The small business exemption is slightly different right now in the House and the Senate [versions of the bill] but it would look at the payroll of a small employer. I think right now they’re looking at payrolls under $1million which would really be exempt from the employer mandate that you offer coverage. So they’d have an option to come in, have some tax incentives but they wouldn’t pay a penalty if that still were not an affordable situation.
What about midsize businesses? They go through similar challenges as small companies when it comes to health insurance.
They’d have access to the new health exchange. Depending on the size of their payroll, they may or may not be exempted. So they’d have, as the president said, a shared responsibility. Government would play a role in helping to subsidize low-income workers. Individuals would have a responsibility to have coverage. And employers would either have some incentives to provide employee coverage or kick in some payment. One of the things that happens right now is some employers voluntarily offer coverage and they’re less competitive than somebody who’s dumping their employees into a public plan or out on the street. We have a real imbalance.
You talk about shared responsibility. An individual mandate is part of the administration’s program. How do you enforce individuals to take health insurance?
The state of Massachusetts is one of the states that actually now has full coverage. And they verify insurance on the tax rolls that people fill out. When you file your taxes, you declare that you have health insurance. We verify the fact that people have auto insurance coverage in order to get a license tag. Young, healthy folks stay out of the market. But as soon as they have a car accident or get diagnosed with a disease then they come into the market so you have only people who are sick using the benefits. The responsibility really is that people need to have coverage day in and day out, anticipating that everybody’s going to have to use it at some time or another, that some may use it more than others but we can’t just have a system where people wait until they have an accident or a tragedy because then it will never survive.
Even with responsibility, there are some who are uninsured. There are disparities in healthcare delivery. How do you deal with disparities in African American communities?
The recent Census data says that a little over 19% of African Americans are uninsured compared to 11% of Caucasians. So there’s a big gap. And I think that the president sees that as part of the moral imperative; that it’s not okay to say that we have 46 million Americans, a majority of color, who don’t have health insurance, who don’t have access to the system. It’s time we step up. We’ve solved the problem for older Americans; everybody over 65 can rely on the fact that they will be eligible for Medicare, that Medicare will be there. But we need to now take care of the rest of the population and make sure that we no longer have this huge gap between people who get good care, get primary care, have a health home, keep in better shape, and folks who have to come in through the doors of an emergency room to access a doctor or the health care their families need. It’s time for a change.
— Q&A Part 1: HHS’ Sebelius on Healthcare Reform