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A Tale of Two SHOPs

A Tale of Two SHOPs

By Ken Ruotolo, Chief Operating Officer, May 19, 2017, < 1 Minute Read

Last week, the Centers for Medicare and Medicaid Services (CMS) announced that it will propose closing the small business enrollment portion of The reason: low enrollment in states that rely on this federal government version of the Small Business Health Options (SHOP) marketplace. Contrast that with recent news from Covered California for Small Business (CCSB), which is meeting sales targets, has a diverse mix of carriers and plans, operates without federal funding and is unaffected by the federal government’s proposed action on SHOP.

These federal/state differences are just as striking when comparing the ACA exchanges for the individual and family markets. In parts of Tennessee, there are no carriers planning to offer coverage in 2018 and in hundreds of counties in other states only one carrier will offer coverage, while in California’s exchange (Covered California), 11 carriers actively compete, providing a wide range of options to a sustainable mix of healthy and not-so-healthy members. The risk mix, in particular, is improving and allows Covered California to negotiate more competitive rates with the carriers, a trend that is rarely reported in the media.

The takeaway? It is very difficult to generalize the impacts of healthcare reform. Significant regional and federal/state differences dictate that as professional advisors, we should not assume that news at the federal level or in other states accurately reflects the situation in California.

This observation will be particularly useful when or if a new healthcare law is passed in Washington. How it gets implemented in California and how it will impact California could be vastly different from its implementation and impact in other states.

Contact the small group experts at 800.696.4543 or