The Window of Opportunity on Health Reform Slams Shut [Commentary]

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The Window of Opportunity on Health Reform Slams Shut [Commentary]

Oct 20, 2009

Posted by Kristie Arslan – With the successful passage of Sen. Baucus’ America’s Healthy Future Act out of committee, health reform has moved out of the light of day and into those closed-door rooms of the Senate Office buildings to begin the process of merging the Senate Finance Committee bill with the Kennedy-drafted Affordable Health Choices Act. 


What’s that you hear? Could it be the window of opportunity to provide meaningful health reform slamming shut?  I am afraid so.  


Per usual, the voices of the self-employed fell on deaf ears in our nation’s Capitol.  Based on current reform bills, the earliest any American would receive some relief from current high health costs is 2013, leaving the self-employed to sweat it out for another three years.  Assistance would come in the form of a tax credit, with the hope that other reforms such new pooling arrangements will facilitate long-term cost savings.     


The legislative process still has a long way to go and health reform is not yet in the bag.  However, the opportunity to substantially modify or incorporate any additional provisions in the final legislation is slim.  Faced with this reality, based on the three major reform bills, here is what we hope ends up in a final health reform package that is sent to the President.   

  • National Exchange:  The House Tri-Committee bill is the only reform legislation providing for the creation of a new health marketplace, an Exchange, on the national level.  The Senate versions create state-based exchanges only.  The rationale behind an Exchange is that by pooling individuals and small businesses together you will create more competition and better economies of scale, thus lowering health costs.  The size of the pool is important - the larger the pool, the better chance of the Exchange lowering health costs.  In an exclusively state-based model, small states would be at a disadvantage and likely not achieve the same amount of cost containment as larger states.   
  • Participation in the Exchange:  As mentioned above, to ensure actual cost savings it is important that the exchanges have significant participation.  The NASE supports allowing individuals and small businesses with up to 50 employees to have immediate access to the Exchange.  
  • Premium Assistance:  The Senate HELP Committee’s legislation has the most generous tax credit for individuals while small employers would get the most financial assistance under the House Tri-Committee bill’s employer tax credit.  Unfortunately, employer tax credits are temporary under the other proposals.
  • Market Reforms: All of the key reform bills include necessary market reforms to ensure that individuals will be able to access coverage regardless of health status, age and gender. 
  • Self-Employed/Small Business Input on Health Benefit Requirements: An important component of reform recommendations is the creation of an essential benefits package.  This will be a slate of benefits that is the minimum allowed in any insurance policy offered.  Two of the bills set up a committee or board to help establish what these benefit requirements should be.  As we all know, the type and amount of benefits can greatly affect the cost of insurance.  We see very high health insurance costs in states with a high number of mandates.  Therefore, it is imperative that the self-employed and small business is represented on these decision-making bodies to ensure a balance between cost and coverage.

If you are a blogger, reporter or just interested in finding our more about the self-employed perspective on health reform, join us for a two-part series of teleconferences on this important issue.  For more information contact Kristin Oberlander at

The opinions expressed in our published works are those of the author(s) and do not necessarily reflect the opinions of the National Association for the Self-Employed or its members.

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