One of the first and most interesting questions posed by the California Health Benefit Exchange (HBEX) to its Small Business Health Options Program (SHOP) stakeholder work group was “who is the SHOP consumer?” Early discussions clearly revealed a fundamental assumption that the “consumer” in SHOP was the employer. As a member of the stakeholder work group, we felt there were TWO consumers in a SHOP – certainly the qualified employer, but also the employee. The Children’s Partnership developed its report SHOP TALK: Recommendations for Ensuring Best Health Coverage Outcomes for Children and Families to highlight the potential of a SHOP to address not only employee needs, but those of family members as well. We hope the report has helped reframe the vision of SHOP, so that in addition to being a marketplace for small employers, it is also an important link to coverage for working families.
Small business health options programs (SHOPs), as envisioned under the Affordable Care Act, can be established by states as part of an Exchange. They are intended to create a small group purchasing market for employers with fewer than 100 employees. The goal is to both increase the number of small employers who offer coverage to workers, and to reduce the cost of those plans. There is no requirement that qualified SHOP employers offer dependent coverage to their employees, but we came to the view that SHOP can and should be a key part of the systems and linkages that connect everyone to coverage.
Because most children get their health coverage through employer-sponsored health insurance, a SHOP could also enhance the availability of coverage for dependent children. For that reason, we jumped at the invitation to serve on the HBEX work group and to contribute to the dialog about how to maximize SHOP success.
In “SHOP TALK” we share a series of recommendations we’ve submitted to the California Health Benefit Exchange Board. In ongoing, robust conversations we have also been able to suggest ways that HBEX can actually implement these recommendations. We’ve recommended that:
* HBEX explore how to broaden the consumer perspective so that a SHOP employee is regarded as a SHOP “consumer;”
* HBEX require the development and implementation of appropriate, systemic linkages between SHOP and other public coverage options;
* SHOP be specifically required to provide information to employees that will direct the employee to resources for determining eligibility for, and enrollment in, other available health coverage options including Medicaid and CHIP, for dependents;
* The SHOP employee application should provide an opportunity for employees to indicate if they have dependents for whom health coverage is needed or sought;
* HBEX should ensure that SHOP families are made aware of, and have access to, the most suitable and affordable coverage for children.
The California HBEX appears to be putting SHOP on its policy and operational roadmap. Several provisions for the implementation of our recommendations were included in California’s recent Request for Proposals for its eligibility, enrollment and retention IT system, so we are hopeful that the important family linkages we have highlighted will be developed. But in many ways, this conversation is just beginning. The focus on Exchanges has largely been on the individual Exchanges – we hope other advocates will consider and comment on the tremendous potential of SHOP to enhance family coverage. And please share your ideas and thoughts with us as well.