Small Businesses And Health Insurance

This book offers an overview of the issues and status of small business health insurance in the United States and examines the question of whether existing tax incentives at the Federal and State level provide sufficient inducement to small businesses to adopt health insurance plans for their employees. Also discussed is the small business health insurance tax credit which was adopted as part of the Federal health care reform legislation and the factors contributing to its low use and complexity.

First published in 1999, this volume responds to a large and growing interest among health policy and research circles on the use of purchasing alliances to leverage change in health care. This book gives detailed and useful specifics on how a leading alliance has fared in California, the most competitive health care market in the United States. Although it is generally accepted that large organizations are more effective purchasers of health insurance, little work has been done to carefully examine the reasons that underlie that phenomenon. Yet, creating interventions and designing potential solutions requires a thorough understanding of the issues. The econometric analysis adds to the limited literature on the influence of premium on choice behaviour for employees of small firms, and introduces an analysis of choice behaviour in a purchasing cooperative setting. The political section of this book presents a much more detailed historical account and analysis of California’s small group market reforms, the most significant health-related legislation in the state in the prior decade, than has been previously available. The conclusions are becoming particularly relevant, both in California and elsewhere, as the issues of reform of the individual market for health insurance comes to the forefront.

The Patient Protection and Affordable Care Act contains several provisions to encourage employer-sponsored health coverage, particularly among small businesses. The provisions that most directly relate to small businesses are, an employer penalty for not providing health insurance; a tax credit to increase the affordability of health care for the smallest firms; and small business health insurance exchanges designed to increase plan options and lower plan costs. First, this book explains how employer-sponsored insurance can be used to address concerns about health insurance coverage and cost. It summarises the three ACA provisions most relevant to small businesses, listed above, and analyses these provisions for their potential effects on small businesses. The book then presents several approaches that could address some concerns associated with these provisions (particularly the employer penalty).