Every health care reform proposal attempts to offer some relief for small businesses. According to the National Federation of Independent Businesses (NFIB), small businesses create 2/3 of American jobs, yet half of the uninsured are in small businesses.
Look at President-elect Obama’s health care proposal on his campaign’s web site. The first two items:
- Require health insurance companies to cover pre-existing conditions so all Americans regardless of the health status or history can get comprehensive benefits at fair and stable premiums.
- Create a new Small Business Health Tax Credit to help small businesses provide affordable health insurance to their employees.
What’s remarkable about these proposals is that we are still discussing them.
Let’s look at the second item – a tax credit for small businesses. In my opinion, it is a mistake to separate the small business market from the individual market. Almost every small business starts out as a solo enterprise. How many creative ideas never come to market because the would be entrepreneur is afraid to go without health insurance?
Yet we don’t make it easy. Anyone who has ever itemized deductions has experienced the limits on the deductibility of health insurance costs. There is also something called a section 105 deduction that you can learn about elsewhere. Yet business owners can deduct the full cost of their medical insurance. I would welcome an explanation that justifies this disparity, or at least explains the politics to me.
The real nut is the first item. That we allow insurance companies to only insure healthy people is the greatest tragedy of American health care. This is called medical underwriting. Jonathan Cohn in his book, Sick, has a wonderful chapter on this stain on American health care.