This will be true for almost all Americans in 2014, if the Affordable Care Act is not repealed or unraveled in court. That’s when online health-insurance marketplaces called exchanges are supposed to be up and running in each state, offering private policies at reasonable rates to the uninsured — regardless of their medical histories — with subsidies available to help low-income buyers.
The Department of Health and Human Services this month released guidelines on how to set up exchanges, and more than half the states already are taking steps to build them. Once they’re up and running, you’ll be able to quit your job at Large Company X and start that plumbing or carpentry business, that mom-and-pop restaurant or barbershop, without putting your family’s health or finances at risk. You can open that dance studio, play in that band, live off savings while you write or paint or launch the tech venture that could make you the next Bill Gates or Mark Zuckerberg.
There’s nothing more American than starting a business. Yet contrary to our self-image, most developed countries have larger small-business sectors than the United States does. The Affordable Care Act could help close the gap — and spur the economy — by removing an obstacle to business creation and self-employment.
“Most start-ups don’t succeed, but the few that do are the growth engines for the whole economy,” said John Harthorne, chief executive of MassChallenge, which runs an annual international start-up competition and offers other help to start-ups. “Imagine that Facebook didn’t get started for want of health insurance. If just one company happens to be a billion-dollar success story, that has a major effect on the economy.”
Republican presidential hopefuls have vowed to repeal what they call “job-killing Obamacare,” and conservative judges are questioning whether parts or all of the law are constitutional. The debate is sprawling and fierce — over its fines for people who don’t buy insurance, its new government regulations, its expensive Medicaid expansions and insurance subsidies, and its mechanisms for curbing the future growth of health costs.
So here’s a point that President Obama and other Democrats who struggled to enact the controversial law might have trumpeted more loudly: It’s good for entrepreneurs, which is good politics. It’s hard to oppose creativity, innovation and the potential for a new generation of risk-takers.
U.S. lagging behind
The liberal Center for Economic and Policy Research (CEPR) triggered debate with a 2009 analysis of small-business data from 21 economically advanced countries. The study, based on data from the Organization for Economic Cooperation and Development (OECD), ranks the United States near the bottom in terms of the proportional size of our small-business sector. The authors cite the patchwork U.S. health-insurance system as one plausible reason for the disparity.
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