Mending the Flaws in the Small-Group Market

Prologue: One of the truths that has emerged from Washington's ongoing debate over reforming the small-group health insurance market is that the major obstacle to broader coverage is its unaffordability. But that has raised the question, What would be considered affordable insurance for a small employer? One of the interesting lessons that emerges from this paper written by David Helms and his colleagues at the Alpha Center, based on their experience directing The Robert Wood Johnson Foundation's Health Care for the Uninsured Program, is that most small employers are not interested in making health insurance available for their workers, even if premium reductions averaging between 25 and 50 percent below prevailing rates are offered. The authors view the result as an important message: “While it is clear to us that voluntary efforts to expand coverage, particularly in the small-group market, will not achieve universal access, our society has to date been unwilling or unable to move to a mandatory system. “Helms is president of the Alpha Center, a Washington-based health policy center that he started in 1976. Helms holds a doctorate in public administration and economics from Syracuse University. Anne Gauthier, who formerly worked for the congressional Office of Technology Assessment and the National Leadership Commission on Health Care, is associate director of the Alpha Center. She holds a master's degree in health administration from the University of Massachusetts. Daniel Campion, an associate at the Alpha Center, received a master's degree in public and private management from Yale University. The Alpha Center directs two major programs for The Robert Wood Johnson Foundation: the State Initiatives in Health Care Financing Reform Program and the Health Care Financing and Organization Initiative.