This morning, the U.S. Government Accountability Office released a report on enrollment in the Small Business Health Options Programs (SHOPs) created by the Affordable Care Act. Through June 2014, it found that "enrollment for [state-run] SHOPs has been significantly lower than expected." The 18 state-based SHOPS had enrolled about 76,000 individuals--including employees, their spouses, and dependent children--in plans purchased through nearly 12,000 small employers. Enrollment data for the federally run SHOPs (the marketplace for small employers in all the other states) isn't expected to be available until early 2015, but officials at the Center for Medicare & Medicaid Services said they do not expect major differences in enrollment trends for 2014 between state and federally run SHOPs. In other words: Don't expect big numbers.  

The low level of participation shouldn't come as a surprise to anyone who's been paying attention--or has tried to actually sign up for a health plan through one of the exchanges. Although premiums for SHOP plans were generally comparable to premiums for other small group plans offered outside of the SHOP--and small businesses could qualify for tax credits on coverage purchased through the SHOPS--the undeniably rocky rollout of the exchanges no doubt depressed enrollment.  

As the GAO report points out, key promised features of the online exchanges have been delayed--most notably, the ability to enroll online for plans offered through the federally run Healthcare.gov site. (That feature is finally supposed to go live on Saturday, November 15.) Additionally, so-called employee choice, the ability for employees to choose among multiple plans--while available for most of the state-run-SHOPs--has been delayed for federal SHOP plans. (Today's GAO report says that employee choice will become available for "many" states using Healthcare.gov for 2015 plans.) And although most SHOPs had multiple plans available in most counties, a small number of states had counties where no small group plans were available at all.  

Other factors the GAO identified as hindering the SHOPs' success so far include employer misconceptions about plan availability, and a small business tax credit that's too small and too administratively complex to motivate employers to enroll. Low enrollment for 2014 could also reflect the fact that many companies were able to renew or implement non-ACA-compliant plans before last January, as a way to avoid rate increases with new plans. These non-compliant plans can't be renewed again this year, though, which could also help send more small firms to the SHOPs for their 2015 plans. Then again, there's a growing view among insurance professionals and policy wonks that small businesses who aren't impacted by the ACA's employer mandate just aren't all that interested in purchasing group plans, and are opting for simpler ways to subsidize workers' health coverage

In conclusion, the GAO writes that "the SHOPs' long-term impact remains premature at this time." That's for sure.