Although the ACA certainly expanded health insurance coverage, mostly through subsidies, creation of insurance exchanges, and Medicaid, small businesses generally did not expand coverage. A RWJ report from Lucia et al. (2015) used MEPS-IC data to track insurance offering among businesses with fewer than 50 workers.
Part of the reason is the rise of health insurance premiums. Further, the Small Business Health Options Program (SHOP) program–a ACA initiated marketplace in every state through which small employers can shop, compare and buy health insurance coverage–has had very low enrollment as most businesses feel SHOP offers little value over their current insurance options. Further the federal program is “so complicated and so hard to actually qualify for” that the modest tax credit employers received was not worth the effort to apply. Finally, some small employers are dropping coverage and transitioning employees to enroll in the individual health insurance exchange marketplaces.
- Lucia K, Corlette S, Ahn S, and Clemans-Cope L. Post-Affordable Care Act Trends in Health Coverage for Small Businesses. Views From the Market September 2015 Publisher: Urban Institute.