The Big Small Business Health Insurance ProblemScott Shane
Through the debate on reforming health insurance for small businesses, an important piece of information was missing: Policymakers had little data on why only some young companies offer their employees health insurance. Common sense and much research indicate that cost plays a big role in business owners' health insurance decisions. Why do some entrepreneurs choose to incur this cost while others do not?
Back in March, Congress passed the Affordable Care Act, which in 2014 will require all Americans to have health insurance or pay a penalty. Although many people would now like to put discussion of employer health insurance behind them, the question of why only some founders of small businesses offer insurance remains an important one. Its answer will influence how much of a role government will play in providing employee health insurance for years to come.
One part of the new law is a set of tax credits and penalties designed to encourage employers to provide insurance.The problem is that for most young small businesses, it won't work.That's the conclusion I reached, based on research I conducted with Alicia Robb of the Ewing Marion Kauffman Foundation.We examined the decisions of founders of young companies on whether or not to offer health insurance, using information from the Kauffman Firm Survey, which tracks a cohort of nearly 5,000 new businesses started in 2004.
The data show that very few new businesses offer employee health insurance. Nearly two-thirds of companies with employees did not offer employee health insurance at any time during their first five years of operation. Moreover, only one in five offered insurance to their workers in all of the years.
insurance: no performance benefits
The few young small businesses that offered health insurance differed dramatically from those that didn't: They tended to be larger and higher-paying, structured as partnerships and corporations, and they offered their employees a wide variety of benefits. Most young businesses don't fit this profile. The majority are sole proprietorships with few, modestly paid employees. Only a handful of young companies grow dramatically. A minority shift from sole proprietorships to other legal structures. Few ever add a lot of benefits. This means that only a small portion of young small businesses are health-insurance-providing types. Most are not.
One argument that's often made to justify giving employees health insurance is that doing so helps companies perform better. Those that offer employee health insurance, the argument goes, get better and harder-working employees. We examined whether the provision of employee health insurance provides any performance benefits to young companies. We found that it does not.
Controlling for a variety of other firm and founder characteristics, we saw no significant effect from providing employee health insurance on firm survival, growth in assets, growth in sales, growth in profits, or growth in employment during the first five years of operation. Stated differently, offering employee health insurance doesn't appear to do anything to improve the performances of young companies, despite what some observers argue. We shouldn't claim that the new law will benefit small business owners by making their companies more successful.
low-paying, sole proprietorships
The data offer three key takeaways for policymakers. First, only a minority of new businesses offer health insurance to employees, even by age five. Fewer still move from not offering insurance to providing it. When thinking about how to manage small business health insurance, policymakers need to keep in mind that offering insurance isn't something that young companies naturally evolve to do as they mature. Consequently, most of the employees at new businesses that don't offer health insurance will need to be covered by government programs and state exchanges.
Second, new companies that don't offer insurance tend to be smaller, lower-paying, sole proprietorships with a large share of part-time workers. These offer employees limited benefits. Policy makers need to recognize that offering employee health insurance is something that fits certain kinds of new companies and not others. Small business owners who don't offer employee health insurance aren't being heartless. They are responding to the economics of the industries they are in and the business models they are pursuing.
Third, offering employee health insurance doesn't improve the financial performance of new companies. Policymakers need to understand that despite the many reasons why they want the founders of all businesses to offer health insurance to employees, requiring that entrepreneurs provide such insurance won't benefit many of the business owners.
Hundreds of thousands of new businesses with employees are founded in the U.S. every year. Few of these companies are large enough, pay enough, or are structured in a way that would lead them to offer employee health insurance. Moreover, few will turn into businesses that provide health care coverage to their workers. As a consequence, most of the several million workers hired by young businesses annually will be getting their insurance from government programs and state exchanges for years to come.