Some 45.8 million Americans, or 15.7% of the population, lacked health insurance in 2004 &emdash; a number that is rising as more employers drop coverage for their workers. However, many states are taking action to reverse these trends and move towards the goal of providing health care for all Americans.
The symbol for this health care problem &emdash; although hardly the only actor &emdash; has been Wal-Mart, a company where half their employees, 600,000 people, are provided with no health insurance by their employer and even those with company health insurance receive a bare-bones policy with high deductibles and large copayment fees. And many of those uninsured Wal-Mart employees end up burdening public hospitals' uncompensated care funds or state Medicaid rolls.
Fair Share Accountability
The first legislative responses to this problem were laws passed in Maryland, New York City and Suffolk County (a 1.5-million population county on Long Island, N.Y.) to require some larger employees to provide health insurance for their workers or pay an assessment to their respective governments to cover the uninsured.
Maryland's law applies only to employers with 10,000 or more employees in the state, so it reaches only a handful of the largest companies in the state, such as Wal-Mart. But it helped spark a wide-ranging national debate on holding more employers accountable for providing health care to their employees.
While receiving less national publicity, the bills in New York City and Suffolk County applied to all medium and large grocery stores in their jurisdictions &emdash; bills that were supported by much of the grocery industry as a way to maintain health standards in their industry. As John Catsimatidis, CEO of the major New York City grocery chain Gristedes Markets, explained, "If I have to compete with low-road cost cutters like Wal-Mart, it's going to be hard for me to continue providing my employees with the care they deserve."
Fair-share bills are now being pushed forward in a states across the country, including Alaska, Connecticut, Kentucky, and dozens of other states. Wal-Mart and its conservative allies have stymied bills in states like Colorado and Washington, but activists in Colorado and Gov. Chris Gregoire in Washington have pledged to pass "fair share" bills next year, even as the fight continues in other states across the country.
Covering More Employers: Massachusetts
While the Maryland and similar laws already passed were good first steps, they still cover only a tiny portion of the uninsured, so focus is already turning to the next step of expanding health care accountability to a larger number of employers.
The most comprehensive model passed by any state house chamber has been the Promoting Access To Healthcare (PATH) bill that the Massachusetts House of Representatives overwhelmingly approved last November, a bill that would cover nearly all of the state's 500,000 uninsured residents. At the core of the proposal was a requirement that all businesses with 10 employees or more provide insurance to their employees or pay 5-7% of their payroll costs to the state to cover costs for the state's uninsured.
However, facing opposition by conservative state businesses and the top political leadership in the state's Senate chamber, it was announced on March 3 that an alternative deal had been reached between the state's House and Senate leadership that would keep the broad-based assessment on businesses with 10 or more employees but lower the cost to only $295 per employee. While grassroots leaders such as John McDonough, executive director of Massachusetts Health Care for All, declared the amount woefully inadequate to provide decent health care for the state's employees, he did write on the organization's blog that advocates had won at least one fundamental victory, namely establishing the principle that businesses have a legal obligation to provide for health coverage of their employees, either directly or through taxes paid to the state government.
"This is not the end, it's the beginning," writes McDonough, and with the principle of employer responsibility established, raising the assessment on businesses in the future will be far easier than establishing it in the first place. Massachusetts figures show the state already spends $212 million to provide health care to employees at larger firms &emdash; and the number is no doubt far larger when smaller firms are included &emdash; so the adequacy of the health care assessment will immediately become a key policy debate if enacted, so the debate will still be on advocates' terrain.
Covering More Employers: New York State
However, if the final details of the deal in Massachusetts do not live up to the scope of the original House bill last fall, then the ambitious bill introduced in March in the New York legislature, based on a proposal by the New York Working Families Party, could become the model for advocates nationwide.
The bill would require all companies in the state with 100 employees or more to provide health care to their employees, or pay an assessment of $3 an hour per worker to cover the state's expenses in caring for uninsured workers. If enacted, this would be a serious expansion of coverage, extending health care to an estimated 450,000 working New Yorkers, and helping preserve coverage for 3.5 million more where large employers are increasingly threatening to drop coverage.
Significantly, the bill has broad support in the State Assembly and was introduced by a Republican in the State Senate, which is controlled by the GOP &emdash; and the Senate Majority leader Joseph Bruno, while not endorsing the bill, has agreed that it's a serious problem when companies dump their health care responsibilities on the state while responsible businesses pay their fair share: "It's inequitable, it's unfair. That's what has prompted this legislation," [Bruno] said. "We're going to look at it."
While this New York bill will only reach employers with 100 plus employees &emdash; and therefore cover a smaller percentage of employees than Massachusetts &emdash; the $3 per hour of benefits for employees required under the bill would provide a stronger health care package for employees than even the original Massachusetts House bill passed last year and far better than what is being discussed in the current negotiations in that state.
And if the New York bill is enacted, the next debate in the state will no doubt be how to extend those benefits to employees in smaller firms. And it will have established a roadmap for moving the nation towards comprehensive coverage of working families in our country.
Nathan Newman is policy director of the Progressive Legislative Action Network (PLAN). This is adapted from the group's Stateside Dispatches.