Each year, our business leaders rank health care as their top concern. We’ve organized hundreds of briefings on how to control costs and expand coverage. Most of those briefings have focused on how to improve and extend the Affordable Care Act (ACA), but we have also covered proposals to repeal or replace it.
Health care is a complicated business, but the market forces capable of controlling health care costs are simple: information, competition, and incentives. Government takeovers (single payer) and block grants to states (repeal) transfer authority without directly managing those market forces. In order to put information, competition, and incentives to work, a health care system must (1) cover pre-existing conditions, (2) require Americans to buy insurance, and (3) subsidize the cost for lower income families struggling to pay for insurance. Health care experts call this the “three-legged stool” of health care reform. If you eliminate any of the three legs, reform “tips over.”
Instead of replacing the ACA, proponents of repeal are attacking each leg of the stool: They have eliminated the insurance mandate, threatened subsidies, and sued to get rid of protection for pre-existing conditions. Instead of improving the ACA, proponents of single payer want to replace it entirely – and give Congress and the Department of Health and Human Services (HHS) assume control over 950,000 doctors, 3 million nurses, 5,500 hospitals, and the 51 million medical procedures they perform each year.
Over the past two months, we’ve surveyed thousands of local business leaders on the health care proposals being debated by candidates across the country. Here’s what they told us:
- 80% of business leaders agreed we need to continue to expand access to care and saw that as an issue with our current health care system, and 76% noted that we need to bring down insurance costs.
- 79% were concerned that under repeal and replace plans, millions of people would lose coverage, and 73% noted concern about losing coverage for pre-existing conditions.
- 61% were concerned that under a government-run, single payer system, the Trump Administration would decide what health care is covered for them, and 45% were concerned about massive tax increases to support this kind of system.
More than a hundred business leaders provided additional in-depth advice on how to improve health care. David Tuthill, the owner of a glass studio in Dallas, Texas, was explicit about how the health care system should work. “Everyone should be required to purchase affordable health insurance that works,” he said. “When we buy a policy, we need to know what it covers in plain English. Not a bunch of smoke and mirrors. It needs to be affordable.”
JeFreda Brown, the owner and CEO of Goshen Business Group in Pinson, Alabama appreciates the ACA and has concerns about a government-run system. “I’m a self-employed small business owner. When I started my company, I got individual insurance and it was very expensive. The ACA allowed me to get more affordable insurance,” she says. “My concern with a government-run, single-payer system is how would they determine what is fair and reasonable for people to pay across the board? Would consumers have any say in how things would be set up in a government-run system?”
Pam Dewitt, the owner of PJ’s Grill in Madison, Alabama, added, “It’s important to me to defend the ACA because it helps people get insurance.”
Other business leaders focused on the importance of the ACA to employee morale and retention, especially for small businesses that compete with larger companies for talent. “The ACA is very important when retaining skilled and capable employees,” said Icy Williams, President & CEO, ATMOS360, Inc., Cincinnati, Ohio. “My people are important and I do not want them worrying about whether they can afford to take care of a family member if they get sick. Maintaining the best employees by providing health benefits is critical to small business.”
Mariguax Childs, Vice President at Turnover Commercial in Minneapolis, Minnesota summed up the concerns of many business leaders: “Why repeal a plan that has been successful at getting more people insured? Congress and the Administration should give the ACA a chance. Data shows that the plan is working. Despite Republican attempts to undermine it, the ACA has made it possible for 20 million uninsured people to obtain coverage. The best approach for health care is to strengthen and protect the ACA, and improve on what is already in place to make it more affordable and accessible to those in need.”
And there is widespread skepticism among business leaders about schemes to repeal and replace the ACA. Rex Cumming, the CEO, of HDSI in Dallas, Texas, says “My main concern is the one party did nothing but try to debunk and make the ACA fail. So in effect they created the failure they complained about. This is why I don’t feel the ACA has really been allowed to be tested. Why not give it a real chance before ‘replacing’? Especially since they have never come up with anything to replace it.”