Health Care For America Now

Despite it's erosion over recent years due to skyrocketing costs, 60% of Americans still get their health care coverage through work. Strengthening and protecting this coverage is central to the goal of giving everyone a guarantee of quality, affordable health care. Like many aspects of health reform, the House health care bill does much more to give Americans affordable health care at work than the Senate bill does.

The House bill sets up a system of shared responsibility - known in health wonk circles as "pay-or-play" - that would guarantee good coverage at work. Under the system, employers would be responsible for offering employees good coverage - at least as good as the most basic plan in the new health insurance Exchange, covering preventative medicine, mental health, maternity, and other essentials - and they would be responsible for paying for 70% of that coverage. Employers would have to offer coverage to full and part-time employees, with a contribution proportional to the number of hours worked. Small businesses would be exempt from this requirement, though they would receive tax credits to help them provide insurance.

This would result in a system where all employers except the smallest would provide good health benefits for their employees. If they decide not to provide coverage, they pay into a pool of money that would help finance the coverage their employees could then buy on their own in the new insurance Exchange. Either way, employees would get good benefits that are affordable, and employers who can afford it would be pitching in fairly to help finance reform.

The Senate does not achieve these goals, and in fact includes policies that would hurt workers.

Instead of asking employers to pitch in for all employees, the Senate imposes a fine of $750 per full-time worker if a large employer doesn't provide health coverage. This would incentivize employers to reduce worker hours to under 30 hours per week, making them "part-time" workers and removing the fine from the employer. This means lower wages for workers, in addition to no health care coverage.

To avoid the fine, employers would have to offer a plan that cost less than 9.8% of am employee's income. But the Senate doesn't apply a benefit package standard to employers for that health coverage. So employers would be free to offer the cheapest, most bare-bones coverage to their employees. As long as the cost was below 9.8%, a fine would be avoided.

So, to sum up, the Senate provisions would incentivize large employers to cut hours for employees or provide the cheapest health care possible to avoid the fine.

Finally, there's the issue of funding. The House employer provisions are projected to raise $135 billion over 10 years to help finance subsidies for those in the insurance Exchange. The Senate provisions would only raise $28 billion, meaning the Senate bill has to skimp on subsidies to remain deficit neutral. Or, to put it another way, under the Senate bill, large employers get off the hook for helping to pay for reform, and low-income workers' subsidies are cut to make up the difference.

Everyone should pitch in to help reform our failing health care system. Government should step in and provide a guarantee of coverage, individuals should step up and purchase insurance, corporations like drug makers and insurance companies should be reigned in, and employers should be asked to provide good benefits. That's what employer responsibility provisions are about.

For the 60% of America that gets their coverage through work, these employer provisions matter a great deal. The House's will secure their benefits, while the Senate's could make them worse or cut their wages. As we work to finish reform right in conference, employer responsibility provisions will be a key way to make sure health care is affordable for everyone.