Who's the party of business?
I think we could multiply the following story a thousand times over. Modern HealthCare:
Joshua Lapp left a full-time job with health benefits in 2014 to launch an urban planning firm with two partners. Columbus, Ohio-based Designing Locally has grown rapidly, with projects all over the county. There's no way Lapp, 27, would have considered starting his own business before the Affordable Care Act took effect because he has a congenital heart condition. He was able to buy a health plan through the federal exchange, which costs him $300 a month. He hasn't had to worry about insurers denying him coverage -- as they could before the law.But now that Republicans are planning on full repeal and delay, altering the business and job creating dynamic:
“Being able to buy my own affordable plan on the exchange allowed me to step out on my own. It's a big enabler for all of us.”
He and other young entrepreneurs don't like that the GOP repeal-and-delay strategy will leave them hanging in insurance limbo for several years. “If it's repealed, I might have to go back to working for a bigger employer,” he said. “The prospect of losing my business because I'm losing my insurance is sort of ridiculous to me.”Do we have to go through something like this, and the business losses, just to prove Republicans are wrong about health care?
Promises, Promises: It's kinda hard to figure out; Republicans claim ObamaCare provides too much coverage, yet they've promised to create plans that will be even "better." Nonsensical, yes.
Douglas Holtz-Eakin, president of the conservative American Action Forum and former director of the Congressional Budget Office said, the GOP has “committed to keeping the premium subsidies and they've pledged to stabilize the individual insurance market.” The health plans available under the replacement system “will be even better.”The premium subsidies will be smaller, it'll be a write off at tax time and not immediate like it is now on the exchange, and how will it be even better? My biggest pet peeve is the promise to do away with maternity coverage for men, as if men don't have anything to do with pregnancy?
“Both logic and evidence show that the ability to buy health insurance at reasonable prices, even if you don't work for a big firm, allows people to take chances in their work that benefits the economy and society in the long run,” said economist Douglas Elmendorf, dean of Harvard's Kennedy School of Government and former head of the Congressional Budget Office.Of course all of these debates avoid the elephant in the room; single payer. That would wipe out all the hoops and regulations, putting patients truly in charge:
There's research evidence that publicly provided health insurance prompts more people to start businesses. A 2015 Harvard Business School study found that after the Children's Health Insurance Program was started in 1997, the self-employment rate for parents of CHIP beneficiaries jumped 23%, and the their rate of ownership of incorporated businesses increased 31%.Here are a few more entrepreneurs interviewed for this story, which means the impact nationwide would be devastating:
A 2013 study found that after the ACA provision took effect allowing young people ages 19-25 to stay on their parents' health plans, they were more than twice as likely to start their own businesses. That's what Chicago public relations consultant Alyssa Conrardy did. At age 24, she co-founded Prosper Strategies, staying on her parents' plan for two years while she got the company off the ground. It now employs eight people and provides them with group health insurance.
“I don't think we could have gotten here without the security the ACA provided,” she said. “If the ACA is repealed, there are so many young people for whom entrepreneurship will no longer be a feasible financial option.”
How the GOP's alternative model addresses annual and lifetime benefit limits and maximum out-of-pocket costs is a huge concern for Namir Yedid, 35, of San Diego. He left a job with health insurance in 2014 to develop several technology products. Soon after buying a plan on the California exchange, he was diagnosed with a rare cancer. Yedid's cancer is now in remission, and he's preparing to bring his first product to market. He currently employs five people. “There are plenty of talented people in the tech scene who couldn't take the risks I did and go out on their own without the ACA,” he said.So what should budding business creators do?
Ryan and HHS Secretary-nominee Dr. Tom Price have proposed putting people like Yedid into high-risk pools. Yedid notes that these state pools generally did not work well in pre-ACA days in providing affordable coverage for those with preexisting conditions.
He's angry, worried that ACA repeal without an adequate replacement could force him to give up his business and find a job with health coverage.
Lisa Martin, 35, of Cambridge, Mass., expresses similar frustration. She left a job with health insurance in 2014 to start her own website consulting business, made possible by the availability of ACA coverage. Soon after leaving her job, she suffered a minor stroke. Even though she recently switched to her partner's employer-based health plan, she hates the uncertainty. “What am I supposed to do in the next two to four years?” she lamented. “Why create anxiety and replace something that's meeting people's needs?”
Asked what he would advise people considering self-employment during the long interim period following repeal of the ACA, Holtz-Eakin said, “I'd make the leap.
But Elmendorf disagrees, arguing the Republicans have not put out nearly enough details for the CBO to determine how good and affordable the replacement package will be and how it will affect the nation's uninsured rate. There's also no evidence, he added, that Republicans are willing to spend the large amount of federal money or impose the rules it will take to provide good replacement coverage.
“These self-employed folks should be quite concerned,” he said. “I don't know how they should proceed.”