Reform resonates with small employers

In contrast to large employers’ insistence on maintaining the current employer-based health insurance system, small businesses say that health care reform is a top concern, according to a survey by the Robert Wood Johnson Foundation. A recent report on reform notes that nearly one-third of the uninsured – 13 million people – are employees of firms with less than 100 workers.

The most popular health care reform measure, favored by 78% of the small employers to make health insurance benefits more affordable for them, is a combination of government-sponsored purchasing pools to obtain premiums at bulk rates and tax credits. More than two-thirds (68%) would support establishing a market-based approach that gives employees a tax credit to buy health insurance on their own, encouraging the use of health savings accounts, and enacting tort reform for medical liability. More than half of small employers (53% each) would support the following:

1) requiring employers that have at least ten employees and that do not provide health insurance to their employees to pay 4% of their payroll to cover the uninsured; and

2) requiring that employees be offered at least one public plan and one private plan, and also requiring that all insurance companies provide coverage without regard to age or preexisting conditions.

AHPs, anyone? Efforts to help small businesses with the challenges of providing health benefits have not had much success. To dredge up just one example from the past, remember the proposal to create federally licensed association health plans (AHPs)? Such AHPs would have been exempt from state laws and regulations (current Wolters Kluwer benefits customers, click here for an interview about the risks associated with such plans, according to one expert). That means AHPs would not have had to provide state-mandated health insurance benefits, such as emergency room services, diabetic health, cancer screenings or reproductive health services, just to name a few of the ever-growing list of state requirements. For this, and many other reasons, the proposal died on the vine.

We don’t know yet what Congress’ efforts to help small businesses provide health benefits will look like. But I bring up the AHP example to point out that which benefits – those required by state laws, the same (or similar) ones as covered by Medicare, newly created mandates or others? – might be provided is yet another issue that will need to be addressed.