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SHOP: Can it Boost Health Coverage for Small Business Employees?

Dec 14, 2015, 6:04 PM, Posted by Katherine Hempstead

A new report shows that small business owners care about the health insurance coverage they offer their employees, yet the Small Business Health Option Program (SHOP) remains an untapped resource with the potential to help employers find affordable plans.

In 1942, Ken Wilson’s grandfather started Bonnie Brae Conoco, a full-service gas station and neighborhood garage in Denver. Today, Ken is the third generation to manage the business. They’ve offered their employees health insurance since 1970, paying 100 percent of the costs for those who work full-time. Although it’s their largest expense, the Wilsons believe offering coverage is essential. They want to take care of their employees and attract and retain the best people.  

Small businesses, like all businesses, have struggled to keep up with the rising cost of health insurance. But unlike larger companies that can leverage their purchasing power to negotiate lower premiums and more comprehensive benefits, small businesses often have a choice of costlier plans with skimpier benefits. A recent study found small firms are far less likely than larger firms to offer health coverage. In 2012 and 2013, the percentage of small employers offering health insurance was 35 percent, while the percentage of large employers offering insurance was 95.8 percent.  

The Affordable Care Act (ACA) has several implications for small businesses. Under the ACA, small business health plans are subject to the marketplace regulations similar to those in the individual market. Depending on the state in which the business is located and the characteristics of the work force, these changes could make premiums change a lot or a little. Many small businesses are still offering pre-ACA plans, and many of them will need to transition to ACA-compliant coverage in 2017.

One new opportunity is the Small Business Health Options Program or SHOP, which is an online marketplace where small business owners with 50 or fewer full-time employees can purchase health insurance for their workers. Features of SHOP attempt to provide flexibility for both employers and employees. Business owners can set their contribution and their employees can choose the plan and benefits they want. Small business owners with 25 or fewer full-time employees can also qualify for a tax credit to put toward the cost of coverage.

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A Portrait of Women with Health Insurance

Feb 19, 2015, 2:21 PM, Posted by Susan Dentzer

2015 Health Care Coverage Billboard Image

For the second year running, more women than men have signed up for coverage in health insurance marketplaces during open enrollment under the Affordable Care Act. According to the Department of Health and Human Services, enrollment ran 56 percent female, 44 percent male, during last year’s open enrollment season; preliminary data from this year shows enrollment at 55 percent female, 45 percent male—a 10 percentage point difference.

What gives? An HHS spokeswoman says the department can’t explain most of the differential. Females make up about 51 percent of the U.S. population, but there is no real evidence that, prior to ACA implementation, they were disproportionately more likely to be uninsured than men—and in fact, some evidence indicates that they were less likely to be uninsured than males.

What is clear that many women were highly motivated to obtain coverage under the health reform law—most likely because they want it, and need it.

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The Unfinished Work of the Affordable Care Act

Dec 12, 2014, 8:45 AM, Posted by Brendan Saloner

Headshot of Brendan Saloner

The United States is the last remaining rich country in the world where a large percentage of the population lacks health insurance coverage. This situation is being improved under the Affordable Care Act (ACA), with recent estimates showing that from early 2013 to mid-2014 the uninsured rate dropped from 19 percent of adults to 14 percent. The uninsured rate will no doubt continue to fall in 2015, but the problem of the uninsured will not go away with the ACA. It will not go away even if all 50 states expand Medicaid for poor adults, and will not go away if the U.S. Supreme Court rules against the plaintiffs in a pending challenge to the power of the administration to provide subsidies in the federally facilitated insurance exchanges.

In its 2012 baseline estimate, the Congressional Budget Office (CBO) projected that by 2022 the ACA might cut the number of uninsured by half, but would still leave behind 30 million people without insurance. This projection assumed full implementation of the ACA provisions. We don’t yet have a clear sense of how much larger that number will be with incomplete implementation of the core ACA coverage provisions, but even an optimistic assessment is that tens of millions of Americans will continue to spend periods of time without health insurance.

Who does the ACA leave behind? By design, the ACA excludes undocumented immigrants, a group that numbers around 11 million today. Some undocumented immigrants purchase private insurance, receive coverage from an employer, or participate in public programs funded with non-federal dollars, but the majority have no insurance. Undocumented immigrants are prohibited from enrolling in Medicaid, receiving subsidies, and purchasing coverage on the exchanges. Although President Obama recently signed an executive order protecting many undocumented immigrants from immediate deportation, the ACA exclusion will continue in the foreseeable future, barring an act of Congress. 

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What We Learned from the First Open Enrollment Period, and What to Expect from the Second

Nov 18, 2014, 10:32 AM, Posted by David Adler, Lori K. Grubstein

A man fills out an insurance application

It seems like just yesterday we were celebrating the victories from the first open enrollment period under the Affordable Care Act. More than 8 million consumers signed up for coverage through state and federal marketplaces, and millions more enrolled in Medicaid.

As the spring of success gave way to the summer of planning, we are once again in the autumn of enrollment. As work gets rolling for the second open enrollment period, it is an opportune time to reflect on lessons learned from the first open enrollment period, especially since the second one is shorter and there are fewer navigator resources available from the federal government.

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One Nurse’s Leadership Journey

May 10, 2014, 3:00 PM

Headshot of Cynthia Crone

Being asked to write a post about nurse leadership for National Nurses Week presents a wonderful opportunity to reflect on my nursing journey and express appreciation for the many nurses and other leaders who have played a supportive role in my development. A career in public health with an emphasis on vulnerable populations, including most recently directing efforts in Arkansas to implement the Health Insurance Marketplace, has reinforced with me the critical role nurse leaders play in the politics and policy of health care and how very important it is to foster and support community involvement and interdisciplinary collaboration by younger nurses. 

National Nurses Week Blog Logo

I started nursing school in the mid-1970s. Nurse practitioners were just coming on the scene. After graduation I obtained certification as a pediatric nurse practitioner and traveled to 10 rural counties to hold “well child clinics.” I learned a lot from the public health nurses. I loved my job. The work helped me better understand the bio-psycho-social-spiritual art and science of nursing and the social determinants of health. Further, through interaction with nurse and other community leaders, I learned that another element—political–can’t be ignored.

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Generation Y’s Role in Making the Marketplaces Work and Advancing a Culture of Health

Feb 24, 2014, 9:00 AM

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Every New Year brings New Year’s resolutions. It is a time for reflection on years past and to develop actionable changes needed for a hopeful and productive new year. Clearly 2014 is no exception. With the New Year already in full swing, I encourage people—yes, this also includes you, Generation Y—to enroll in a health insurance plan and take advantage of the Affordable Care Act’s (ACA) current and new coverage opportunities in an effort to advance our nation’s culture of health.

You might be asking yourself a few questions such as: Who is Generation Y and why are they important? I am happy to provide answers.

The largest generation, Generation Y, or Millennials, consists of young adults born between 1977 and 1994. This important demographic is key to obtaining a sustainable health care exchange system with affordable insurance plans. Healthy Millennials must enroll in the marketplace to offset the high costs acquired by the disproportionate number of Americans with high medical costs. Unfortunately, only a small number of young adults have participated in the health care exchange since open enrollment. This isn’t surprising. 

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Affordable Care Act Marketplaces Can Contribute to Health System Transformation!

Feb 14, 2014, 9:00 AM, Posted by Jay Himmelstein

Jay Himmelstein, MD, MPH, is a professor of family medicine and community health and chief health policy strategist at the Center for Health Policy and Research at the University of Massachusetts Medical School (UMMS). He serves as a senior advisor to the UMMS Office of Policy and Technology, and is a senior Fellow in health policy at NORC, University of Chicago. Himmelstein is an alumnus of the Robert Wood Johnson Foundation Health Policy Fellows program, where he worked on the health staff of Senator Edward Kennedy. This post is part of the “Health Care in 2014” series.

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The nation's attention has focused in recent months on the politics and challenges related to the roll-out of state and federal health insurance marketplaces created by the Affordable Care Act (ACA). Despite website technical woes, significant numbers of Americans have already gained access to affordable insurance plans through the marketplaces and other provisions of the ACA, and it appears likely that the ‘marketplace’ concept will be successful over time in connecting consumers to health insurance and significantly decreasing the ranks of uninsured.

The better functioning marketplaces currently allow consumers to: 1) determine eligibility for subsidized health insurance, 2) use basic online shopping tools to compare and purchase health insurance plans based on four different "metallic tiers" (i.e., the platinum, gold, silver, and bronze tiers), and 3) make side-to-side comparisons between these plans on features such as deductibles, out-of-pocket cost limits, and number and proximity of doctors and hospitals. A few marketplaces also offer information about plan quality, the ability to search for health care providers and hospitals associated with specific plans, and rudimentary ‘cost calculators’ which estimate the total cost of plans inclusive of premiums, deductibles, and out-of-pocket costs.

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New Infographic, Premium Payment Extension Will Help People Signing up for Health Insurance Coverage

Dec 27, 2013, 11:00 AM

Americans Health Insurance Plans, the trade association of many of the U.S. health insurance companies, has released a very easy to understand new infographic that helps simplify the steps for buying health insurance on the federal or state exchanges under the Affordable Care Act.

The new infographic is not the only bonus from the trade association this season. Last week the group announced that most insurers are extending the deadline for people purchasing coverage to pay their premiums to January 10, so long as signup for the plan is before January 1. Coverage for those signups will be retroactive to January 1.

This commentary originally appeared on the RWJF New Public Health blog.

Enrollment through Health Insurance Exchanges Lagging, but Humming Along In Medicaid in Many States

Nov 4, 2013, 1:22 PM, Posted by Susan Dentzer

Susan Dentzer Susan Dentzer

Amid the attention focused on technology flaws of the nation’s new health insurance exchanges, a happier story has received less attention:  the relative ease with which many Americans newly eligible for an expanded Medicaid program are now enrolling in coverage in many states. There’s a lesson in this story for all of us—that governments at many levels can, and often do, get things right. But sometimes it takes years of effort, policy changes, big dollar investments, and improved know-how to make all the processes work.

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A Success Story: Health Insurance Enrollment in Colorado

Oct 16, 2013, 10:00 AM

Sue Birch, MBA, BSN, RN, is executive director of the Colorado Department of Health Care Policy and Financing, and a Robert Wood Johnson Foundation Executive Nurse Fellow (2002).

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Now that I have caught my breath, I wanted to share the Colorado report on Obamacare’s October 1st Birthday!  Our state has decided to expand our Medicaid program and to form our own marketplace for Coloradans to shop and compare health insurance plans.  These changes will help us cover many uninsured Coloradans. 

In its first week, Connect for Health Colorado, our state’s health insurance marketplace, successfully attracted more than 162,941unique website visitors, had 9,658 calls and chats to the service center, and 18,174 accounts created.  We think this is a strong start and know that it will take time for Coloradans who have not had insurance before to learn about their options and apply for coverage.  We are working across state government to help make this happen.       

At my department, Health Care Policy and Financing, Coloradans can enroll through our new modularized interoperable cloud-based system, PEAK.  We had more than 9,000 applications come through this site in the first 10 days of October.  It is foundational to our desire to increase new consumerism and greater client responsibility by walking through a self-enrollment process.  Our website is Colorado.gov/PEAK and we have seen record traffic to the application site.

Overall, the marketplace opening went quite smoothly for Colorado—the exchange opened successfully, Medicaid began, and our technology functioned efficiently for being such a large, complex system. With the marketplace now up and running, individuals, families, and small employers can start making appointments with Health Coverage-Guides, learn about plan options, and apply for insurance when ready.

This is an exciting moment in health care history and we are proud to be working with partners across our state and our nation to provide affordable health insurance options to all residents of Colorado!

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.