The debate on reforming America's healthcare system is raging in Washington. And, policymakers are legitimately concerned with how Congress's solution will affect small business. Remarkably, politicos in the debate are approaching the issue from very different perspectives.
Many politicians are focused on the uninsured. Congress wants to make sure that people who need it most have access to medical help. Small business owners, their employees, and their dependents make up the largest segment of the uninsured population in the United States. So, if you require every employer to provide health insurance, the problem is solved; right?
Politicians are also focused on how much it would cost every small business owner to provide health insurance and the economic harm to our economy if small employers are forced to swallow more costs or close down. Small business has a proven job creation track record and is responsible for between 60-80 percent of the net job growth in our country. Creating jobs is our way out of this recession, so we do not want to do anything that would make it harder for small businesses to hire; right?
Perhaps a different perspective on small business would help inform the debate. From 2002-2008, my job was to shape government policy from the perspective of small business. My government position brought me to cities like Providence, Trenton, Boise, San Marcos, and other places where small business is the life blood of their economy. Healthcare was a top concern voiced by small business owners at every roundtable, town hall, open forum, and coffee shop that I visited.
Every owner had a story and they all wanted to provide health care for their employees. I will never forget listening to the owner of a fish market in Providence, Rhode Island, who described meeting with his workers and tearfully explaining that he could no longer provide 100 % of their health care premiums. His experience was no different than thousands of other small employers who are faced with skyrocketing premiums on a yearly basis.
It is inaccurate to think that small employers do not want to provide health insurance for their employees. The opposite is true. Options that provide affordable health insurance with a focus on keeping costs down have always been attractive to the small business community. A key problem with legislation that Congress is considering right now is the lack of legitimate cost controls. And, if small business cares about anything, they care about cost. In fact, cost of health care has topped the list of small business concerns for twenty-years.
A legislative approach promoted by President Obama and under consideration in the House and Senate contains a public insurance plan that is described as "injecting competition" into the health insurance market. Small business may be skeptical that a government plan will keep costs down. It is hard not to resurrect images of the Pentagon paying $400 for a hammer and $600 for a toilet seat even after those stories were debunked. That skepticism was given new ammunition when the non-partisan Congressional Budget Office told Senators on Thursday that their legislation would not keep costs down and that, instead, "the legislation significantly expands the federal responsibility for healthcare costs."
Now that cost has risen in the healthcare debate as a primary concern, I hope the spotlight continues to shine on the views of small business. Policies that are designed to lower costs like allowing small businesses to band together across state lines for greater purchasing power and encouraging cost-containment through entrepreneurial approaches to healthcare like medication therapy management are solutions that small business can support.
As Congress continues its worthwhile attempt to fix problems with our healthcare system, issues concerning cost will continue to plague the debate. Small business owners are well positioned to provide solutions because they want to offer their employees health insurance and reverse the trend of rising costs that hits small business the hardest.
Tom Sullivan is part of a growing government affairs practice at Nelson Mullins Riley & Scarborough. Tom is a Senior Fellow in Regulatory Studies at the Institute for Liberty, serves on the Advisory Board of the NFIB Small Business Legal Center, and is an advisor for the Center for Small Business and the Environment.
