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Community Members,

Please join us in welcoming Michelle Dimarob from the National Federatin of Independant Businesses (NFIB) to provide an overview of the various employer provisions being discussed as part of the healthcare reform debate. Specifically, Michelle will cover What can Congress do to help small businesses afford health insurance, provide a legislative Update - Washington, DC at work on healthcare reform, and help commnity members understand the the 3 C's: cost, choice and competition. Today, Michele will be using the screen name NFIBHealth8.

About Michelle Dimarob

Michelle Dimarob is a healthcare lobbyist at the National Federation of Independent Business (NFIB), the nation's leading small business advocacy organization. A nonprofit, nonpartisan organization founded in 1943, NFIB represents the consensus views of about 350,000 members in Washington D.C., and all 50 state capitals.

To all Community Members
If you have questions for Michelle, post it here by simply hitting reply and then refresh your browsers often to view Michele's responses. She will try to answer as many of your questions as possible.

Thanks for your questions. Certainly with so much activity and so much media coverage around some of the most controversial aspects of health reform, it is tough to keep up with each and every issue. From a business owner standpoint it is critical to understand how all the various aspects of health reform can affect your business. But most important, particularly to small business owners, is to understand the effect that the debate has on the ability for you to run your business. For instance, as a business owner, you are both a consumer (you use the healthcare system) and a payer (you help finance access for you, and possibly for your employees). Many of the legislative proposals that are being discussed affect your ability to find and afford care. For instance, an employer mandate to purchase healthcare or to finance a certain amount of the insurance plan you provide for your employee is certain to affect your cost of doing business. Any new cost will influence other business decisions, whether it is expanding your business, hiring another employee or investing in new equipment. Similarly, there are provisions in some proposals that affect your tax liability and payroll decisions – all of which may necessitate retaining your accountant to help make additional business decisions. In short, the debate affects you and your ability to run your business and that is why it is great that you are following along. You can also utilize various tools including www.nfib.com/healthcare and www.kff.org to gain more insight into how various proposals affect you.

Thank you for the question about the sticking points - no doubt that there are several! It is hard to disagree that we need to do something about the ever-increasing cost of healthcare, and that we need to focus on commonsense solutions that make access to healthcare and affordability of those plans the central goals of reform. Having said that NFIB has four top goals for health care reform legislation: lowering costs while increasing access, reforming the individual and small group insurance markets, providing greater choice for insurance options and making insurance plans portable.

In Congress, there is little disagreement that these are goals that we should all strive to achieve if we are to have a healthier and more productive society. However, the pathway to accomplishing those goals is where we run into the sticking points. Some believe that a mandate requiring employers to provide coverage or pay a fine is the best way to increase coverage of the uninsured. Others think that it is necessary to enact insurance market reforms that will foster greater competition for private insurance. Still, others think the best way to increase coverage is to have the government more involved in determining what health insurance is and how it's paid for. Overwhelmingly, the small business owners we hear from day in and day out want to obtain insurance in a reforms marketplace (so you can get coverage even if you have been sick), want more predictable premiums (they have seen too many years with 10, 20 and 30% price increases) and they want more choices in a competitive environment. And, above all, they demand that insurance remain a voluntary tool that they use to recruit and retain a skilled and talented workforce. It is defined in their individual sprit of entrepreneurism to have the freedom and flexibility to run their businesses the way they see fit and they tend to want less, rather than more government involvement, lower rather than higher taxes and better cost containment across the healthcare system - because they know that waste is not the bath to sustainable health reform.

You are right on the mark with many of your colleagues when pointing out that cost is a concern. More than 65% of small business owners in a recent Mason-Dixon poll indicated that "costs" should be the priority that Congress addresses in healthcare reform. For small business owners the issue of cost has long been the number one issue they face - if they are offering health insurance they are concerned because the costs are continually increasing - premiums have increased 113% since 1999. If the owner isn't offering insurance, they cite cost as the number one issue that is hindering them from offering coverage.

The goal of reform ought to be to look for ways to decrease costs in the overall health system and for employers. However the majority of the bills (such as H.R. 3200) simply shift the "costs" that exist today onto the shoulders of the business community - this is particularly true of the employer mandates that require employers to offer a specific package or to pay additional payroll taxes or penalties. This puts an employer in a precarious position. Should they determine to NOT hire someone in order to offset this new cost of doing business? Should they simply pay the new tax because it might be less than the health insurance policy itself? Or, should they close up their business altogether? These are the types of questions small businesses are being forced to think about as they evaluate legislation. Instead, we ought to be evaluating legislation to determine: Does it increase affordability? Does it provide greater premium predictability? Is it going to increase the amount of money government money, which can increase my tax bill as a business owner? Does it ensure that the dollars we are spending are being used prudently and efficiently? These are the types of questions business owners ask each day when making decisions, and we ought to ask the same of elected officials since they are the stewards of our tax dollars.

With the recent introduction of the Senate Finance Committee legislation we will be watching closely to see how that bill might result in the types of meaningful health reforms that are critical to the livelihood of America's entrepreneurs.

The legislation released by Senate Finance Chairman Baucus is notable because it highlights many of the small business' needs in the health reform debate.

Those include individual and small group insurance market reforms, as well as the framework for the health insurance exchange. These are just some of the reforms so badly needed by small businesses and their employees. In addition, the legislation outlines important provisions that create broader risk pools across state lines and new ways to offer competitive benefit packages on a national level.

There are many areas yet to be defined and some that still cause concern for small business. In particular, concerns have been expressed by many in the business community about the structure of the tax credit and the potential expansion of tax reporting requirements that will increase the paperwork burden on small business owners.

NFIB believes this proposal looks at the markets where small firms buy health insurance, and it makes significant steps to reform the rules for these markets to help increase choice, competition and, ultimately, reduce costs.

With the bill set to be discussed and debated in Senate Finance beginning next week, it is important to keep in mind that this is just the first step in the legislative process.

As a business owner, you have the opportunity to help shape the debate. Please tune into resources such as http://www.fixedforamerica.com/ and http://www.smallbusinesshealthcarecoalition.com/

to learn about the most up-to-date developments. Be sure to share your thoughts and ideas about what Congress can do to develop a healthcare reform package that address the needs of small businesses and their employees.