Employer participation in the small group marketplaces, known as the Small Business Health Options Program (SHOP), is off to a slow start, with enrollment figures dwelling in the low thousands, and sometimes only in the hundreds. While SHOP has faced multiple challenges, benefit brokers have noted particular shortcomings with how states market the exchanges and major deficiencies with the content and value of benefit adviser training.

Brokers and agents have particularly been disappointed by how the new marketplaces fail to recognize and advertise the support brokers can offer in state marketing campaigns, which have focused instead on navigators and in-person assisters under contract to the exchanges, according to a recent Urban Institute report.

Benefit advisers also reported problems with the state-run broker training sessions, often finding the substance of them inadequate. In fact, in New York, the training and certification materials have been factually inaccurate—misstating the state’s insurance market rules that differ from the federal minimums. And, because the incorrect information was also reflected in questions on the certification test, instructors had to teach false information in order for the group to pass the test, hopefully correcting the group afterward.

See related story: Adviser training for 2015 SHOP enrollment to begin in July

In Colorado, the broker training session was held before the website was functional, so they were unable to learn how to interact with the system, leaving many feeling like the training was impractical. In Minnesota, two of the “true or false” questions on
the broker certification exam were, according to one source, “fluff questions,” such as, “MNsure can be relied on as a reliable source of information,” and “Using MNsure’s on-line tools can be fast, easy and convenient.” Questions such as these propelled the belief that the process was “embarrassingly uninformative.”

In Maryland, some sources complained navigators and assisters were inadequately trained on the SHOP and thus were unable to assist employers, the presumption being that the small employers would rely upon agents and brokers.

Brokers and agents also expressed frustration that the level of compensation was not commiserate with the time demands of selling coverage through the SHOP, which they consistently reported to be more time-consuming than the time it took to sell outside products. Applying for off-marketplace products requires simply filling out one or two short forms, while working with the marketplace can take brokers several days, especially if they have to educate employees about employee choice options.

Frequently, brokers felt that the training did not prepare them sufficiently for using the SHOP interface, sometimes requiring the broker to struggle through the website with little to no understanding of the system, which added more time to the enrollment process. It’s no surprise that brokers quickly lost interest in selling SHOP-based coverage. In states that allowed early renewal of policies, small-business groups reported that their brokers often urged them to renew their plan early rather than explore SHOP coverage. Thus, even brokers certified to sell coverage in 2014 generally stated that they conducted few to no sales through it, and many were unclear whether that would change in 2015.

“One of the main reasons that SHOP enrollment is low is because small businesses trust their brokers, and brokers have been steering people away from the SHOP,” noted one informant.

On top of complaints over the rate of compensation, with broker attribution systems have left some advisers uncompensated for completed work. Either the enrollment system does not properly inform the insurance company which broker helped sell the policy, or the enrollment system only allows for one name to be applied per consumer, leading to call centers dropping brokers from the system and vice versa. For example, if a small business employer used the Colorado call center, which staffs brokers and health coverage guides, even for a simple question, in order to receive compensation for the help, a call center broker could “drop” another broker’s assignment to the same small group, regardless of whether or not the call center broker actually conducted the sale.

Low-priority profile

With support from the Robert Wood Johnson Foundation, the Urban Institute conducted an analysis of early implementation experiences with the SHOP based on case study interviews in eight states: Colorado, Illinois, Maryland, Minnesota, New Mexico, New York, Oregon, and Rhode Island. Interviewers reached out to stakeholders in each state, including brokers and agents, small business representatives, insurance carriers, consumer advocates, and application assisters (navigators and in-person assisters). The project began tracking implementation and the effects of the Affordable Care Act in 2011 and will continue monitoring health care reform’s progress over several years.

Across most of the eight states studied, stakeholders perceived that SHOP had yet to be made a priority either at the state or national level. In six states, sources were not aware of SHOP-targeted marketing by state agencies, however Rhode Island marketing efforts were described as “robust” and those in New Mexico as “comprehensive.”

The one-year delay in the introduction of the federal online SHOP marketplace likely fueled the sense that this program was of secondary importance and led to lackluster public relations around the SHOP program.

Further, stakeholders reported a significant lack of awareness among the small-employer community, and that many of those who are aware of it do not understand its function or role in the market.

Thus, state agencies should enhance their marketing and sales efforts to engage employers and describe the SHOP program clearly and concisely as well as the value it brings to the existing small group market.

Unfortunately, developing such a convincing campaign about the added value of SHOP has been challenging due to limitations of the reach of the small business tax credit, early renewals, extensions of non-ACA compliant plans, and other issues.

 

 

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