UPDATE: There's a reason you never see SHOP data reported in ASPE or CMS reports.
2018 MIDTERM ELECTION
Time: D H M S
Long-time readers know that ever since I started this project in 2013, I gradually added and enhanced the healthcare coverage data that I was tracking. First it was exchange-based QHPs only; then I added (or separated out) Medicaid expansion, SHOP (small business) exchange enrollment, off-exchange individual policies and so on. The off-exchange numbers were always significant but spotty because most insurance carriers are very cagey about breaking out their membership in too much detail if they don't have to, and many state insurance departments don't bother to track (or at least publicly report) those numbers.
SHOP enrollment, on the other hand, should be very cut and dry. Like exchange-based individual QHP enrollments, there's no reason why these shouldn't be included in every regular exchange enrollment report, and several of the state-based exchanges do just that...although in some cases, even that's a bit fuzzy. For instance:
- In March 2015, Covered California reported 16,000 employees covered by SHOP plans, which I assumed was actually closer to 40,000 when you included dependents. Unfortunately, I was later informed that this actually included family members; it was only 16,885 total covered lives.
- Connect for Health Colorado just reported 2,897 SHOP covered lives as of 4/30/16...except that's cumulative for 2016, so the currently-effectuated number could be a bit lower.
- Connecticut had 1,100 SHOP enrollees back in February 2015. I probably have a more recent number for CT, but can't find it right now.
- DC Health Link recently reported 27,583 SHOP enrollees as of 4/12/16 (the number is disproportionately high because this includes Congressional staffers). However, this is cumulative since way back in 2013. Last June, for instance, it was only 19,124 people; I find it hard to believe that they increased SHOP enrollment by 44% since then.
- Hawaii reported 2,400 SHOP enrollees way back in January 2015...but their numbers turned out to be highly questionable.
- Massachusetts reported 5,522 SHOP enrollees state-wide as of 3/31/16
- Minnesota just reported 1,929 SHOP enrollees as of 4/17/16
- New Hampshire is the only non-state-based exchange state which regularly reports exchange enrollment; they had a mere 847 SHOP enrollees as of the end of April (this was a major correction from erroneous data entries in earlier months)
- New Mexico reported 877 covered lives via SHOP back on 6/30/15
- New York hasn't reported SHOP numbers since 2014 to my nowledge, but they did state around 10,000 covered lives as of 3/29/14.
- Rhode Island: 4,075 covered lives as of 2/20/16
- Vermont has been radio silent for a solid year now, and didn't give out much SHOP data last year, but in July 2014 they repoted exactly 33,696 SHOP enrollees. Like DC, Vermont has an unusually high number of SHOP enrollees, although it their case, it's mainly because of a state law which requires all individual and small business policies be sold through the Vermont Health Connect exchange.
- Washington State: The most recent SHOP number I have for WA is just 535 people.
So...a hodge-podge of states reporting SHOP numbers from as recently as last month...or as out of date as 2 years ago.
Unfortunately, neither HHS, CMS nor ASPE has ever included SHOP enrollment data in their official reports.
In the past I've tried extrapolate out from some of these numbers nationally based on the total population of the state or the ratio of individual QHPs to the SHOP numbers, but this proved to be pretty futile. I came up with a range of somewhere between 180,000 - 300,000, but always knew that was awfully shaky.
Since I had absolutely nothing to compare against, so eventually gave up even trying. Obviously the numbers are so low that they aren't even bothering to mention them.
However, it turns out that Kevin Counihan, CEO of HealthCare.Gov, did mention a specific, national SHOP enrollment number last July in a blog post...sort of (h/t to Rachel Karas for the heads up):
On November 15th, 2014 we launched the HealthCare.gov portal for 33 states to enroll in SHOP Marketplaces. As of May 2015, approximately 85,000 Americans have 2015 coverage through SHOP Marketplaces with about 10,700 small employers participating in SHOP Marketplaces. These totals do not include employers that began coverage in 2014 and have not yet renewed their coverage through HealthCare.gov for 2015.
More than 500 businesses have enrolled each month using HealthCare.gov since November 2014. Because employers may begin participating in SHOP Marketplaces at any point during the year, additional employers and their employees are expected to enroll each month through the end of 2015.
OK, so that's 85,000 as of last July, ouch. However, besides the lack of 2015 renewal data, there's a footnote:
 As of May 2015, Vermont and Idaho are State-based SHOPs, and have not reported 2015 enrollment data to CMS and are not included in this total. Included in this total are Minnesota and Utah’s enrollment data, which includes employers and participants in SHOP that had coverage beginning in 2014 and carried over into the 2015 calendar year in addition to 2015 enrollment. Also included in the total is California’s enrollment data, which includes employers and participants in SHOP that had coverage beginning as of November 2014 and carried over into the 2015 calendar year, in addition to 2015 enrollment.
OK, I can't really tell whether this includes the other state-based exchanges, but assuming it does, that just leaves Vermont and Idaho; call it around 35,000 more between the two? That would bring the grand total up to around 120,000 nationally. If it doesn't include the SBE's besides CA, MN & VT, the total may have been up to 45,000 higher, or around 165,000 total.
I'm fairly certain that the SHOP numbers haven't improved much for 2016, so my new, best guesstimate is that somewhere between 120,000 - 170,000 people are enrolled in exchange SHOP policies as of today.
I have no idea why CMS hasn't been including the actual data in their reports, however. Yes, the numbers are anemic...but everyone already knew that. Publish and be free.
UPDATE: I've been informed that one of the reasons for the lack of SHOP data in the official reports is that many small businesses did enroll in the SHOP program over the past 3 years, but did so off of the official exchanges, directly via the carriers; this was particularly true in 2014, when the online federal SHOP exchange wasn't even operational--the odds are that more businesses did so off-exchange than on-exchange that year as well as in 2015.
I'm sure this is true, but it still doesn't explain the inability to track on-exchange SHOP enrollments; this seems no different from the individual market, where 12.7 million people enrolled on-exchange and an unknown number (estimated to be around 7 million or so) enrolled off exchange. In the case of SHOP, the ratios may be skewed heavily off exchange (it could be 130K vs., say, 500K?), which is fine...but they should still be able to report those 130K. Obviously they have the capability to do so, since Counihan did exactly that in his blog post, at least for most states.
So really, the answer is: Between 120K - 170K on exchange, plus an unknown (but likely larger) number off exchange.