Small-Business Group Seeks Affordable Health Care

Under various health care overhaul bills on Capitol Hill, small-business owners would be required to insure themselves. Amanda Austin, director of federal public policy for the National Federation of Independent Business, says affordability is the key if the government mandates health coverage.

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ROBERT SIEGEL, host:

More now on what small business owners want to see or not to see in a revised health insurance system.

Joining us is Amanda Austin, director of federal public policy for the National Federation of Independent Business. Welcome to the program.

Ms. AMANDA AUSTIN (Director, Federal Public Policy, National Federation of Independent Business): Thank you for having me.

SIEGEL: Under various bills on Capitol Hill, Mr. Arriola - whom we just heard from - first of all, would be required to insure himself. He'd be mandated to do that. Does NFIB support or oppose the idea of that so-called individual mandate?

Ms. AUSTIN: Well, certainly we think there is a sense of personal responsibility in this system, not just jumping in and out of the system. Most importantly, affordability is going to be key. If it's unaffordable, how can we mandate something that someone or a business, frankly, can't afford?

SIEGEL: But if Congress were, in fact, to guarantee affordability, it would also, under the proposals on Capitol Hill, be requiring insurers not to cap benefits, not to preclude people because of prior conditions. So, in effect, such a bill would require the insurers to offer more risky insurance to people. At the same time, you say, it would have to be affordable before you could accept the personal mandate.

Ms. AUSTIN: It certainly is a balancing act between the insurance industry and significant changes that they want in the insurance market. And certainly, like the story we heard before, guarantee issue being denied for preexisting conditions. Certainly, we think they should be changed. People should be able to get insurance and not be precluded from getting it because of various health problems.

And I think, certainly, Congress is looking towards that way. It is a matter though of balancing out, how do we keep people on the system versus jumping in and out.

SIEGEL: Now it happens that Mr. Arriola's crew, there is some reference to it, number is just three people right now. And he describes them as independent contractors. If his business thrived, and let's say he got up to having a couple of dozen employees, will the National Federation of Independent Business support the idea that he, as their employer, should be required to provide insurance for them, health insurance?

Ms. AUSTIN: Certainly this is a sensitive topic for small employers. And I think the ability for them to offer coverage is really dictated by the profits and in the ability to pay. I mean, currently only half of the small employers out there today have the ability to purchase coverage. And I think we've got to focus on how to insure competition in the marketplace, the ability to have more choice and, frankly, to have more predictability in their premiums each year.

I think a mandate would be very scary for some small employers. And it could actually harm them in the long run. And frankly, the biggest burden on the most vulnerable employers out there today are looking for us to create jobs in this economy.

SIEGEL: But the NFIB, your organization, says that the all Americans should have access to quality care. If indeed mandates are scary and are controversial, one could say, all right, the government should step in then and it should offer insurance. But you're also opposed to that.

Ms. AUSTIN: Well, small employers out there and our members certainly believe that that there is innovation in the private market. And we do have concerns that something that looks like Medicare for all may not be the best choice down the road.

I think it's important to know that the two most broken marketplaces out there today are the individual and small group market. And there are a number of things, including various proposals out there that allow for across the state lines pooling(ph), these exchange proposals. And certainly, many of the reforms to the individual market that we think can provide access to individuals.

SIEGEL: But aren't the very problems that people are trying to solve right now in Washington, creations of the marketplace for health insurance. We've been letting the market do the job so far and it's all of the flaws in the market that have people so upset.

Ms. AUSTIN: I think taking a heavier hand to the insurance industry is certainly a big first step. Certainly, we've let them get away with too many reclusions and ways to get around denying coverage and recessions and whatnot and I think that that must be stopped.

We (unintelligible) there is an ability to provide some competition with some new federal roles being put in place and let the states expand on what they're already doing.

SIEGEL: Amanda Austin, thank you very much for talking with us.

Ms. AUSTIN: Thank you.

SIEGEL: Amanda Austin spoke to us on behalf of the National Federation of Independent Business.

MADELEINE BRAND, host:

And tomorrow on MORNING EDITION, families with so-called Cadillac health care.

Unidentified Man: I know there are people out there that have little or no insurance and need something better. On the other side, I don't want to give up what we've got personally for something significantly lesser to try to equalize.

SIEGEL: And there is more about Americans and their health care at npr.org.

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Facing Aging Without Health Insurance

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Fernando Arriola spends his days keeping track of four or five construction projects, and his nights praying for good health. The New Orleans home builder is one of the 46 million people in this country who don't have health insurance.

Four years ago Arriola, 58, bought a friend's contracting business, just as New Orleans was starting to rebuild after Hurricane Katrina. He named it New Beginnings Enterprises.

Fernando Arriola sits at the desk of the contracting business he owns. i i

Fernando Arriola, 58, had full health coverage for years at his former job, but since starting his own contracting business, there are no affordable coverage options for him and his wife. Sean Gardner/Aurora Select for NPR hide caption

itoggle caption Sean Gardner/Aurora Select for NPR
Fernando Arriola sits at the desk of the contracting business he owns.

Fernando Arriola, 58, had full health coverage for years at his former job, but since starting his own contracting business, there are no affordable coverage options for him and his wife.

Sean Gardner/Aurora Select for NPR

"It was a new beginning for me; it was a new beginning for the city; it was a new beginning for a lot of people we were working with," he says.

And business has been good. He does mostly residential work, like the quaint mother-in-law cottage in the Garden District where his crew is laying tile and putting on the finishing touches.

Making A Living, But Not Enough For Insurance

Arriola makes about $50,000 a year and says he enjoys working for himself. But what he's missing is the comprehensive health coverage he had at his former job as a sales manager.

Are You Covered?

A look at Americans and health insurance

Ever since he's been self-employed, Arriola has been on a health insurance roller coaster. Initially, he bought a standard policy with a $1,000 deductible to cover his family. Then, when business slowed down and money got tight, he decided to temporarily drop the coverage. When he tried to reinstate it, he could only afford a catastrophic plan.

"I was paying $900 a month for a $5,000 deductible that would cover nothing until I hit that $5,000. So I was paying in essence $15,000 before I had one penny covered. And that was too expensive," Arriola says.

So he dropped that coverage, only to have second thoughts. And when he tried to get it back, he was denied even the expensive catastrophic policy. Arriola doesn't know exactly why, but he acknowledges that he and his wife both have high blood pressure and are approaching 60.

"Insurance is nothing more than just a business. And they try to limit their liabilities. So where there's an older person, they don't want to cover it," he says.

Aging Without Coverage

Maria Arriola doesn't think it's fair that after years of paying for coverage and not having many claims, now, when they are starting to have health problems, they can't get insurance.

"There's nothing you can do about that. As you get older things don't work so well, so..." she says.

The Arriolas did buy a policy for their two daughters, ages 22 and 16. But Fernando and Maria are uninsured. They pay for doctor visits and prescriptions out of pocket.

If something major comes up, Arriola says he would leave the country for medical services. Arriola is a naturalized citizen and has lived in New Orleans since 1970. But last year, he traveled to his native Guatemala for arthroscopic knee surgery. It cost him less than $1,000.

"Over here [it] would cost me thousands. They have just as good of doctors as they have over here. Most of them graduated from here," he says.

Not Waiting For Congress To Fix

As for the debate on Capitol Hill over health care reform, Arriola takes a businessman's approach to the issue: Open up the marketplace, he says, and create a national playing field so consumers will have more options.

But he does not have faith that Congress will come up with a fix because of partisan politics. So, in the meantime, he's working to do something locally as a member of the board of directors for the New Orleans Faith and Health Alliance. The group is trying to start a health clinic in unused classroom space at a midcity church. Patients would pay based on their income.

"The purpose is to be able to provide the working uninsured medical services. There is definitely a need. I'm a perfect example of it," Arriola says.

The alliance hopes to start providing care this fall. Arriola plans to sign up. In the meantime, he prays that nothing serious happens. The way the system works now, he says, he'd have to experience a major calamity to get coverage.

"I would have to go into the hospital, I would have to lose my house, I will have to lose all my savings, lose everything for the government to be able to help me. So 40 years of work, 40 years of struggle has to come to nothing. I have to be totally destitute in order for me to be able to get some help."

Arriola says he doesn't want anybody to give him anything. He just wants to be able to afford health insurance.

"There has to be a way," he says.

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