Healthcare Business News
Linda Blumberg, senior fellow at Urban Institute

Small-business exchanges hope for a better 2015 after rocky start

By Paul Demko
Posted: July 10, 2014 - 2:30 pm ET

Health insurance marketplaces for small businesses have largely been a bust in their first year of operations.

That's in large part because online enrollment hasn't been available for businesses in the 32 states relying on the federal website. In addition, several state-based exchanges, most notably Covered California, also have required businesses to send in paper applications to enroll. That undoubtedly served as a deterrent for companies with less than 50 employees that might otherwise have considered shopping for coverage through the Small Business Health Options Program (SHOP).

“It's been a rocky beginning for sure,” said Linda Blumberg, a senior fellow at the Urban Institute. “The attention really in the first year was focused on the non-group portion of the marketplace. As a result, SHOP really got a bit of the short end of the stick.”

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Early renewals were also a huge factor in limiting the number of enrollments in 2014. Many health plans encouraged small businesses to renew their coverage just before the market reforms of the Patient Protection and Affordable Care Act went into effect. By some estimates, roughly 70% of small business groups opted for early renewals, severely depleting the potential market for SHOP exchanges. The Obama administration's decision to allow plans to continue that don't adhere to the coverage requirements of the federal healthcare law for up to three years is expected to further limit the number of businesses initially shopping for coverage through the government-run marketplaces.

“In many, many states, because the number of early renewals was so high, they likely didn't even consider SHOP,” said Kevin Lucia, a research professor at Georgetown University Health Policy Institute's Center on Health Insurance Reforms.

Grant Lahmann, national outreach director for Small Business Majority, a national advocacy group, said businesses often opted for early renewals as their safest option, given the technological problems the federal and state exchanges experienced. “There was a lot of uncertainty and misinformation in the business community, quite frankly, going into 2014,” Lahmann said.

Deciphering exactly how many individuals have obtained coverage through the SHOP exchanges is impossible. The CMS hasn't released any enrollment data for the 32 states utilizing the federal exchange. The agency expects to do so before the end of the year.

However, some state-based, small-business marketplaces have released initial figures. New York has signed up more than 4,000 businesses, covering roughly 10,000 individuals. As of April 1, California had signed up roughly 1,200 businesses, with more than 8,000 covered lives. And as of April 23, Colorado had signed up 220 businesses, covering 1,860 individuals. Unlike the individual marketplace, enrollment through the SHOP exchanges continues year round.

Kelly Smith, director of New York State of Health's Small Business Marketplace, said her organization is working closely with small business associations and insurance brokers to spread the word about available coverage options. New York had 10 carriers offer plans through the small business exchanges in 2014, more than any other state, and Smith anticipates that most will continue to sell products in 2015. That will allow many individuals to automatically re-enroll in their current coverage.

“Our biggest goal is to minimize any disruption,” Smith said.

By contrast, Washington state's SHOP exchange had just one health plan selling products in two counties, Clark and Cowlitz, in 2014. Consequently, just eight businesses have signed up for coverage through the marketplace. According to Michael Marchand, director of communications for the Washington Health Benefit Exchange, they hope to offer small-business insurance plans statewide in 2015. But Marchand also anticipates that insurers will find the marketplace more attractive in 2016, when companies with up to 100 employees will be able to utilize the SHOP exchanges.

“All of a sudden the available pool gets much, much bigger,” Marchand said.

Many policy experts still see a need for insurance marketplaces for small businesses. That's because historically, such companies faced a turbulent market and often paid higher prices to provide coverage to their employees. According to the Kaiser Family Foundation, just 57% of companies with fewer than 200 employees offered health coverage in 2013, compared to 99% of firms with more than 200 workers.

The federal government anticipates that online enrollment will be available for coverage that takes effect in 2015 for SHOP exchange plans. The CMS, the U.S. Small Business Administration and Small Business Majority are hosting weekly webinars to provide business owners with information about SHOP-exchange coverage options. In addition, the site will give employers the option of offering their workers more than one plan for 2015 coverage. That's seen as a significant enticement for small businesses because historically, they have only been able to offer their workers a single coverage option.

“That's a major feature that folks are very, very interested in taking a look at,” Lahmann said.

But the CMS is allowing states to opt out of offering employees a choice in health plans if they are concerned that it could adversely affect the risk pool. And insurance officials in 18 states—including Illinois, North Carolina and Pennsylvania—have indicated that they won't allow employers to offer more than one 2015 coverage plan. That's likely to make the marketplace less attractive to small businesses.

“I think 2015 is still going to be a challenge,” Blumberg said. “I'm hoping that we're going to see some strong success in at least a handful of states that will demonstrate what can be done here.”

Follow Paul Demko on Twitter: @MHpdemko

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