It is March 12, 2010, and we have had negotiations, debates, votes, summits and all sorts of speeches on health care and we still do not have a clear sense of what, when or how a health care reform bill is going to get passed. As someone who has spent the better part of the past eight years working on this issue as a representative of a membership that is largely made up of small independent businesses, I have to say that I am really disappointed with both political parties for not delivering a health care reform bill that will help small businesses gain access to quality affordable health insurance for themselves and their employees. Unfortunately, what we have ended up with is a highly partisan process that is so procedurally convoluted that even the most inside insiders are not sure how this is going to play out.

Just to recap, here are some of the things the American Rental Association (ARA) has strongly supported in the health care reform debate:

1. The ability to buy insurance across state lines using insurance pools that lower costs.
2. Reasonable and balanced insurance market reforms that maintain the employer-based system.
3. Guaranteed issue with no ratings by insurance companies based on health status and no rescissions of coverage when people get sick.
4. An individual mandate that requires individuals to obtain coverage. We are already paying for emergency room care for the uninsured; we need them in the system.
5. Tax equity for all small businesses and sole proprietorships.
6. More choices for simple cafeteria plans.

While some of these provisions are included in the bill passed by the Senate (H.R. 3590), there also are some provisions that resulted in a bill that could go way beyond what our nation can afford:

1. A mandate that employers provide a very expensive level of minimum coverage.
2. Fines on employers that do not provide this coverage.
3. Fines on employers who have employees who are eligible for federal subsidies under the bill. These fines are not only on the number of employees who are eligible for the subsidy, but on the employer's entire workforce.
4. A significant expansion of Medicaid. Medicaid is not only a very costly federal/state program that states are having trouble affording now, but Medicaid reimbursements are well below the reimbursement rates paid by private health plans. This will increase the cost-shifting from government-sponsored health plans like Medicaid on to private insurance plans. Bottom line, people insured under private plans pay more.
5. Taxes on businesses and individuals will need to go up to pay for all of this.
6. Unions and others who over insure get a break from tax hikes.
7. The budget gimmick that collects taxes in the early years before any benefits are paid so that the Congressional Budget Office can report big savings over a 10-year window does not account for the full cost of this legislation over the long-term.
8. After the House passes the Senate-passed (H.R. 3590) bill, there will be a reconciliation bill that, at the moment, is a total black hole.

I have talked to many ARA members about this legislation and I know that there are opinions on all sides of the issue, as well there should be. My disappointment with Republicans on health care is that their alternatives are not bold enough and do not drive enough of the reforms that ARA members really need. Therefore, I see the current health care debate as way too much from one side and not enough from the other.

However, in the end, politics is all about choosing sides. My conclusion is that the Senate bill and the mystery reconciliation bill that is supposed to follow are not good policy and are not affordable. That is why I am urging ARA members to contact their member of the House of Representatives and ask them to vote “No” on H.R. 3590. To find your representative’s name and phone number, click here and enter your ZIP code. Call either their Washington, D.C., office or the district office to register your position on H.R. 3950.