It's no secret — cost remains the top cited reason why small businesses do not offer health coverage to their employees. This was true before the ACA, during the implementation of ACA, and now years after it. 

In its current state, major medical small group plans are far from an attainable reality for the majority of small businesses and their employees. Per the NFIB, of the 60 percent of small businesses not offering health coverage to their employees, 52 percent said the cost of coverage itself was the deciding factor. This, coupled with the cost of complying with coverage legislation, like the ACA, makes offering the benefit all the more unattractive. 

For brokers to ensure client retention and keep clients happy year over year, this is the sticking point: shop coverage options that are more affordable to the small businesses owner. Show clients that there are often additional cost savings options for employees and sustainable methods of providing affordable coverage. 

Flexibility

Make no mistake, the ACA has effectively covered more Americans than ever before. It has reduced coverage discrimination, worked towards stabilizing health care costs, spurred industry innovation, and placed regulatory guardrails enhancing the quality of health coverage. Yet much, if not most, of these positives directly benefited those in the individual market, a market that small businesses have been wary of taking advantage of. 

Small businesses are looking for a better way of taking advantage of the individual market for their employees. Per the NFIB, in 2015, 16 percent of small businesses attempted to do just that by helping pay for individual plans of their employees, and under the ACA, were penalized for it. Additionally, little was done to assist those contracted or self-employed benefit from the tax advantages of employer sponsored insurance. This, compounded with the regulatory compliance headache, left many small businesses wavering in the new health insurance landscape. 

Flexibility, as small business stakeholders see it, comes with new models for cost-sharing. A good place for brokers to start? Section 18001 of the 21^st Century Cures Act allows employers with less than 50 full-time employees to fund HRAs to pay for out-of-pocket medical costs and premiums for coverage purchased on the individual market, encouraging flexibility for small business employers to choose between the group market or the individual market, both in a tax-advantaged way. 

Predictability

Another side effect of what many small business owners viewed as convoluted legislation was confusion. Per the NSBA, 14 percent of small business owners spend more than 20 hours a month on federal regulations, noting the ACA as one of the most burdensome. Many were left feeling unsure of their compliance with the law, and also unsure of how to take advantage of it. The Small Business Tax Credit was one such example that small businesses felt was not simple nor broad enough to take full advantage of. 

For brokers, this means providing increased transparency to small business owners onto their coverage options year over year, and taking the time to sit down and explain existing and upcoming legislation. 

By prioritizing affordability, flexibility, and predictability of health care and coverage, brokers can be a bigger part of the solution in reducing the current barriers preventing mass entry into the health insurance market.