Look North
New York should consider a Massachusetts prescription.


For years this nation has sought a way to provide every American with affordable health-care coverage. Now the problem is coming to a head. Small businesses and the self-employed are multiplying by the day–yet they cannot access affordable health insurance.

Today, the fastest-growing group of uninsured are small-business owners and independent contractors. They are shut out of buying insurance at group rates.

The choice is clear: We can set aside special-interest politics in order to expand coverage for all. Or we can continue utilizing the power of government to exclude some–namely small businesses and the self-employed–while rewarding others.

Massachusetts has chosen the first path, while New York seems intent on catering to special interests. The Massachusetts legislature recently passed a bipartisan bill that seeks to insure every resident.

It requires able-bodied people to obtain coverage at group-health rates. It gives the self-employed the same buying power and tax breaks enjoyed by large corporations when purchasing health care.

Finally, it provides subsidies, scaled to income and family size, that allow people to buy insurance though groups formed by religious, civic, and community organizations. The Bay State health proposal uses a combination of market innovations, quality improvements, and government support to provide fair care for all.

The Massachusetts approach is not perfect. But it stands in stark contrast to the so-called “Fair Share Health Program” bill being pushed by New York Assemblyman Daniel O’Donnell.

The New York bill is a typical example of the quick-fix solution that misguided legislators and labor organizations are proposing in states all around the country.

Modeled after legislation that passed in Maryland, the bill would force companies–Wal-Mart in particular–to pay an arbitrary amount of their payroll toward health benefits. Specifically, it would require companies with over 10,000 employees in the state to contribute 8 percent of their payroll to health-care coverage.

Troublingly, it was introduced without any serious study of the long-term effect of these massive health obligations–whether they would result in the same unfunded liabilities that are now pushing our auto and steel companies toward bankruptcy.

Nor was there any evaluation of whether such a bill would encourage companies to pare back benefits to minimize coverage. Or whether the bill would simply shift costs from state-subsidized programs to private businesses.

Because this type of legislation is driven by politics and not facts, it fails to address the real issue: More people have to find health insurance on their own. Indeed, the proposed New York legislation is a triumph of special-interest politics. It completely ignores the urgent needs of small businesses and the self-employed to access affordable care.

According to the Kaiser Family Foundation, last year only 59 percent of firms with fewer than 200 employees offered health insurance, compared to 98 percent of firms with 200 or more employees.

Additionally, the Employment Policies Institute reported that a full 45 percent of the uninsured work in firms with fewer than 25 employees.

New York’s legislators should be able to work together with our business and community leaders to provide health care for all without resorting to political ploys like “Fair Share Health Care.” The problems facing our health-care system are bigger than any one business or group of citizens, and we must continue to seek solutions that include everyone, instead of attacking one group or benefiting a privileged few.

As Massachusetts has shown, it is possible for a broad coalition to come up with a real solution that provides affordable and fair health care for all. It’s a great model for the Empire State–perhaps even the starting point for a New York health-care revolution.

–Robert Goldberg is vice president of the Center for Medicine in the Public Interest.