The end of the public health emergency in 2023 will result in millions of individuals losing Medicaid coverage and moving onto other forms of insurance. Small businesses, which employ over 61 million people but offer health benefits to only a third of them, provide an opportunity to provide higher quality and less costly employer-sponsored insurance, while avoiding increased reliance on the federal government for insurance coverage. This paper explores ways to improve access to employer-sponsored insurance through small businesses, including policy options such as association health plans, reformed self-insurance regulations, improved tax incentives, and expanded telehealth benefit options.
According to an Urban Institute report, individuals disenrolled from Medicaid would have access to some form of insurance coverage, including the ACA Marketplace, employer-sponsored insurance, and public programs like Medicaid and CHIP. However, it is important to understand why all forms of coverage are not equal or even beneficial to the enrollee. Medicaid has shown negligible effects on health outcomes and decreased access to care. Access to services has been a struggle for enrollees, and physicians are less likely to accept Medicaid. The overall cost of Medicaid is also a major concern, particularly for states that cannot use deficit spending to fund health and welfare programs.
The ACA Marketplace is an attractive option due to enhanced advance premium tax credits that provide zero-premium coverage to individuals making up to 200 percent of the federal poverty level. However, like Medicaid, ACA Marketplace plans have more limited networks than private insurance.
Improving access to employer-sponsored insurance through small businesses can be achieved by addressing cost and compliance barriers. Policy options such as association health plans, reformed self-insurance regulations, improved tax incentives, and expanded telehealth options can increase the number of small businesses offering health benefits to employees.