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Expanding Health Care Coverage to the Working Uninsured
In spite of the fact that employers spend nearly half of all US health care dollars, three-fourths of uninsured Americans live in a household where a family member is a full-time worker, As the cornerstone of all health care coverage in our country, voluntary employer-sponsored coverage is a valuable mechanism for organizing and expanding coverage to the working uninsured. The advantages of the existing group market for health coverage are many reliable premium payment and risks are spread among a group, thereby providing greater leverage and lower costs.


Availability of affordable health insurance to all Americans requires special attention to the needs of small businesses, which employ a majority of the working uninsured and individuals who are changing jobs.

  • The National Business Coalition on Health (NBCH) supports the continued strong role of employers as advocates for their employees in seeking and obtaining value from providers in the health care marketplace's complex environment.

  • NBCH is committed to improved health care insurance access by helping design employer, provider and public sector solutions.

  • NBCH is strategically positioned to organize collaboration among these stakeholders and work toward the common goal of expanded affordable health care coverage, with improved administrative efficiency, quality, and patient safety.

The employer members of our coalitions understand that health care cost increases, with double digit levels for the third year in a row, are not sustainable for them or for the public sector. Any policy to expand coverage must include serious reform mechanisms that have the real probability of reducing the rate of health care cost increases to an affordable and sustainable level. Failure to do so will ultimately undermine any effort to expand coverage and will threaten continued coverage for those who now have it.


To improve small business' access to affordable, quality care, the public sector must establish the foundation and encourage the business community's interest in mentoring and lending expertise to smaller firms. The public sector should help liberate and expand innovative and successful initiatives already tested in communities around the country. For example, employer business coalitions are developing purchasing cooperatives for small employers. Large employers or coalitions of employers are sharing their provider networks with small employers resulting in similar discounted rates and administrative fees. The following are prevailing community-based initiatives lead by NBCH coalition leaders.

  • The New York Business Group on Health (NYBGH) oversees HealthPass, an affordable consumer-choice purchasing alliance comprised of four health plans for small businesses with less than fifty employees. New York City Mayor Guiliani's office provided NYBGH with seed money and in-kind assistance to begin HealthPass. Program enrollment began in December 1999 and currently boasts nearly 1000 employer members, of which 61 percent were previously uninsured. Among the total beneficiary lives covered, 50 percent did not have coverage prior to HealthPass.

  • In Madison, Wisconsin, The Alliance-Chamber Health Insurance Program (A-CHIP) ended the fiscal year (5/31/02) with 355 employers and 3,735 employees. A-CHIP is a collaborative effort between The Alliance, an employer-owned health care cooperative, and area chambers of commerce to make health insurance affordable and accessible for small employers. Offered through Group Health Cooperative HMO (GHC), A-CHIP is now growing at a rate of (net) four new employers per month with a total of 30 employees per month.

  • In California, the Pacific Business Group on Health (PBGH) operates a health care purchasing service for small businesses that promotes value purchasing and makes health care programs affordable for small employers. PacAdvantage is a small employer purchasing pool for employers with 2-50 eligible employees that PBGH took over from the State of California in 1999. It offers small employers choice (17 health plan products, seven dental plans, two vision plans and a complementary care plan), affordability (same rate stability offered to most large purchasers), and quality (the same benefits as large employers associated with PBGH). PacAdvantage now includes 11,000 small California businesses and approximately 147,000 employees and dependents. Research shows that more than 30% of small employers were previously uninsured before enrolling in PacAdvantage.

  • The Missouri Consolidated Health Care Plan (MCHCP), based in St. Louis, is one of the state's largest purchasing groups and negotiates coverage for about 106,000 state employees and 8,500 municipal, school district and library system employees. Created in 1992 by the Missouri General Assembly, MCHCP has become the health insurance purchasing pool for most state employees with its own Board of Trustees charged with administering the health benefits program but also making these plans available to all Missouri public entities.

We need to focus on redistributing our valuable health care resources to the uninsured by eliminating waste from the system and improving patient safety. Employers face tremendous challenges in the area of quality and patient safety, particularly on the issues of overuse, underuse and the misuse of health care, which deplete vital financial resources while presenting significant safety and cost issues to American consumers. There are employer coalitions who have undertaken efforts to quantify which problems of overuse create additional cost for purchasers and consumers. Preliminary reports suggest that as much as 30% of the average benefit dollar is wasted because of unnecessary care. Underuse of benefits creates other complications. Appropriate screening and diagnosis improves workplace productivity. It is also important to focus on medical errors, which is an issue popularized by the Institute of Medicine (IOM) in 1999. IOM research indicates that patient injuries caused by medical care have led to an unacceptable number of injuries and deaths.


Business coalitions understand the financial investment of expanding coverage to the working uninsured. It lowers consumer reliance on expensive emergency services that have resulted in cost shifting to the private sector. It also improves the health and productivity of the community's workforce, increases retention and reduces absenteeism. However, NBCH opposes all attempts to mandate employer insurance coverage or specific provisions of employee health benefit plans. Such approaches are counter productive and especially do not work in the economics of emerging and small businesses. Public policy should focus on incentives for employer and individuals.

  • NBCH also supports reform that encourages more individual consumer responsibility for the prudent purchasing of health care as well as responsibility for life style choices that impact on health. Consumers will need much better health care cost and quality information, as well as incentives for healthy life style behaviors.

  • NBCH supports needed legislation to allow insurers to offer state mandate-free health coverage so that more affordable coverage options may enter the marketplace. At the same time, Congress should also firmly resist further efforts to adopt mandated benefits. Employers who choose to sponsor health care plans for their employees must continue to have the flexibility to design and manage their health benefits a right currently assured them by ERISA.