ability to help establish and administer the Exchanges 

on a state-by-state basis, as well as assisting in federal 

implementation. It would be ironic if some of the organizations 

represented by our members had to unwillingly drop coverage because 

of increased expense from the loss of grandfather status as they wait 

for the Exchanges. 

Thank you for your attention to this important issue. If you have any 

questions about these comments, please contact Jim Clarke, senior 

vice president of public policy, at 202.626.2703 or 

jclarke@asaenet.org.