In contrast to the widely publicized enrollment numbers on the health care law’s individual marketplace, there’s apparently no way to know how many business owners and employees have signed up through the law’s new small-business exchanges.
By all indications, though, it’s not very many.
One House Republican has twice asked federal health officials to provide data on how many owners and employees have enrolled in and paid for plans through the law’s new insurance marketplaces for small businesses. Since the launch last fall, the employer portals, known as SHOP exchanges, have suffered even more technical problems and delays than the exchange for individuals and families.
“The SHOPs opened, although without online enrollment and many promised features, on October 1, 2013,” Rep. Sam Graves (Mo.), chair of the House Small Business Committee, wrote in his latest letter to the Centers for Medicare and Medicaid Services, which oversees the exchanges. “Over seven months later, we still do not have any federal and some state SHOP enrollment data.”
In response to a similar letter earlier this year, officials informed Graves that the “metrics you requested are not currently available.”
Now we know why.
Responding to an inquiry concerning the latest request from Graves, CMS officials explained that, unlike on the individual exchange, employers are not required to first verify their eligibility with federal regulators before enrolling in a plan on one of the state-based or federal small business exchanges.
Moreover, because employers using the small business exchange may enroll at any point during the year — unlike shoppers on the individual exchange, who have a limited enrollment window — they say the numbers on the small-business sites are harder to track.
Despite those challenges, then Health and Human Services Secretary Kathleen Sebelius told Graves in the agency’s first response back in March that her team was “working to collect enrollment data from insurance companies” and would provide “SHOP enrollment data at a later date.”
However, the response to Graves’s second request for that data, courtesy of HHS Assistant Secretary for Legislation Jim Esquea, made no mention of any attempts to collect small-business enrollment data from insurers or whether that information, if gathered, would be made available.
In the absence of national totals from HHS, we can still get a sense of the enrollment based on anecdotal evidence from states that elected to run their own health insurance marketplaces.
In the District of Columbia, for instance, roughly 45,000 people have enrolled in plans through the city’s health care exchange, known as DC Health Link. However, fewer than 600 of those are employers or employees who signed up through the small-business portal.
New York’s state-run exchanges, meanwhile, have racked up nearly a million enrollees, but only about 10,000 came in through the small business marketplace. In California, through the end of March, 1.4 million people have signed up through the individual marketplace, while only 5,000 had bought plans through the SHOP exchange.
It’s a similar scenario in Colorado and Connecticut, which built their own exchanges and had signed up a few hundred small businesses through the first four months of enrollment.
A number of factors have likely depressed the small business enrollment numbers — namely, that health officials at both the federal and state level have put significantly more emphasis on fixing early technical problems with the individual exchanges. Consequently, employers in many states, including those using the exchange run by the federal government, don’t yet have access to online enrollment.
Additionally, HHS officials allowed states not to implement this first year a key cost-cutting feature that would have allowed business owners to give their employees a choice of multiple plans through the SHOP. Without that option, experts say small business owners are less likely to consider the small-business exchanges.
Thus, with the agency last month approving 18 states’ requests to delay that feature for yet another year, it appears less likely that those small-business enrollment numbers will turn around in 2015.