Health Care

WomenMatter will continuously post updates on all this and other issues as we monitor the continuing philosophical and practical debates nationwide. Please check back often for updates. Past updates are available for reference on the Healthcare Archives page.

To Good to be True? (Employees, Employers, Communities and Government All) Working Together to Get Heathcare for Working Uninsured

About 45 million Americans go without health insurance.

You may be one of them. Or, maybe you know someone who works, and works hard, but doesn’t get benefits through her or his employer. Why is this? Why is it that some full-time workers receive benefits and others do not?

Many uninsured full-time workers are employed by small businesses. As the cost of healthcare rises, fewer and fewer small businesses can afford to extend benefits to workers. But employees of small businesses deserve full health care coverage.

Whose responsibility is it to provide healthcare?

Do you think it should be an employer’s responsibility? Maybe it should be the government’s responsibility? Maybe both?

Right now, it is largely up to employers to provide health insurance. The government does insure the most needy Americans through Medicaid through federal grants to the states, but what about those who make too much to qualify for Medicaid but not enough to pay for health insurance?

Sharing the load

There is a relatively small program in the works that most people haven’t heard about. The Community Access Program (CAP) gives government funding to communities that have made an extra effort to help the uninsured and underinsured. It builds on the work that these communities have already done by giving them funding, training, and organizational help. So far, this program has helped 158 communities insure the uninsured.

Many successful CAP communities utilize three-share programs to insure small-business workers. A three-share program is a health plan that is paid for by the employer, the employee, and the community. The employer and employee each pay 30% and the community pays 40%.

The local government does more than pay 40% of costs. They help put the whole thing together. The local government works with health care providers and/or insurance agencies to develop a health care plan that will work. They also take responsibility for administering the program.

New Legislation

Senator Debbie Stabenow from Michigan is proposing the Health Care Access for Small Business Act of 2003. This legislation builds on the three-share programs developed by communities themselves.

Her proposal hopes to expand three-share programs in two ways: first, it encourages continued funding of the CAP program; second, it proposes a tax credit for employers that participate.

This is how it works:

The employee pays for 30% of the premium through payroll deductions. The employer pays their 30% of the costs PLUS the 40% that is the community share. They are then reimbursed for the community portion through a tax credit.

Once it is laid out in this way, Stabenow’s plan raises some questions. Are employers going to be willing to participate if they have to front 70% of the costs? While it’s true that 40% will be returned to them, they have to put up a big chunk of money to get things started.

Small business owners who are motivated to give their employees benefits would probably take advantage of this plan. However, business owners who are struggling may feel that this option is still too expensive.

Three-share reviewed

Since these programs are relatively few, we still don’t know the various outcomes that three-share programs could have in different communities. However, participants are excited about the results so far.

The programs have offered high-quality health insurance with co-payments as low as $5; members can choose their own primary care provider; members have access to local physician services, in-patient hospitalization, outpatient services, ambulance service, prescriptions, diagnostic lab and x-rays, home health, hospice care and behavioral health.

What’s the philosophy behind the policy?

The philosophy behind three-share programs is that small businesses want to be a part of the solution. By making businesses and communities partners, a different kind of resolution can be reached.

Advocates of three-share programs believe that the working uninsured should be separated from the indigent, unemployed population because they are different populations with different needs and resources.

Public and private funds, resources and ideas can be combined to solve issues in healthcare.

The three-share program is a step away from privatization and towards more community and government involvement in healthcare.

Voice your opinion

Do YOU think three-share programs are a good idea? Connect to our online forum and let others (and us) know how you feel. Or, contact your senator and tell her or him what you think about the Health Care Access for Small Business Act.

Posted on: 6/17/2003

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