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February 2012 St@teside

Small Business Exchanges

The Affordable Care Act (ACA) requires the creation of Small Business Health Options Program (SHOP) exchanges to make coverage more accessible and affordable to small employers. The federal government will operate exchanges in states that do not set up their own by 2014.

Comments from the Center for Consumer Information and Insurance Oversight (CCIIO) provided at a conference of the National Association of Health Underwriters indicates that the federal SHOP exchange will allow brokers to sell and manage small business sales through those exchanges, and that commissions should be the same inside and outside of the exchange1. States that create their own exchanges will have to make a policy decision about how the exchanges will treat agents and brokers inside and outside of the exchange. Many states are currently grappling with this issue along with a myriad of other decisions.

State Coverage Initiatives (SCI) and the Wakely Consulting Group recently hosted a meeting for the State Health Reform Assistance Network (State Network) on SHOP policy and operational issues for state-based exchanges. The meeting brought State Network states and experts together for peer-to-peer learning that focused on:

  • SHOP functions and business operations;
  • SHOP federal requirements;
  • Market definition issues;
  • SHOP operations;
  • Interface with the SHOP and the exchange’s individual market; and
  • How to protect the SHOP against adverse selection.

SCI and Wakely brought both in-house and outside experts to the meeting including Phil Vogel, CEO of The Connecticut Business & Industry Association (CBIA), a private-sector exchange in Connecticut. To view all expert faculty presentations follow this link.

Final rules from CCIIO on the exchanges are expected soon.

1Hansard, S. (2012, January 30). CCIIO Director Outlines Principles for Federal Small Business Exchanges. BNA’s Health Care Policy Report (Subscription Only). Retrieved February 2, 2012 from,