Small businesses are collateral damage in healthcare chaos

In 2014, one in five individuals who purchased healthcare on an ACA marketplace owned a small business


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The Republican plan to overhaul our healthcare system is causing anxiety for millions of Americans and uncertainty for small businesses and entrepreneurs who are the backbone of our economy.

The Senate bill was drafted in secret by Republican senators with no input from the public, no testimony from doctors or hospitals and no public hearings. This backroom maneuvering follows passage of the House Republican healthcare plan, which even President Trump has called “mean.”

These bills roll back protections for people with pre-existing conditions, raise out-of-pocket costs and strip coverage from millions of people. They also slash Medicaid — our nation’s program for insuring children, people with disabilities, seniors in nursing homes, and people with substance use disorders — by nearly half.

I recognize that the Affordable Care Act needs changes. I believe we should focus on improving the law, keeping what works and fixing what’s not working, while helping to level the playing field for small businesses.

But instead of fixing it, the Trump administration is systematically undermining the ACA by cutting outreach and enrollment efforts, suggesting it won’t enforce the law and refusing to commit to making cost sharing reduction payments essential to the ACA-created health insurance marketplaces for more than a month at a time. President Trump has made clear his desire to see the system fail, saying: “The best thing we can do politically speaking is let Obamacare explode.”

That’s irresponsible, and treats small businesses as collateral damage.

While some small businesses buy health insurance in the small group market, many entrepreneurs, sole proprietors and people working for small firms purchase their insurance on the individual market through an ACA marketplace.

According to the nonpartisan Congressional Budget Office, the chaotic, incoherent and secretive process in Washington is creating “substantial uncertainty about how the new law would be implemented [and] could lead insurers to withdraw from or not enter the non-group [individual] market” for insurance purchased individually on ACA marketplaces.

In 2014, one in five individuals who purchased healthcare on an ACA marketplace was a small business owner, self-employed, or both. Before passage of the ACA, small businesses paid an average 18 percent more for coverage than large businesses.

Data from the Centers for Medicare and Medicaid Services says the average yearly premium increase in the small group market was 10.4 percent between 2008 and 2010 (pre-ACA), but dropped by half between 2011 and 2015. The number of uninsured small business employees (those working at firms with fewer than 50 workers) dropped by more than four million between 2013 and 2015.

The ACA also enabled many Americans to consider entrepreneurship by ending the disincentive known as “job lock,” which kept many Americans in jobs they didn’t want because they feared losing their health insurance.

David Lucier, owner of Claremont Spice & Dry Goods in Claremont, said: “Before the ACA, insurance costs were more than a third of my business expenses. Now, they’re less than an eighth. The ACA made it possible for me to go out on my own and realize my dream of starting a small business.”

Citing the uncertainty and the general unpredictability of the legislative process in Washington, insurers are departing the exchanges. This is especially damaging for sole proprietors and small businesses that rely on the ACA and its affordable insurance options.

Without the ACA, millions of Americans will lose their insurance, and small businesses will face the prospect of closing or shifting health costs to employees.

New Hampshire is a small business state. Small businesses employ more than half our private workforce and are a job creating engine. They need certainty so they can make prudent decisions about payroll, budgets and product development.

Running a small business is hard enough. The current chaos in Washington makes it that much more difficult.

Instead of tearing down the ACA and taking health coverage away from people and small businesses, we should be building on the gains and achievements of healthcare reform and work together on a bipartisan basis to fix what’s not working.

The ACA has had a positive impact all across America, but it needs commonsense repairs and strengthening. My message to Republican leaders in Congress and President Trump is: stop undermining the ACA, and let’s work together to improve America’s healthcare system.

U.S. Sen. Jeanne Shaheen is the lead Democrat on the Senate Committee on Small Business and Entrepreneurship.

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