A few years ago, nearly 65 percent of small businesses in America offered health insurance to their employees. Estimates now put that number under 50 percent.
But Ohio has no such programs in place.
In the vast number of cases, it's not that the business owner doesn't want to provide health insurance - it's simply that they can't afford the mounting costs, according to State Rep. Randy Gardner, R-Bowling Green.
"With the national debate in Washington, small business health insurance affordability should be a top priority," Gardner said. "This is the one aspect of health care reform that holds the greatest promise for bipartisanship and success."
So the state legislator has sponsored a bill creating the Small Business Health Care Affordability Task Force. The group would study whether tax incentives would help encourage small businesses to offer and maintain health insurance coverage for employees, and if wellness programs and disease prevention could be enhanced with state incentives. The task force would consist of six state legislators and five members representing small business employers and employees.
Currently, 10 other states have tax policies that help with health programs. Those are Colorado, Georgia, Kansas, Louisiana, Maine, Missouri, Montana, North Carolina, Oklahoma and South Carolina.
"Small businesses are creating more than 80 percent of the new jobs, and the rising cost of health insurance is a significant burden for many small businesses," Gardner said. "It only makes sense that we can help small businesses be more competitive for jobs and make health insurance coverage more affordable with one targeted policy."
The discussion on health care is nothing new.
"Health care and health care affordability is a growing major issue in Ohio and across the country," he said. "Yet nothing gets done."
So Gardner is hoping his legislation will force a more focused debate on the issue - "instead of just complaining about the problem."
With all the discussion at the federal level about health care reform, Gardner is hearing concerns from small business owners about possible changes.
"In general, they don't expect it to be positive."
Gardner is interested in the state offering incentives rather than penalizing companies that don't provide health insurance.
"We need tax incentives for small businesses, not penalties," he said. "Most small businesses want to offer health insurance." After all, they can usually attract better employees if they offer the benefit. But some are concerned they will not be able to stay in business if forced to offer insurance - and that is at odds with what America needs now, Gardner said.
"Most elected officials are talking about more jobs, not less," he said.
Carrie Haughawout, of the Ohio Chamber of Commerce, said business owners will welcome efforts to set up a task force.
"Small businesses are struggling every day trying to afford health care," she said. "Anything we can do as a state or a country to help them afford health insurance for their employees is a good thing."
Haughawout agreed with Gardner that penalties are not the answer.
"Penalizing them is no good," she said.
A survey sponsored by the state chamber last year showed that 71 percent of small businesses offering health insurance to employees are struggling to do so, and 67 percent just can't afford it.
"It's not that they don't want to provide it. That's just not the case. They just simply can't afford it," Haughawout said.
Earlene Kilpatrick, head of the Bowling Green Chamber of Commerce, hears those same concerns from local business owners.
"A number of small businesses want to provide it," she said. "It is extremely unaffordable for them right now."
Business owners are closely watching health care reform efforts to try to gauge how they will be impacted. Kilpatrick agreed that some proposals are more likely to be received positively by businesses.
"Incentives work better than penalties," she said.
Kilpatrick said the local chamber will review Gardner's proposal in its advocacy task force.
Businesses surveyed on health care
A telephone poll of 300 randomly selected small business owners across Ohio last year showed that health care costs are a major concern among the owners. There was agreement that something needs to be done and interest in a wide variety of reform measures, but there was no consensus on any single reform option.
The survey, sponsored by the Ohio Chamber of Commerce, showed:
¥ 77 percent of those businesses not offering health insurance say they can't afford to do so.
¥ 71 percent of those businesses offering health insurance say they are really struggling to do so.
¥ 73 percent agree people should be able to buy health care policies without regard to their health care status.
¥ 67 percent agree that health care is a consideration for people with pre-existing conditions who are thinking about starting a small business.
¥ 67 percent say it's appropriate for individuals, employers, insurers, government and health care providers to share the responsibility for making health care more affordable.
¥ 57 percent believe that moving toward high-deductible insurance plans and higher co-pays will help their employees better understand the price of health care and make choices to protect their health.
¥ 53 percent believe their businesses that don't offer health insurance should be required to pay something to cover their employees, although 30 percent of respondents said no contribution should be required.
¥ 51 percent agree government should play a bigger role in the regulation of the health care market.
¥ 43 percent believe that individuals should be required to obtain their own insurance, and 61 percent believe that if this is required, government should subsidize those who can't afford it.
The survey examined small business owners' attitudes about different approaches to reforming health care. The strongest support was for an approach that would create a national insurance health exchange.
¥ 62 percent favor the creation of a national health insurance exchange that would offer a choice between public and private plans.
¥ 57 percent support a Medicaid buy-in option.
¥ 50 percent support creating a basic, affordable benefit plan to allow all Ohioans to have at least a minimal level of insurance coverage.
¥ Respondents were evenly split 43 percent to 43 percent on the question of whether the state should use a high-risk pool to provide insurance for residents with pre-existing medical conditions.
¥ 35 percent favor a single-payer system.