Opposition from small businesses is generally viewed to be one of the reasons why Bill Clinton was unable to achieve health care reform. In 1993-94, the National Federation of Independent Businesses (NFIB) and the health insurance industry trade association (now called America's Health Insurance Plans) effectively joined forces to derail Clinton's Health Security Act.
Small businesses face the greatest barriers in finding affordable health coverage, lacking the access to pooling arrangements, community rated plans, and self-insurance options that benefit larger employers. Yet small businesses historically have opposed mandates that they provide coverage. Even when such mandates are linked to subsidies, insurance market reforms, and pooling arrangements to make coverage more affordable, as Clinton proposed to do, and as Obama is now proposing.
Now, as Joanne Kenen writes in the New Health Dialogue Blog,
small businesses want major reforms to make coverage affordable, and are open to solutions from right to left.
She writes that "a new survey of 400 small businesses (fewer than 50 employees) that currently pay for some portion of their workers' health insurance shows they are open to considering all sorts of different forms of change from left, right, and center." Slightly more than half of the respondents said they could support a four percent payroll tax on businesses with 10 or more employees who do not provide health coverage and/or requiring that all employees be offered at least one public plan (like Medicare) and one private plan, without regard to age or pre-existing conditions. (Keep in mind these are the views of small business owners who already offer health insurance, and may not reflect the views of businesses that currently don't provide health benefits to their employees.)
And this time around, the NFIB has proposed principles to achieve universal access, although the association continues to state that employer mandates or "pay or play" requirements are not acceptable.
Many internists - a majority of ACP members - are small business owners themselves. Like other business owners, they struggle to find affordable coverage for themselves and their families. But as physicians, most feel especially obligated to try to provide such coverage.
Today's questions: If you are an internist who owns a small business (practice), would you support a requirement that businesses with more than 10 employees provide coverage or pay a four percent payroll tax to help fund coverage for the uninsured - if it gave you and your employees access to subsidies and affordable coverage options without regard to age or pre-existing conditions?