While the Small Business Health Options Program, known as SHOP, element of the Affordable Care Act has failed to lift off in most states, Rhode Island’s state-run exchange — HealthSource RI — leads the pack of those that managed to get their programs up and running. One reason could be that the exchange worked closely with benefit brokers and advisers on their SHOP’s design and enrollment.

“Right from the start we’ve been involved. They’ve sought our opinion and input and they knew they needed to include us in order to drive enrollment. I think they’ve been receptive to what we’ve suggested,” says Jim Borah, senior benefits consultant at Cornerstone Group in Warwick, R.I. and member of the exchange’s Expert Advisory Committee. 

So far, HealthSource RI has provided coverage via SHOP to 175 businesses totaling 1,110 lives, which is a bigger percentage of the population than any other state, according to data released by the exchange. These numbers represent 0.1% of the population, double the percentage of New York’s SHOP enrollment which came in second, HealthSource RI data provided to POLITICO states.

See related: SHOP is a flop for brokers across the nation

See related: Lawmakers upset by HHS silence on SHOP enrollment numbers

SHOP exchanges in the 36 federally run states saw more trouble than the rest because the website never become operational. The U.S. Centers for Medicare and Medicaid Services only accepted paper and call-center applications in those states and did not allow employee choice, or a defined contribution model, as a part of the plan design for 2014. Most state-run exchanges continued their SHOP development and Rhode Island was one that did allow for employee choice of tier after their employer selected a plan option.

Borah says the process hasn’t been all rosy. His firm has enrolled about half a dozen groups, and of the few that they signed up for Jan. 1 effective dates, there were issues connecting premium data to the carriers, ensuring identification cards were correct and received by consumers and more. “It hasn’t been tremendous enrollment … but I guess compared to other SHOPs it’s something,” he says, adding that businesses they’ve enrolled more recently have seen fewer problems.

The smallest state’s success with this component of the ACA isn’t all that surprising. In August, former HealthSource RI marketing director Ian Lang, who left the outfit for the private sector in January, told EBA that they were putting a major focus on SHOP. “We're one of the only states where a lynchpin of our success is through small business," he said.

Because of the state’s size, brokers are legally only allowed to conduct SHOP enrollments and cannot enroll individuals. Lang said in August  there are around 300,000 lives associated with small businesses in the state, so there’s a rich market for brokers.

Borah says he’s not using SHOP as the be-all and end-all option for his small groups. “Our process at our firm is, when we meet with small groups we talk about the different options and Healthsource RI is one of them,” he says, adding that he’s seen some small businesses reject or request the idea on a matter of principle in opposition or support of the law and others who take more of a business-minded approach to the decision if it’s cost-effective.

Borah adds that there’s a question mark around HealthSource RI’s funding, because of the requirement that state-run exchanges procure standalone finances from the federal government by 2015.

“At this point when we talk with groups about the exchange, we don’t know for sure that it’s going to be around next year, it is a little bit of a concern, Can we really put a group on there?,” he says.

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