In mid June TIBA surveyed members and prospects on six health insurance issues.

TIBA has been closely tracking the health insurance issues proposals in Washington.  The six questions on the survey were taken from the Kaiser Family Foundation website, www.kff.org, from the “comparison of health plans” available on its main page under “Health Reform Comparison Tool.”

The issues we surveyed are ones that were getting the most attention from the two U.S. Senate committees presenting health plans, and received the most comment by President Obama.  Here is this week’s list of the hottest small business issues in TIBA’s opinion.  

1.  “Fair Share” responsibility for individuals – all individuals would be required to have health insurance.  Subsidies would be provided to those who can’t afford the insurance.  In the past week, the proposed subsidies were lowered from those with family incomes at five times the poverty level to three to four times.  Insurance companies would not be allowed to turn down an applicant for insurance (“guaranteed issue”). 

2.  “Fair Share” responsibility for employers – This has changed somewhat in the past week.  The requirement that employers be required to furnish and pay for insurance has softened somewhat.  The insurance companies still want the right to turn down groups – in other words, no “guaranteed issue.”   

3.  Insurance policies issued by the government.  This is a very hot issue during this debate.  Insurance companies insist this will quickly lead to national health insurance with the government as the only payer, eliminating all competition.  Advocates of single-payer insist they will not support health reform unless this is included.  Some Democratic and Republican moderates are now proposing that non-profit co-ops be allowed instead, which would provide new competition for insurance companies.  In TIBA’s survey the co-ops were by far the most popular reform of those mentioned.   

4.  Health insurance costs and health care costs would no longer be exempt from federal income taxes, or only a portion of them would.  It may be impossible to fund reforms without doing this.  It certainly is unlikely that “tax equity” can be extended to employees and owners of small businesses without eliminating part of the huge subsidy enjoyed by big businesses and unions.   

5.  “Health Insurance Technology” would track the health care of providers and patients.  Providers not conforming to so-called “best practices” would suffer financial or other penalties.  This one has legs because the insurance companies support it as do government officials.  Independent health care providers, whose lobbying strength is as weak as small business groups, simply have few effective allies on this issue. 

ADDITIONAL COMMENTS

The Congressional Budget Office threw much cold water on the two Senate plans.  Neither plan has all its elements yet, so the C.B.O. can price out those parts.  As they stand now, the Kennedy committee’s plan will cost $1 trillion over ten years and the Senate Finance Committee’s plan will cost $1.3 to $1.6 trillion over ten years.  The Kennedy plan would result in a reduction of the number of uninsureds from 47 million to 30 million, extraordinarily costly when considered on a per capita basis.