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Delays to small biz health exchanges

July 1, 2013

On June 19, 2013, the Government Accountability Office (GAO) released a new report, “Patient Protection and Affordable Care Act: Status of Federal and State Efforts to Establish Health Insurance Exchanges for Small Businesses,” which explores the status of the Small Business Health Options Programs (SHOPs) across the states. Among the findings, GAO reports that many of the core functionalities of some of the SHOPS are behind schedule.

Enrollment in the SHOPs is scheduled to open October 2013 for insurance effective January 2014 or after. Already, there has been a delay to part of the SHOPs whereby the ability of employees to choose their own individual health plan, as offered through the SHOP, has been delayed by one year, meaning that employers for 2014 will still pick the health plan options for their employees.

The GAO report highlighted that, in the 18 states planning to operate their own SHOPs as well as the 33 states planning to utilize the federally facilitated SHOP (FF-SHOP) missed deadlines could impact implementation. Specifically, the report stated:

“CMS [Centers of Medicare and Medicaid Services] and states have made progress in establishing SHOPs, although many activities remain to be completed and some were behind schedule. CMS issued regulations and guidance necessary to establish SHOPs and took steps to establish processes and data systems necessary to operate the FF-SHOPs. For example, funding awards and development of a training curriculum for a key program that will provide outreach and enrollment assistance to small employers and employees have been delayed by about 2 months.”

And while GAO pointed out that CMS—the federal agency charged with overseeing implementation of the SHOPs—showed most states had accomplished first steps, such as approvals to run the SHOPs and other key areas, “[m]any key activities remained to be completed–some scheduled for near the start of enrollment in October 2013–and, as of May 2013, states were behind schedule in completing some key activities.”

Approximately 44 percent of the key activities identified by CMS to be finished by March 31, 2013, were behind schedule. To address these delays, CMS stated it is working with states to develop plans for implementation and that it doesn’t expect these delays to impact the implementation and operation of the SHOPs.

Despite these efforts, however, GAO was unable to conclusively say whether or not CMS will ensure timely and smooth implementation of the SHOPs.

SBAM will keep our members up-to-date on all happenings related to PPACA so stay tuned.

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