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Small businesses could win big in House health reform bill

Small businesses—particularly those with 10 employees or fewer—stand to be the big winners if a public health insurance option such as the one now before the House of Representatives becomes a reality, according to a new issue brief by the Economic Policy Institute (EPI) in Washington, DC.

The study, “Health Care Reform, Big Benefits for Small Businesses” estimates that small businesses with 10 or fewer employees could save about $3,500 per worker annually under a public plan similar to the House Tri-Committee’s proposal.

Elise Gould, director of health policy research at EPI and one of three authors of the issue brief, says the findings shouldn’t be surprising. “Small businesses bear a heavy burden in the current failing healthcare system,” Gould says. “Small businesses and their employees pay higher prices for less coverage. They are often priced out of the private market completely and, when that happens, it puts them at a great disadvantage when it comes to hiring and retaining employees.”

The EPI brief compares the House bill to a similar plan called Health Care for America, which was drafted under EPI’s Agenda for Shared Prosperity program. The House bill and the EPI plan create a new public insurance option and a requirement that employers offer affordable coverage to their workers or pay to defray the costs of enrolling in a national insurance marketplace.

“The gains to small business are likely to be even greater under the House version of the healthcare reform bill, as it is even more generous to small business,” says Josh Bivens, EPI economist and coauthor of the brief.

Employer-sponsored insurance is the primary source of health insurance for nonelderly Americans, covering nearly 63% of U.S. adults. EPI premiums of $532 billion in 2008 accounted for nearly one-quarter of all non-Medicare healthcare spending in the United States.

However, rising healthcare costs have been particularly tough for small businesses. Small employers hold little bargaining leverage with health insurance companies and have suffered relentless cost hikes that threaten to make health insurance too expensive. The brief notes that the ongoing decline in small business coverage for employees is responsible for much of the erosion in EPI coverage since 2000.

Nearly half of the uninsured worker population is employed by small businesses. In 2008, an employer survey by the Menlo Park, CA–based Kaiser Family Foundation found that 35% of small businesses offer health insurance to their workers, compared to 99% of large firms with 200 or more workers, and 63% of all firms.

Small firms that offer health insurance pass on a higher share of the cost of plans to workers; average contributions by workers in small firms are 30%–45% higher than in larger firms. Small businesses are paying, on average, 18% more than larger firms for identical health insurance policies, owing to higher and more variable health risks, a lack of competition among small-group market insurers, greater administrative expenses, and lower wages, according to the issue brief.