美国国家公共电台 NPR Uncertainty Over Health Care Law's Future Hobbles Entrepreneurs

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SCOTT SIMON, HOST:

Right now, the Affordable¹ Care Act is still the law of the land. It gave some Americans the comfort to start their own businesses because they didn't have to worry about keeping a job just for the health insurance. But this week's repeal² efforts created uncertainty³ about whether those entrepreneurs could count on that insurance option in the future. From KCUR in Kansas City, Alex Smith reports.

ALEX SMITH, BYLINE⁴: Stinson Dean of Independence, Mo., says when he started his company last May, he laid down a firm rule.

STINSON DEAN: One of the things I wasn't really willing to risk was the health of my family.

UNIDENTIFIED CHILD: Whoa, we're going to go fast.

SMITH: Dean is the proud father of three young children - two girls and a boy. And playing with them in his front yard, he and his wife, Stephanie, talk about the possibility of another. Stinson left a good-paying job to start his company buying Canadian lumber⁵ to sell in the U.S. At the same time, they were expecting their youngest daughter, Julie. It's a move he says was only possible because of the Affordable Care Act.

DEAN: I'm glad it worked out because it's been such a successful, you know, 15 to 18 months.

SMITH: So successful that he's ready to expand, to bring on three or four people, but there's a problem.

DEAN: There's a huge unknown with the ACA and what that's going to look like.

SMITH: The Affordable Care Act, or Obamacare, is still the law of the land. The Republicans are currently proposing far less generous coverage⁶ and subsidies⁷ in the ACA. And the president continues to threaten to cut payments for insurers. And many insurance exchanges remain on shaky ground.

DEAN: What that's doing for me is preventing me to convince folks who are in a similar situation to where I was - in a nice corporate⁸ job making good money with great benefits with kids - convincing them to leave that to work for me with no benefits, like, I'm not going to offer any benefits.

SMITH: Exactly how the ACA has effected entrepreneurs and job growth is still unclear according to Dean Baker⁹ with the left-leaning Center for Economic and Policy Research. There was a sharp increase in entrepreneurial activity in 2013, when insurance marketplaces started. He says that prior to the health law, larger companies were often able to offer health insurance and smaller entrepreneurs were at a disadvantage in attracting talent. But...

DEAN BAKER: Once their workers are able get insurance through the exchange, much of that disadvantage goes away.

SMITH: Baker says uncertainty is poison for any business. And 2017's health care battles have been especially toxic¹⁰ for entrepreneurs.

BAKER: For a lot of small businesses, they're sitting there with some trepidation¹¹, saying, OK, how does this work out? Where we are a year from now? Where are we two years from now? And, presumably, at least some of them are going to be putting their plans on hold.

SMITH: That's the case for Stinson Dean. He sees big opportunities ahead he's not sure he can take advantage of. He just can't promise potential employees they'll have decent insurance in the long run.

DEAN: What about 2019, 2020? So these are the questions I'm being asked by these folks I'm trying to recruit. I don't have an answer for them.

SMITH: The future of the current GOP plan to repeal Obamacare is still uncertain. A vote is possible this week. For NPR News, I'm Alex Smith in Kansas City.

SIMON: And that story part of a reporting partnership¹² with NPR and Kaiser Health News.