Initially created with the goal of helping small businesses comply with the requirements of the Patient Protection and Affordable Care Act (PPACA), the Small Business Health Options Program (SHOP) has not been meeting expectations.

According to Don Donner, CEO and president of the National Federation of Independent Business (NFIB), "Almost no one is using the SHOP exchange, according to the government's own enrollment data, and to the extent that there are subsidies available in the form of tax credits, they are complicated, temporary, and too small to offset the costs."

A February 26, 2015, letter from Steve Chabot (R-Ohio), chair of the U.S. House of Representatives Committee on Small Business, to Sylvia Burwell, secretary of the U.S. Department of Health and Human Services, highlights these concerns, with a focus on problems associated with incorrect SHOP tax forms that were recently sent out by HHS.

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