Shopping for Small Business Health Options Program health coverage has been light, as small business owners and insurance carriers have confronted a variety of obstacles to adopting it.
A research report prepared by the Urban Institute, and funded in part by the Robert Wood Johnson Foundation, lays out in more detail the challenges confronting SHOP success.
"From interviews with insiders from eight states [Colorado, Illinois, Maryland, Minnesota, New Mexico, New York, Oregon, and Rhode Island], researchers conclude that employer participation was low due to a number of factors, most notably that many states spent the majority of their energy on the individual marketplaces," RWJF said in a release.
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Other major barriers to enrollment included:
- The one-year delay by the federal government;
- Limited reach of tax credits;
- Low number of brokers/agents steering their clients to SHOP plans; and
- IT problems.
One recent study of small business health insurance trends, by Mark Farrah Associates, suggested SHOP could be an industry "game-changer." While declining to pronounce the SHOP concept dead in the water, the Urban Institute researchers did conclude that SHOP has "a long way to go to be successful."
Marketing efforts to push benefits of SHOP coverage were lackluster, the report noted, creating yet another barrier to success. From the interviews with those in the eight states, researchers above all found "that SHOP had yet to be made a priority either at the state or national level. Rhode Island and New Mexico were exceptions in that there was some explicit state marketing focused on the SHOP."
Elsewhere, such marketing efforts did not exist to any significant degree.
The Obama administration decision to delay the launch of the federal online SHOP Marketplace, "fueled the sense that SHOP was of secondary importance," researchers observed.
"Sources reported that there is a tremendous lack of awareness of the SHOP at the most basic level within the small-employer community, and that many of those who are aware of it do not understand its function or role in the market. Consequently, a significant marketing and sales effort is required to engage employers, but such an effort has yet to significantly materialize. A clear, concise description of the SHOP and the added value it brings to the existing small group market seems not to have been elucidated or communicated.
"But developing an accurate, convincing description of the added value of SHOP has been challenging because of limitations of the reach of the small business tax credit, early renewals, extensions of non-ACA compliant plans [of pre-existing coverage, another concession made by the feds], and other issues," the report said.
The report concluded that, because of the many challenges to SHOP adoption in its first year, predicting its potential for providing coverage options to small businesses going forward is difficult.
"To move the SHOP business to stronger ground, however, considerable thought and effort must be put into the most effective framework for marketing and sales of the small-group products that they offer. A clear and concise understanding of the extra value brought to the market by the SHOP is particularly important, and is an effort that can be taken jointly by the state-based Marketplaces and the federally facilitated ones. Administrative simplification and employee choice hold substantial promise in this regard, but developing avenues for adding additional product lines (e.g., COBRA management, disability insurance) may be especially vital to developing a strong competitive stance in the face of the growing presence of private insurance exchanges," the report said.
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