ISSUE. The Small Business Health Options Program (SHOP), established alongside the Affordable Care Act's individual insurance marketplaces, has weathered the storms of its early implementation. But the program's future is uncertain. GOAL. To evaluate the impact of changes to SHOP since 2014, focusing on California and Colorado--two states that run their own marketplaces and have full-featured SHOPs. METHODS. Interviews conducted with more than 50 stakeholders and policymakers, as well as employee surveys. KEY FINDINGS. Although SHOP has made modest gains in enrollment in California and Colorado, and in the many states in which it is managed by the federal government, the program still covers fewer than 150,000 people nationwide. The relative fortunes of SHOP appear closely tied to the performance of the ACA insurance exchanges for individuals and families. Though the California and Colorado programs are similar in design, California's has had more success, largely because of its stability and the broad political acceptance of the ACA within the state. CONCLUSION. While SHOP has the potential to grow, especially if it evolves into more of a "one-stop shop" for employee benefits, the program has a long way to go if it is to become a focal point of the small-group insurance market.
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