As insurers encouraged many small employers to maintain policies that are not compliant with the Affordable Care Act, reforms such as the small business health options program (SHOP) marketplace have yet to be fully realized.
State and federal policymakers also are concerned with the notion of employers shifting away from traditional policies, and worry that midsize employers may soon be considered small employers under the ACA, according to a brief from the Urban Institute, with support from the Robert Wood Johnson Foundation.
In interviews with stakeholders from Arkansas, Montana, New Mexico, Pennsylvania and Vermont, the Urban Institute found that a number of state insurance departments are not actively analyzing enrollment data to track trends in the small-group market. And because many states do not directly regulate self-funded plans, they don't have pertinent available data.
While it varies from insurer to insurer, most of the small-group market remains in plans that aren't required to comply with the ACA. That's because many states left the decision up to insurers to decide whether or not to maintain small employers in non-ACA-compliant plans.
But as the brief points out, continuing to allow these plans means dominant insurers were able to safeguard their share of the small-group market for longer.
What's more, due to the availability of non-compliant ACA plans, the number of small employers interested in the SHOP marketplace has dwindled.
As noted by the Urban Institute, 2017 will be a critical year when it comes to assessing the true effects of the ACA on the fully insured small-group market. That's the year when employers with 51 to 100 employees will need to choose between joining the fully insured small-group market or shifting to another option.
In addition, politicians already have legislation in place that would overturn the expansion of the small-group market.
- here's the brief (.pdf)