The launch of Obamacare was accompanied by promises to small businesses that they would have a straightforward, easy-to-use portal to providing health insurance to their employees. Reality turned out differently, and few businesses participated. Now President Trump has announced his intention to scrap the provisions of the Affordable Care Act that allow for small businesses to enroll employees through healthcare.gov.
The ACA’s small business enrollment system is slated to be phased out by 2018 and is one of the first tangible steps in the administration’s broader efforts to make good on Trump’s plans to dismantle the health care law. Congressional budget predictions for the Small Business Health Options Program (SHOP) were set at roughly 4 million enrollments, but according to The Hill, just 85,000 employees of about 11,000 small businesses participate. The Centers for Medicare and Medicaid Services claim that number is under 39,000, making it an easy target for an administration looking to make a move on a major policy promise.
Instead, small businesses will be able to work with insurers or brokers to provide for their employees starting January 1.
According to the Washington Times, Seema Verma of the Centers for Medicare and Medicaid Services said, “The ACA has failed to provide affordable insurance to small business and to the American people. This new direction will help employers find affordable health care coverage for their employees and make the SHOP exchanges function more effectively.”
Under the new proposal, 33 states that use the healthcare.gov exchanges would see their businesses with 50 or fewer employees continuing to use the site to determine eligibility, but going through insurers and brokers for coverage.
The healthcare.gov SHOP exchanges were designed to pool risk for businesses too small to do it on their own, but few businesses pursued the option -- with some opting for more choices and flexible options through PEOs.
The Washington Business Journal reports that Sabrina Corlette of the Center on Health Insurance Reforms at Georgetown University's Health Policy Institute pointed out that insurers themselves never bought in fully to the ACA’s SHOP marketplace:
“"I think this is a purely practical decision that reflects the fact that carriers are deciding to drop out of the SHOP," Corlette said. "The truth is these SHOP marketplaces, with the exception of D.C. and Vermont, never got off the ground. If you don't have carriers, you don't have a market."
Small businesses continue to struggle with reading the Trump administration’s tea leaves on the future of health care requirements. With less-than-full agreement on the Republican side and options from Democrats that range from single-payer, universal coverage to keeping the status quo, businesses are left to wonder what 2018 will bring them -- and what it will bring their employees.
In a climate in which workers increasingly look to small businesses for career satisfaction and where high-quality, well-administered benefits are significant draws to both recruiting and retaining talent, businesses want solid options. Both employers and employees desire stability in this area: top-tier, Fortune 500-level health plans at affordable prices with minimal hassle for the businesses themselves.