Obamacare’s SHOP could be facing a big chop.
Citing very low enrollment, the Trump administration on Monday proposed that beginning in 2018 small businesses would no longer be able to enroll workers in health insurance plans through the federal Obamacare marketplace HealthCare.gov
A top Trump health official said the suggested move was prompted by the failure of Obamacare to provide affordable health coverage through the SHOP program “to small businesses and to the American people.”
Nationally, there are fewer than 233,000 people covered via SHOP plans — far short of the 4 million people that the Congressional Budget Office in 2014 had predicted would be covered by this year.
The program, formally called the Small Business Health Options Program, is open to employers with 50 or fewer full-time workers.
Under the proposal announced Monday, small businesses in the 33 states served by HealthCare.gov for SHOP would still use that exchange to determine their eligibility for the program.
But they would have to buy health coverage for employees from an insurance agent or broker, or from an insurance company directly.
Small businesses that buy SHOP coverage in other states would be unaffected by the move, which was announced by the federal Centers for Medicare and Medicaid Services.
And employers with fewer than 25 workers that are eligible for a Small Business Health Care Tax Credit through their purchase of SHOP coverage will still be able to get that credit.
CMS pointed to low participation by small businesses in the SHOP program in announcing the proposal to end sign-ups on HealthCare.gov, which would be accomplished through a change to regulatory rules. The public would be allowed to comment on the proposed rule change, and CMS could modify its proposal in reaction to those comments.
“Out of the nearly 30 million small businesses in the country, less than 8,000, just 0.1 percent of small businesses currently participate in the [federally faciliated]-SHOPs in 33 states,” CMS said.
And just 38,749 people are covered through HealthCare.gov-sold SHOP plans, according to CMS.
Seema Verma, administrator of CMS, said, “Our goal is to reduce ACA burdens on consumers and small businesses and make it easier for them to purchase coverage.”
“The ACA has failed to provide affordable insurance to small businesses and to the American people,” Verma said. “The new direction will help employers find affordable health care coverage for their employees and make SHOP exchanges function more effectively.”
CMS said the move will “reduce the federal government’s role in health-care coverage decisions and make it easier for issuers to use their own enrollment systems for SHOP plans.”
“Employers that have enrolled in SHOP coverage for plan years that began in 2017 would be able to continue using HealthCare.gov in 2018 for enrollment and premium payment, until their current plan year ends and it’s time to renew,” CMS said. “Employers can sign up for SHOP coverage taking effect in 2017 on HealthCare.gov until November 15, 2017.”
The Small Business Majority, an advocacy group, said it was “very disappointed” in the proposal, calling it “just one more example of how the Trump administration would rather undo key parts of the Affordable Care Act that are good for small businesses, their employees, their families.”
“Forcing small employers to make this extra effort just to enroll in SHOP will make it likely that SHOP usage dwindles to little or nothing,” said John Arensmeyer, founder and CEO of Small Business Majority.
“As disappointing as this proposal is, it does not come as a surprise since the success of SHOP has not been a priority,” Arensmeyer said. “Thanks to delays of key SHOP provisions like implementation of employee choice, and lack of efforts to ensure the SHOP marketplaces are robust and competitive, the program has not been nearly as successful as we had hoped.”
Obamacare mandated the creation of the SHOP program to sign up workers at smaller companies in health insurance plans.
SHOP was designed to fill a need for people who did not work at larger companies that Obamacare now requires to offer health insurance to their workers or face a fine.
But unlike the other, better-known part of HealthCare.gov, which enrolls people in individual health plans, the SHOP portion of the exchange since 2014 has “failed to sign up significant numbers of small employers,” CMS said Monday.
In contrast, HealthCare.gov signed up 9.2 million people in Obamacare individual health plans during open enrollment for 2017. Another 3 million people signed up for individual plans sold through state-run marketplaces.
In data released Monday, CMS said 19,651 small businesses used SHOP plans sold in states that run their own Obamacare marketplaces, covering nearly 194,000 people. The total number of employers using SHOP plans nationally, after including enrollment from HealthCare.gov, is 27,205 small business, with 232,698 people covered.
In the HealthCare.gov state of Florida, which has a population of 20.6 million people, just 579 business have enrolled in a SHOP plan, covering just 2,631 people.
In Texas, where 27.8 million people live, only 1,158 employers are using a SHOP plan, covering 5,753 people.
The District of Columbia, which operates its own Obamacare marketplace, has a population of fewer than 682,000 people, but it is the SHOP enrollment leader nationally, with more than 3,900 employers participating in SHOP, covering 64,805 lives, according to CMS.
Vermont, which also runs its own exchange, has a population of fewer than 625,000 people, but also has more than 4,000 small businesses participating in SHOP plans, which cover 46,099 people.
California, which like D.C. and Vermont operates its own SHOP exchange, has more than 4,300 small businesses using SHOP plans, covering almost 32,700 lives, CMS said.