From tax breaks that benefit the wealthy to keeping the federal minimum wage low, plenty of elected officials mistakenly believe they have things all figured out when it comes to helping businesses thrive. But with the process of dismantling the Affordable Care Act already underway, it is very important to understand why a full repeal of the ACA is one thing small business owners really do not need — or want.
The reality is the ACA has been instrumental in helping small employers and their employees who struggled previously to afford health insurance coverage.
Prior to the enactment of the health care law, small businesses and their employees comprised a disproportionate share of the working uninsured. In 2014, just 65 percent of small employers offered insurance on average. For firms with fewer than 10 employees — 80 percent of all small businesses — the offer rate was considerably lower, at just 49 percent. The situation was even worse for businesses with predominantly low-wage workers — a scant 18 percent of such companies with fewer than 10 employees offered insurance.
And for the smallest firms: 28 percent of the nation’s 22 million self-employed were uninsured just a few years ago.
By 2016, however, the insurance landscape for small employers had undergone a dramatic shift. According to the Kaiser Family Foundation 2016 Employer Benefits Survey, 97 percent of firms with at least 50 full-time employees reported that they offer coverage to at least 95 percent of employees who work at least 30 hours per week. Furthermore, 96 percent said they offered at least one plan that met the ACA standards for affordability and minimum value.
Also, a new report released by the U.S. Treasury Department and the Department of Health and Human Services revealed that in 2014, 1 in 5 people who purchased health care through an ACA exchange was a small-business owner, self-employed or both. And a separate Kaiser survey taken in early 2016 found 31 percent of non-group health insurance enrollees were self-employed, showing the ACA is helping that segment as well.
And thanks to the health care law’s cost-containment provisions, premiums are stabilizing for many small firms. We’ve seen much smaller increases in the small group market compared to pre-ACA, where double-digit increases were often the norm.
Yes, there are certain provisions of the ACA that can and should be improved — including support for the small business marketplaces, expanding the small business tax credit and addressing issues of risk in the insurance market — but repealing the law would eradicate hard-won benefits for America’s entrepreneurs, cause a rapid rise in health care costs and create tremendous economic instability.
This is why it’s crucial to fix the law where necessary, not abandon it. But opponents of the ACA have yet to offer a plan that would remedy any of the health care challenges facing small employers today.
Instead, these opponents speak loudly of “repealing and replacing” the law, even though they have spent far more time on the “repeal” part than the “replace” aspect. Repealing the law without a replacement plan would throw the insurance markets into chaos by creating extreme uncertainty for several years.
If a replacement is ever presented, we still have little idea of what it would look like. After all, those who have spent six years railing against the ACA have yet to offer any practical alternatives to the law.
Essentially, there are only three basic frameworks for health care: we can go back to what we had before, but that’s not realistic; we can adopt single-payer, which is not politically palatable right now; or we can maintain a private insurance-based hybrid system that is some version of Obamacare. That doesn’t leave ACA opponents with a lot of wriggle room because only one option allows small businesses and their employees to keep the hard-won coverage and benefits they now get through the ACA.
We absolutely cannot go back to the old way of doing business. So rather than repealing the ACA, we must improve the law to make it even easier for small business owners, their employees and self-employed Americans to gain the coverage that is necessary for their success and prosperity.