President Obama hailed the effects of his health care law this spring when 8 million Americans signed up on the individual market, but the Obamacare marketplace for small businesses remains a work in progress.
The small-business exchanges, or SHOPs, were supposed to be an easy way for employers of 50 or fewer full-time workers to gain leverage in the insurance market and provide coverage options to their employees.
But the federal government last year delayed online enrollment and the “consumer choice” function that would have let employers offer their workers an array of plans.
Now some insurance commissioners in states that use the federal exchange system are opting out of the employee-choice model for the 2015 plan year too, because they fear the small-business risk pool will be imbalanced.
As it stands, employers in states covered by the federal Obamacare marketplace must go through an agent, broker or insurer that offers a certified SHOP plan.
Companies of 25 or fewer full-time workers can still qualify for a government subsidy that pays up to 50 percent of premiums.
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Despite the delays and spotty enrollment, there are outward signs the federal government is speeding things along, issuing new regulations that guide the SHOPs and tacking on $54 million to its contract with Accenture to — among other things — enhance online enrollment through the SHOPs.
“They’ve been working on that very actively,” said Timothy Jost, a professor at the Washington and Lee University School of Law who tracks Obamacare regulations.
Unlike individual enrollment, small businesses can use the SHOPs year-round and are not limited to open-enrollment periods.
The federal government and states focused their energy on individual enrollment after Obamacare launched in earnest last fall, particularly after a rocky web rollout and fix-it campaign produced a compelling narrative.
Open enrollment does not begin again until mid-November, so stakeholders are paying attention to the SHOPs.
Rep. Sam Graves, Missouri Republican, asked the Centers of Medicare and Medicaid Services last week why he never got enrollment numbers for the small-business component of Obamacare.
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The agency only had released monthly reports for individual enrollment.
Agency spokesman Aaron Albright told The Washington Times that “since businesses do not need to apply for SHOP eligibility before enrolling, CMS doesn’t generate the enrollment data itself.”
“Instead, we will collect it from insurance companies under a new process being finalized with insurers,” he said. “As a result, we don’t anticipate having federal Marketplace SHOP enrollment data until later this year.”
The administration expects enrollment to be modest until they set up full online capability and employers can offer their employees more plan choices, according to a government official.
Work on the consumer-choice model is coupled with efforts to install “premium aggregation,” in which employees will be able to offer plans from multiple insurance companies but pay a single bill.
Many small businesses renewed plans they had before the launch of the SHOPs, which also suppressed enrollment on the exchanges, according to analysts.
Mr. Jost said by his count, more than a dozen states in the federal marketplace have requested another delay to the employee-choice option, although CMS declined to confirm a figure.
“We are currently reviewing state submissions and we will provide more information very soon,” Mr. Albright said.
In the District, officials had their state-run SHOPs up and running from day one and offered employees a spectrum of choices.
Now the nation’s capital is trying to boost enrollment among its city employers, because the bulk of its SHOP enrollment through May came from members of Congress and their staff members.
A provision in Obamacare and regulations had directed the Capitol Hill employees into the D.C. SHOP for their health coverage.
“Now our only focus is on the small businesses,” Mila Kofman, executive director of the D.C. Health Benefit Exchange Authority, said in an interview.
She said the exchange is working with the city’s Chamber of Commerce, as well as Hispanic-business and restaurant associations, to determine which of their members could benefit from coverage through the new marketplace.
For the time being, the nation will head into a type of SHOP experiment. Some state-run exchanges are fully functioning, while the federally run states will be a mix of marketplaces with and without employee choice.
“We’ll see how it all works out,” Mr. Jost said.
• Tom Howell Jr. can be reached at thowell@washingtontimes.com.
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