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Searching for a Cure

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Articles - July/August 2014
Friday, July 11, 2014

Healthy Business Alliance

Nationwide, President Obama and the business community haven’t always seen eye to eye on health care reform — perhaps understandably, considering the hefty financial burden the ACA’s employer mandate represents for medium- and large-size businesses. In Oregon, though, a tradition of health care innovation and a progressive, health-conscious ethos has nurtured a more proactive dynamic between business and reform advocates.

For example, when the president last year delayed the employer mandate, giving businesses with 50 or more workers additional time to provide health coverage to their employees, his decision came in response to stiff opposition from larger employers across the country. But in Oregon, it appears these bigger businesses aren’t waiting for the mandate to go into effect to offer benefits. “My sense is that they know it’s coming, so they’re just getting ahead of it,” says D.J. Vogt, vice president of government affairs for the Oregon Business Association.

Even some employers with fewer than 50 workers, who were never required to provide coverage, are doing so here, anecdotal evidence suggests. More than 200 smaller businesses, for instance, have signed up with Health Republic. “My guess would have been that now that there’s individual coverage with guaranteed issue, and maybe a subsidy, small employers would say, ‘Go out there! Good luck to you!’” says CEO Bonder.

But in this labor market, she continues, employers need to offer coverage to be competitive: “To get your choice of the best and the brightest, you’re competing with companies that are offering health benefits,” Vogt concurs, adding that many Oregon business owners simply see providing coverage as the right thing to do. “It doesn’t surprise me that people are doing that,” he says. “I feel that’s just part of an ethos that comes with the territory here.”

Some insurance executives predict that once Cover Oregon is fully functioning and there’s more certainty in the individual market, under-50-employee businesses in Oregon may do exactly what Bonder imagined they would. Prows, of Oregon’s Health CO-OP, says the “prevailing prediction” in the industry is that smaller employers will opt to offer a defined contribution for individual insurance instead of sponsoring their own health plan.

For these businesses and their workers, that would mean the end of employer-provided health coverage as we know it. “I think it’s early to just have small employers say, ‘OK, good luck,’” says William Johnson, president of Moda. “But I do think that may happen in the future.”

As the fate of small-group insurance — like that of CO-OPs, hospitals and CCOs — hangs in the balance, reform proponents underscore the potential for meaningful change. If nothing else, Johnson says, the ACA has started a far-reaching, industry-wide discussion: “We’re all engaging in a conversation now that’s going to change health care as we know it.” 


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