Pacific Community Ventures, a San Francisco based non-profit funded by the California Endowment recently presented the results of a study called, CA_Small_Business_Decision_Making.pdf: Understanding Health Care Decision Making in California at the December board meeting of the California Health Benefit Exchange. The study focused on health care decision-making attitudes by owners of small businesses with fewer than 20 employees. Methodology included focus groups in Oakland, Fresno and San Diego and a telephone survey with n-depth interviews of over 800 CA small businesses in the spring of 2011.

Key Findings

• Awareness of the Exchange is low among CA small business owners; 62% have not yet heard about the Exchange
• When small business owners learn about the Exchange, they are more likely to offer coverage through the Exchange
• Many small business owners will learn about the Exchange from insurance brokers. Those who don’t use them may learn from accountants or industry organizations.
• Messaging about the Exchange should downplay the role of government.

Two strong messages conveyed by the study will prove challenging for the California Health Benefit Exchange.

• Few small business owners (25%) trust state government agencies in health care. “Small businesses do not want to see ‘.GOV’ on the website”. Most (65%) trust their insurance brokers to help them make decisions about health insurance.
• Small business (67%) don’t value expanded “employee choice” as offered in the SHOP Exchange model.

The distrust small business owners in this study voiced for state government agencies in health care was clearly not something the Exchange board wanted to hear and in fact one of the board members made a dismissive comment referring to “tea party” attitudes. Indeed, the majority of small business owners are white (80%), male (81%) and Republican (46%). It’s not surprising that most Exchange board members have a different political bias, however the SHOP Exchange will need to be successful in all of California not just Sacramento.

Employee choice (the option to select from a wide variety of health benefit plans from multiple carriers) is thought to be a major selling point of the SHOP Exchange. The fact that small business owners don’t agree should be very disappointing news for the Exchange board. Whereas the individual market exchange will be the exclusive provider of public insurance plans and subsidized private health insurance, the SHOP exchange lacks a compelling attraction. The SHOP will have compete on a more-or-less level playing field with private exchanges, insurance carriers and brokers.

Pacific Community Ventures, a San Francisco based non-profit funded by the California Endowment recently presented the results of a study called, CA_Small_Business_Decision_Making.pdf: Understanding Health Care Decision Making in California at the December board meeting of the California Health Benefit Exchange. The study focused on health care decision-making attitudes by owners of small businesses with fewer than 20 employees. Methodology included focus groups in Oakland, Fresno and San Diego and a telephone survey with n-depth interviews of over 800 CA small businesses in the spring of 2011. - Small business (67%) don’t value expanded “employee choice” as offered in the SHOP Exchange model.