Some state-based Patient Protection and Affordable Care Act (PPACA) exchanges may have gotten Small Business Health Options Program (SHOP) plan enrollment up to the interesting-pilot-program level.

In Colorado, for example, managers of Connect for Health Colorado say their SHOP exchange may be covering about 1.4 percent of the people in their state’s small-group market.

But, in many states, exchange managers prefer to talk about some other subject.

Officials at the U.S. Department of Health and Human Services (HHS) have refused even to give members of Congress information about HealthCare.gov state SHOP enrollment.

See also: Collins: Where’s the PPACA group plan enrollment data?

Christopher Koller, president of the Milbank Memorial Fund, an organization in Hawaii, told lawmakers there earlier this year that it looked as if the typical exchange that provides SHOP data may be serving less than 0.5 percent of its state’s small-group market.

Now officials in Nevada have revealed why they have not spent much time talking about SHOP enrollment: as of Feb. 22, Nevada Health Link, a transparent, agent-friendly but glitch-plagued exchange, had enrolled only six people in SHOP coverage.

Damon Haycock, the chief operating officer, gave that number at a board meeting in April, according to meeting minutes posted on the exchange website and, apparently, first noticed by Sophia Peramteau of Optomis Insurance. 

The typical minivan sold in the United States today has enough room to seat at least seven passengers. By mid-April, Nevada’s individual exchange had taken plan selection information for 73,596 people.

Bruce Gilbert, the executive director of the Nevada exchange, said one obstacle to expanding SHOP enrollment is that, even though the exchange has talked with agents and brokers about the small-group plans, it has not emphasized SHOP sales. Gilbert said he would be talking to agents and brokers to come up with strategies for improving results.

For a look at what else Gilbert said about the challenges of breaking the minivan passenger capacity barrier, read on.

Nervous piggy bank

1. Small employers have tight budgets.

Gilbert said the exchange has to work hard to get small employers to buy coverage from it.

“These are smaller businesses, where they’re counting every penny,” Gilbert said. “Unless we can provider a significant reason for them to come onto the SHOP exchange and go ahead and purchase, then, I think, we’ve got a tough road to hoe.” 

See also: HHS postpones SHOP choice requirement

U.S. Capitol

2. In most states, no one requires small employers or other employers to get their health coverage from a public exchange program.

Vermont and the District of Columbia now require all sales of fully insured small-group coverage to go through their exchange programs, but PPACA does not require small employers to offer health coverage of any kind, and Nevada does not require small employers to offer coverage.

PPACA does not require individuals to buy coverage from a public exchange, either. But, for the low-income and moderate-income individuals who need the premium subsidies provided by the public exchange system to afford coverage and avoid the individual mandate penalty, “You have, basically, a requirement,” Gilbert said.

See also: CCIIO: Producers critical to small-group exchanges 

Complicated, confusing street signs

3. The eligibility rules for the PPACA small-business tax credit may be too tight and are certainly too complicated.

To avoid crowding out existing private small-group coverage, and to avoid giving tax breaks to the high-end employers that would provide solid health benefits no matter what, Congress set specific eligibility requirements for the small business health insurance tax credit available with SHOP coverage.

“You’re looking for people with under 50 employees, whose average salary per employee is under $50,000,” Gilbert said. 

“It simply isn’t as attractive to a business to enter into the SHOP plan as it is for an individual to take advantage of the subsidies that are available for individual coverage,” Gilbert said

See also: PPACA-Based Age Rating Pinch Could Leave a Million More Uninsured