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Why don't brokers love PPACA small-group exchange programs?

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Many public health insurance exchanges did a lousy job of setting up their small-group programs and reaching out to brokers — and many are scared of private exchanges.

Linda Blumberg and Shanna Rifkin, analysts at the Urban Institute, report on eight state-based exchanges’ Small Business Health Options Program (SHOP) divisions in a paper distributed by the Robert Wood Johnson Foundation. 

The analysts looked at the SHOP programs in Colorado, Illinois, Maryland, Minnesota, New Mexico, New York, Oregon and Rhode Island.

The Patient Protection and Affordable Care Act (PPACA) public exchange system has helped 9 million people sign up for individual qualified health plan coverage this year, but, an exchange enrollment tracking blog, knows of only about 72,000 SHOP plan enrollees. The U.S. Department of Health and Human Services (HHS) has declined to give any information about SHOP plan sales at the exchanges it runs.

See also: Congressman demands small business health insurance data

A PPACA small business tax credit was supposed to help SHOP sales. In practice, the tax credit is too narrow to help many employers, the analysts say. The analysts say exchange SHOP division technical problems also hurt sales. 

In some communities, the analysts say, QHP issuers scared off small employers by providing only in-network coverage, with no access at all to any coverage for non-emergency out-of-network care. 

The analysts said low agent and broker participation was another major barrier to SHOP sales. ”Even brokers certified to sell [SHOP] coverage in 2014 generally stated that they performed few to no sales through it, and many were unclear whether that would change in 2015,” the analysts write.

Agents and brokers said exchanges often ignored them in marketing campaigns, paid them poorly, and gave them low-value training, the analysts say. In Minnesota, the analyst’s report, the agent certification exam included the following statement in a series of “true or false questions”: “Using MNsure’s on-line tools can be fast, easy and convenient.”

When producers did help exchange users, the exchanges made getting the commissions or fees promised difficult, the analysts write. In Colorado, for example, the compensation system encouraged exchange help desk call center brokers to cut the brokers who brought employers to the exchange out of the case, the analysts write.

The analysts found that SHOP division managers in Minnesota, New York and Rhode Island see the birth of private health insurance exchanges “as a threat to the viability of the SHOP.”

For a SHOP program, offering more products, such as disability insurance, “may be especially vital to developing a strong competitive stance in the face of the growing presence of private insurance exchanges,” the analysts say.