2014 Enrollment in State-Run SHOP Exchanges ‘Lower Than Expected’
Enrollment in the state-run small business exchanges in 17 states and Washington, D.C., created under the Affordable Care Act was "significantly lower than expected" during the initial open enrollment period, according to a Government Accountability Office report released Thursday, the Washington Post's "On Small Business" reports (Harrison, "On Small Business," Washington Post, 11/13).
Similarly, GAO said while data for enrollment in the federal small business exchange would not be available until early 2015, officials "do not have reason to expect major differences in enrollment trends" when compared with the state-run exchanges (Ferris, The Hill, 11/13).
Under the Affordable Care Act, the Small Business Health Options Program allows small businesses to offer either a single plan to all of their workers or select a benefit level and allow employees to choose among several plans offered at that level. In June, Covered California Executive Director Peter Lee announced that the state's SHOP exchange would expand to allow employers to offer health coverage in two benefit levels beginning Oct. 1 (California Healthline, 9/22).
A total of 17 states and Washington, D.C., operated their own SHOP exchanges, only some of which had a SHOP exchange website and other features, such as "employee choice." Meanwhile, 33 states use "federally facilitated" SHOP sites (Reichard, CQ HealthBeat, 11/13). Both the state- and federally run SHOP exchanges will launch their 2015 open enrollment periods on Saturday ("On Small Business," Washington Post, 11/13).
GAO found that about 76,000 U.S. residents from almost 12,000 small businesses had signed up for coverage through the state-based shop exchange as of June 1, which was fewer than anticipated based on official estimates and stakeholder expectations (GAO report, November 2014).
According to The Hill, the Congressional Budget Office originally projected that two million U.S. residents would enroll in coverage via SHOP, meaning that each state-run SHOP exchange would need to enroll roughly 40,000 individuals. By contrast, GAO found that 16 state-run exchanges enrolled on average fewer than 5,000 individuals (The Hill, 11/13).
Further, the report found that while most state-run small business exchanges had health plans available in each county, some states had counties where there was no health plan available via SHOP.
Researchers also found that the health insurance premiums on state-run SHOP exchanges were comparable to the small group premiums offered outside of such exchanges (GAO report, November 2014).
According to GAO, stakeholders attributed the low SHOP enrollment to:
- Delayed implementation of SHOP features in some states;
- SHOP website technical difficulties (The Hill, 11/13);
- Many employers being unaware they could enroll in SHOP (GAO report, November 2014); and
- The SHOP exchanges' small business tax credits, which GAO said might "be too small and administratively complex to motivate many employers to enroll" ("On Small Business," Washington Post, 11/13).
GAO said that while some stakeholders were optimistic that the SHOP exchanges might enroll more individuals going forward, there was not enough information to determine the program's "long-term viability" (The Hill, 11/13).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.