Analysts at the National Federation of Independent Business (NFIB) recently published a new batch of survey data showing how the Patient Protection and Affordable Care Act (PPACA) is, and isn’t, helping owners of businesses with two to 100 employees.
Drafters of the Patient Protection and Affordable Care Act (PPACA) had made helping owners of small businesses one of the main reasons for passing PPACA.
The prime Small Business Health Options Program (SHOP) enrollment period started Nov. 15 and is set to end Dec. 15. Small employers that sign up for SHOP during the public exchange coverage period can offer coverage without meeting minimum participation requirements.
In theory, the SHOP exchange system can offer small employers access to a generous temporary health insurance premium subsidy tax credit.
In reality, The PPACA small business tax credit requirements are notoriously complicated, and use of the tax credit has been low. HealthCare.gov managers, and managers of most state-based exchanges, have had trouble finding the time to get their SHOP divisions up and running in any noticeable way.
The Census Bureau says about 60 million people work for U.S. small businesses. That means that SHOP exchange plans could be covering as many as 100 million workers and dependents.
Charles Gaba of ACASignups.net has estimated the SHOP exchanges might have enrolled about 330,000 people in 2015 coverage.
Vermont has boosted its SHOP numbers by requiring small groups to get their coverage through its exchange. The District of Columbia has increased its SHOP enrollment both by requiring small groups to get insured coverage through the exchange and by covering members of Congress and many congressional aides. (The U.S. Office of Personnel Management has applied a PPACA provision requiring lawmakers and some aides to have exchange coverage by telling the affected Capitol denizens to sign up for coverage through the DC Health Link’s SHOP division.)
But the U.S. Department of Health and Human Services (HHS), the parent of HealthCare.gov and the regulator of the state-based SHOP divisions, has not even bothered to publish SHOP enrollment numbers.
The struggling state-based exchange in Nevada, which shifted to using the HealthCare.gov enrollment system this year, reported in February that it had enrolled only six people in SHOP exchange coverage.
Meanwhile, when the NFIB analysts conducted their latest business owner survey, in June and July, they found that 41 percent of the 910 owners polled were offering health insurance to employees, and that 59 percent weren’t.
Fifty-two percent of the owners that don’t offer coverage gave “too expensive” as the top reason for not offering coverage.
Forty-eight percent of the owners that don’t offer coverage had no second reason for not offering coverage. “Too expensive” was the one and only reason they don’t offer coverage.
For five other sad NFIB survey findings, read on.
5. Only 63 percent of the owners that offered employee coverage had help from agents or brokers.
Four percent did not know whether they had help from producers, or refused to answer the question, and 34 percent said they set up their plans on their own.
See also: PPACA: Will Exchanges Be Producers?
4. As poorly as the SHOP system has worked, 23 percent of the employee-plan-sponsoring owners said they or their benefits advisors had looked into it.
Some business owners may not have heard of the program, and some may be disgusted by the idea of having anything to do with a PPACA program.
But a large minority of business owners at least gave the SHOP system and the small business tax credits a chance to win them over.
3. Twenty-nine percent of the owners affected by health insurance premium cost increases said the increases led them to delay, postpone or reduce business investment.
Eighty-nine percent of the owners said per-employee health insurance costs increased more than 5 percent, and 10 percent said costs increased more than 35 percent.
The most common response to the question about how cost increases had affected the owners’ businesses was a positive one: The owners said their businesses became more productive or more efficient.
But 21 percent said they responded by freezing or reducing employees’ wages, and 11 percent said they reduced non-health employee benefits.
2. Some of the owners are so broke, they themselves qualify for individual exchange premium tax credit subsidies.
About 41 percent of the owners said they had individual health coverage for themselves, and 224 were willing to talk about how they bought their coverage.
About 28 percent of those 224 owners said they got their coverage from a PPACA exchange.
Fifty-seven percent of the public exchange users, or about 15 percent of the individual coverage owners who described their source of coverage, qualified for PPACA premium tax credits.
1. Six percent of the business owners admitted that they have no health coverage for themselves.
They’re supposed to be the engine for our economy and the creators of many of our jobs, but good luck if they break a leg.