3 secrets about the ACA small-group exchange program

Just a few years ago, federal paperwork analysts were estimating that the Affordable Care Act exchange system’s Small Business Health Options Program (SHOP) division could attract 200,000 small groups per year.

Related: PPACA: CMS Talks SHOP

The builders of HealthCare.gov, the exchange enrollment and administration system for states unwilling or unable to set up their own exchange programs, struggled to reassure agents and brokers that they knew producers were important to small employers, and that HealthCare.gov wanted to have a good relationship with producers.

Related: CCIIO: Producers critical to small-group exchanges

Then, the individual exchange system opened. Technical glitches and management problems ate up so much exchange builder energy that HealthCare.gov and many of the state-based exchanges let SHOP implementation deadlines slip. Nevada, for example, had a state-based exchange with strong individual health sales, but so many technical glitches it switched to using HealthCare.gov for individual plan enrollment. In mid-April, an executive told the Nevada exchange board that, as of February, the state’s SHOP division was providing coverage for just six people.

The U.S. Department of Health and Human Services has infuriated Republicans in Congress by refusing to give even rough estimates of HealthCare.gov SHOP plan enrollment. A U.S. Government Accountability Office official, James McTigue Jr., gave a possible clue about the size of SHOP use in March, when he testified at a hearing that, in 2014, 181,004 employers used an ACA tax credit tied to SHOP plan use.

Emily Curran, a health policy analyst at a Georgetown University health think tank, and two colleagues have tried to fill the ACA SHOP information void by publishing a report on SHOP implementation.

Curran and her colleagues ran into a major obstacle: HHS would not give them any information about the performance of the HealthCare.gov SHOP division.

But managers of most of the locally based SHOP exchange divisions in 17 states and the District of Columbia were more helpful. The researchers found that those exchanges are serving employers with about 144,000 covered lives.

For a look at some of what Curran and her colleagues found, read on.

In March, Covered California was serving SHOP plans with 27,467 enrollees. (Image: Covered California)

1. Three SHOP exchanges have broken the 10,000-covered-life barrier without help from a mandate.

The District of Columbia and Vermont inflated their SHOP transaction figures by requiring all employers seeking fully insured group plans, including those using brokers, to sign up for the coverage through the SHOP exchange system.

The District of Columbia has another factor helping to increase its SHOP numbers: The ACA requires members of Congress and some of their aides to use ACA exchange plan coverage themselves. The U.S. Office of Personnel Management has arranged for those lawmakers and aides to get their health coverage through the D.C. SHOP division.

The District of Columbia reported having 924 SHOP plan sponsors and 19,768 SHOP covered lives in May.

Vermont had 4,007 SHOP plan sponsors and 44,787 SHOP lives.

The other three states with more than 10,000 covered lives are California, with 27,467 covered lives; Utah, with 14,748 covered lives; and New York, with 14,628 covered lives.

Managers of Mississippi’s SHOP program did not give the researchers any numbers.

Idaho, which started its exchange late, had 27 SHOP sponsors and 264 covered lives.

All of the other SHOP divisions had at least 98 sponsors and at least 717 covered lives.