Amid the public policy mess created by the Affordable Care Act (Obamacare), a tiny pebble of a good idea looked set for passage at a recent committee hearing of the Washington Legislature — that is until the heavy boot of Premera Blue Cross came down on it, crushing it in a way that in times past would have stirred public outrage.
But no longer. In a Legislature that hastily convenes a special session for the sole task of giving Boeing the tax breaks it demands, a ham-fisted carve-out for Premera Blue Cross shouldn’t come as a surprise.
According to the Associated Press, House Bill 2572 would have created an all-payer claims database. “Loaded with statewide health insurance claims, the database would allow people to compare what health care actually costs and how well it turns out - procedure by procedure, hospital by hospital. It would answer questions like these: What would a knee replacement or childbirth cost, and who does it best?”
Backing the idea, reports AP, was “ just about everyone who buys, uses, provides or shapes health care: small and large businesses, consumer advocates, tribes, hospitals, doctors, nurses, the governor, the insurance commissioner, the agency that governs insurance for state employees and the poor, and even Premera's competitors.”
Apparently just about everyone was no match for the influence of Premera Blue Cross, which bristled at the notion of reporting cost data, arguing its competitors and the state’s medical practitioners might somehow reverse-engineer it to reveal how much the insurance giant pays specific providers for medical services.
While the experience in a dozen others states that have adopted all-payer claims databases shows this argument to be hollow, Premera nonetheless convinced the Senate Health Care Committee chairwoman to strip the database and quality provisions from the bill with a last-minute amendment introduced with no public notice.
Premera 1, just about everyone else 0.
The treatment small businesses in particular have received at the hands of the big health insurers remains one of America’s under-reported disgraces.
For years, the Big Blues (Blue Cross, Blue Shield) and other major health insurers successfully lobbied Congress to prevent small businesses from banding together across state lines in order to form the same large purchasing pools for health care enjoyed by big businesses, big labor and big government. Having the same economies of scale would have decreased the cost of health insurance and allowed more small businesses to offer coverage to their employees.
Then, in the dead of night, came the passing of Obamacare, which has since come to resemble a beach strewn with washed-ashore debris of implementation delays and difficulties with state health-insurance exchanges across the country.
If we as a state and nation are ever to get serious about addressing cost and insuring more of our citizens, the job must begin with small businesses. “Smaller firms are less likely to offer health insurance: 45% of firms with 3 to 9 workers offer coverage, compared to … 91% of firms with 50 to 199 employees,” reports the Kaiser Family Foundation.
Small businesses are no small pool, as the U.S. Small Business Administration’s Office of Advocacy reports, “Most of Washington’s small businesses are very small as 73.7 percent of all businesses have no employees, and most employers have fewer than 20 employees.”
The reason more small-business owners can’t offer health insurance is cost. Small business health insurance costs have increased by 74 percent over the past decade, making it more difficult to offer benefits to employees. Those small businesses fortunate enough to afford health insurance for their employees have now been hit with a health insurance tax (HIT) contained in the Affordable Care Act. Larger businesses and unions that self-insure are exempt from this tax.
House Bill 2572 had contained a very good free-market idea liked by almost everyone. If you understand nothing else about the issue of health-care reform in America, know this: In the absence of true political leadership, big Insurance companies call the shots, and will continue to do so.
Patrick Connor is Washington state director for the National Federation of Independent Business.