U.S. Code » Title 42 » Chapter CHAPTER 157— QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS › Subchapter SUBCHAPTER III— AVAILABLE COVERAGE CHOICES FOR ALL AMERICANS › Part Part A— Establishment of Qualified Health Plans

42 U.S.C. § 18024

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(a) Definitions relating to marketsIn this title: 11 See References in Text note below.(1) Group market

The term “group market” means the health insurance market under which individuals obtain health insurance coverage (directly or through any arrangement) on behalf of themselves (and their dependents) through a group health plan maintained by an employer.

(2) Individual market

The term “individual market” means the market for health insurance coverage offered to individuals other than in connection with a group health plan.

(3) Large and small group markets

The terms “large group market” and “small group market” mean the health insurance market under which individuals obtain health insurance coverage (directly or through any arrangement) on behalf of themselves (and their dependents) through a group health plan maintained by a large employer (as defined in subsection (b)(1)) or by a small employer (as defined in subsection (b)(2)), respectively.

(b) EmployersIn this title: 1(1) Large employer

The term “large employer” means, in connection with a group health plan with respect to a calendar year and a plan year, an employer who employed an average of at least 51 employees on business days during the preceding calendar year and who employs at least 1 employee on the first day of the plan year.

(2) Small employer

The term “small employer” means, in connection with a group health plan with respect to a calendar year and a plan year, an employer who employed an average of at least 1 but not more than 50 employees on business days during the preceding calendar year and who employs at least 1 employee on the first day of the plan year.

(3) State option to extend definition of small employer

Notwithstanding paragraphs (1) and (2), nothing in this section shall prevent a State from applying this subsection by treating as a small employer, with respect to a calendar year and a plan year, an employer who employed an average of at least 1 but not more than 100 employees on business days during the preceding calendar year and who employs at least 1 employee on the first day of the plan year.

(4) Rules for determining employer sizeFor purposes of this subsection—(A) Application of aggregation rule for employers

All persons treated as a single employer under subsection (b), (c), (m), or (o) of section 414 of title 26 shall be treated as 1 employer.

(B) Employers not in existence in preceding year

In the case of an employer which was not in existence throughout the preceding calendar year, the determination of whether such employer is a small or large employer shall be based on the average number of employees that it is reasonably expected such employer will employ on business days in the current calendar year.

(C) Predecessors

Any reference in this subsection to an employer shall include a reference to any predecessor of such employer.

(D) Continuation of participation for growing small employersIf—(i) a qualified employer that is a small employer makes enrollment in qualified health plans offered in the small group market available to its employees through an Exchange; and(ii) the employer ceases to be a small employer by reason of an increase in the number of employees of such employer;the employer shall continue to be treated as a small employer for purposes of this subchapter for the period beginning with the increase and ending with the first day on which the employer does not make such enrollment available to its employees.(c) Secretary

In this title,1 the term “Secretary” means the Secretary of Health and Human Services.

(d) State

In this title,1 the term “State” means each of the 50 States and the District of Columbia.

(e) Educated health care consumers

The term “educated health care consumer” means an individual who is knowledgeable about the health care system, and has background or experience in making informed decisions regarding health, medical, and scientific matters.

(Pub. L. 111–148, title I, § 1304, title X, § 10104(d), Mar. 23, 2010, 124 Stat. 171, 900; Pub. L. 114–60, § 2(a), Oct. 7, 2015, 129 Stat. 543.)Editorial NotesReferences in Text

This title, referred to in subsecs. (a) to (d), is title I of Pub. L. 111–148, Mar. 23, 2010, 124 Stat. 130, which enacted this chapter and enacted, amended, and transferred numerous other sections and notes in the Code. For complete classification of title I to the Code, see Tables.

Amendments

2015—Subsec. (b)(1). Pub. L. 114–60, § 2(a)(1), substituted “51” for “101”.

Subsec. (b)(2). Pub. L. 114–60, § 2(a)(2), substituted “50” for “100”.

Subsec. (b)(3). Pub. L. 114–60, § 2(a)(3), amended par. (3) generally. Prior to amendment, text read as follows: “In the case of plan years beginning before January 1, 2016, a State may elect to apply this subsection by substituting ‘51 employees’ for ‘101 employees’ in paragraph (1) and by substituting ‘50 employees’ for ‘100 employees’ in paragraph (2).”

2010—Subsec. (e). Pub. L. 111–148, § 10104(d), added subsec. (e).

Notes of Decisions
Cited in 14 cases (1 in the last 5 years), 2013–2025 · leading case: King v. Burwell, 135 S. Ct. 2480 (2015).
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King v. Burwell, 135 S. Ct. 2480 (2015). · cites it 2× “Second, we must determine whether a Federal Exchange is "established by the State" for purposes of Section 36B. At the outset, it might seem that a Federal Exchange cannot fulfill this requirement.”
Jacqueline Halbig v. Sylvia Mathews Burwell, 758 F.3d 390 (D.C. Cir. 2014). · cites it 4× “See 42 U.S.C. § 18024 (d). But the Internal Revenue Service has interpreted section 36B broadly to authorize the subsidy also for insurance purchased on an Exchange established by the federal government under section 1321 of the Act.”
Geneva Coll. v. Sebelius, 929 F. Supp. 2d 402 (W.D. Pa. 2013). · cites it 3× “See 42 U.S.C. § 18024 (b)(2). As a small employer, SHLC is exempt from the requirement that it provide health insurance to its employees at all.”
Andrea Schmitt v. Kaiser Found. Health Plan, 965 F.3d 945 (9th Cir. 2020). “See 42 U.S.C. § 18024 (b)(2)–(3). 2 The other categories are: “[a]mbulatory patient services”; “[e]mergency services”; “[h]ospitalization”; “[m]aternity and newborn care”; “[m]ental health and substance use disorder services, including behavioral health treatment”;…”
New Mexico Health Connections v. HHS, 946 F.3d 1138 (10th Cir. 2019). “” 42 U.S.C. § 18024 (a)(2). The “small group market” means “the health insurance market under which individuals obtain health insurance coverage .”
Johnson v. United States Off. of Pers. Mgmt., 783 F.3d 655 (7th Cir. 2015). “42 U.S.C. § 18024 (b)(2). The plaintiffs argue that this limitation would seem to make Members’ employer- — either “Congress” or “the federal government,” according to the plaintiffs — ineligible for a SHOP exchange.”
United States House of Representatives v. Burwell, 185 F. Supp. 3d 165 (D.D.C. 2016). “at 2490 (acknowledging that the ACA had expressly defined “State” to mean “each of the 50 States and the District of Columbia,” 42 U.S.C. § 18024 (d)). This was the “problem” identified by the Court: If we give the phrase “the State that established the Exchange” its most…”
Halbig v. Sebelius, 27 F. Supp. 3d 1 (D.D.C. 2014). “” ACA § 1304(d), codified at 42 U.S.C. § 18024 (d). The phrase “Exchange established by the State under [ 42 U.”
New York v. U.S. Dept. Of Labor, 363 F. Supp. 3d 109 (D.C. Cir. 2019). “gov/cciio/programs-and-initiatives/health-insurance-market-reforms/state-rating.html (last updated June 2, 2017).”
Geneva Coll. v. Sebelius, 941 F. Supp. 2d 672 (W.D. Pa. 2013). “See 42 U.S.C. § 18024 (b)(2). As a small employer, SHLC is exempt from the requirement that it provide health insurance to its employees at all.”
Jacqueline Halbig v. Sylvia Mathews Burwell (D.C. Cir. 2014). · cites it 2× “See 42 U.S.C. § 18024 (d). But the Internal Revenue Service has interpreted section 36B broadly to authorize the subsidy also for insurance purchased on an Exchange established by the federal government under section 1321 of the Act.”
Oklahoma ex rel. Pruitt v. Burwell, 51 F. Supp. 3d 1080 (E.D. Okla. 2014). · cites it 2× “” In other words, the “legal fiction” reading does not appear to comport with normal English usage, as Professor Richard Epstein describes: These long and learned opinions should not obscure the fact that at the root of the case is a simple question: Do the words an “exchange…”
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