Small Business Health Insurance Problem

Through the debate on reforming health insurance for small businesses, an important piece of information was missing: Policymakers had little data on why only some young companies offer their employees health insurance. Common sense and much research indicate that cost plays a big role in business owners' health insurance decisions. Why do some entrepreneurs choose to incur this cost while others do not?

Back in March, Congress passed the Affordable Care Act, which in 2014 will require all Americans to have health insurance or pay a penalty. Although many people would now like to put discussion of employer health insurance behind them, the question of why only some founders of small businesses offer insurance remains an important one. Its answer will influence how much of a role government will play in providing employee health insurance for years to come.

One part of the new law is a set of tax credits and penalties designed to encourage employers to provide insurance.The problem is that for most young small businesses, it won't work.That's the conclusion I reached, based on research I conducted with Alicia Robb of the Ewing Marion Kauffman Foundation.We examined the decisions of founders of young companies on whether or not to offer health insurance, using information from the Kauffman Firm Survey, which tracks a cohort of nearly 5,000 new businesses started in 2004.

The data show that very few new businesses offer employee health insurance. Nearly two-thirds of companies with employees did not offer employee health insurance at any time during their first five years of operation. Moreover, only one in five offered insurance to their workers in all of the years.
insurance: no performance benefits

The few young small businesses that offered health insurance differed dramatically from those that didn't: They tended to be larger and higher-paying, structured as partnerships and corporations, and they offered their employees a wide variety of benefits. Most young businesses don't fit this profile. The majority are sole proprietorships with few, modestly paid employees. Only a handful of young companies grow dramatically. A minority shift from sole proprietorships to other legal structures. Few ever add a lot of benefits. This means that only a small portion of young small businesses are health-insurance-providing types. Most are not.
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