As the rate of business startup activity in the United States flatlines, changes in national health policy, among others, could help turn around the situation, an American Enterprise Institute (AEI) expert said last week.
“Although there is no single magic bullet -- particularly within the conventional parameters of ‘health reform’ -- we first should change current health policies that already slow small business growth,” AEI Resident Fellow Thomas Miller told Patient Daily.
According to Miller, policies needing reform include the Affordable Care Act’s (ACA) overly prescriptive regulatory mandates, such as the employer mandate, essential health benefit requirements and adjusted community rating.
“But more broadly, moving closer to parity in the tax treatment of health insurance and health care purchased, across all types of buyers, is an important goal, tempered by the need for a transition plan that minimizes short-term disruption in current coverage patterns," Miller said. "Recent regulations essentially prohibiting defined contribution support by employers for their employees' purchases of individual market insurance should be reconsidered."
For example, Miller believes extending HIPAA-style protection against pre-existing condition restrictions for individuals with continuous coverage who want to move in or out of the individual market -- and reinforced with better-financed and better-targeted state high-risk pools -- should replace both the ACA's individual mandate and overly broad guaranteed issue rules. Miller studies health care policy at AEI, including health insurance and market-based alternatives to the ACA.
“However, the real stimulants for rapid small business growth must be found in policy reforms beyond health care subsidies and regulations,” he said.
These stimulants involve better pro-growth macroeconomic policy reforms, as well as policy reforms for education, skill development, capital markets, immigration, student debt, social mobility and human capital development, Miller stated.
Additionally, Obamacare’s Small Business Health Options Program (SHOP) marketplace, which is for small employers who want to provide health and dental coverage to their employees, could use some care, as well.
“The SHOP exchanges have failed to provide attractive solutions due to lags and misfires in implementation, a combination of narrow and complex incentives that attracted very few businesses (small business tax credits), and lack of any clear advantages over other alternatives, including private exchanges,” Miller said.
A better approach, he suggested, would be to redefine and rearrange tax subsidies for coverage of employees in small businesses and allow them to be used to purchase any kind of insurance -- whether offered in public or private exchanges, by more traditional employer plans, or in the no-exchange "outside" market for individual coverage.
Meanwhile, with the U.S. presidential election only months away, Miller added that none of the remaining candidates thus far have provided suggestions for reforming health policy to benefit small businesses and entrepreneurs.
“Their occasional rhetoric fails to match market realities,” he said.
