The relentless rise in health care costs is causing states and businesses to fight over whose job it is to insure workers. And nearly two dozen states, struggling with the growing burden of providing public assistance to people with jobs but no insurance, are looking to shift more of the financial burden onto the workers' employers. þþLast month, for example, Maryland, which spends roughly $350 million a year on health care for the uninsured, passed a bill requiring the state's very largest employers to spend at least 8 percent of their payrolls on health benefits for their workers. Lawmakers elsewhere, including Connecticut, are considering legislation that may also require some companies to provide coverage, either directly or by paying into a state fund. þþSome measures, as with a New Jersey proposal, would let companies bid on state contracts only if they provided health insurance for their workers. þþAt the very least, some states would embarrass companies whose workers are on Medicaid or other forms of state assistance by publishing the employers' names - as Massachusetts has already done with a list of companies including Dunkin' Donuts, Stop & Shop and Wal-Mart Stores. Dunkin' Donuts says individual franchised stores, not the company, are responsible for coverage, while Wal-Mart challenged the findings. Stop & Shop declined to comment. þþThe Maryland bill may not presage passage of such measures in other states, but employers and others say there is no doubt that the issue is heating up around the country. Medicaid, the states' main public assistance health care program, now eats up about 16 percent of their budgets. Nationally, the number of uninsured is 45 million and rising. And with federal funds expected to be scaled back by $10 billion over the next five years, the states' burden seems likely to grow. þþSome employers, though, question whether that national problem should necessarily be theirs to solve.þþÿThe focus of the debate is whether there should be an employer mandate,ÿ said Ellen Valentino, Maryland director for the National Federation of Independent Business, whose state group of small companies opposed the legislation. þþBut backers of the Maryland bill, which seemed to take special aim at Wal-Mart, the nation's largest employer, say the support for it there indicates a growing recognition of the growing financial burden of caring for the uninsured. They say taxpayers are unfairly supporting too many companies' uninsured workers, who turn to government programs like Medicaid or simply show up in the emergency rooms of hospitals subsidized by the state to provide care to people unable to pay.þþJonathan Parker, campaign director of Americans for Health Care, a union-led group in Washington that helped push for the Maryland bill, said legislative pressure was rising in state capitals nationwide. ÿWe're going to see it in more and more states,ÿ he said, ÿand we're going to see it sooner rather than later.ÿ þþMr. Parker's group points to people like the Smiths, a couple in Portland, Ore. Cheryl Smith, 54, works as a nurse's aide at a private residential care facility, making about $20,000 a year. Her husband, Vern, 51, has diabetes and an array of conditions associated with the disease. þþMr. Smith, a former security guard, has not worked for about three years, and Mrs. Smith's employer does not offer insurance. After he had a heart attack at the end of March, the couple faced enormous bills - $68,000 for the hospital stay, $38,000 for doctors' fees, with more on the way for other services. þþÿI personally don't know what to do with them,ÿ Mrs. Smith said. þþAn Oregon proposal to require all employers to contribute to a health care fund failed in 2003, but its backers vow to revive the effort. Oregon has reduced the number of people eligible for its state programs, and Mr. Smith is among those who lost benefits. þþSeveral other states, including Tennessee and Minnesota, have also been dropping people from public programs or are considering such cuts as they try to balance their budgets. ÿThey are in fiscal crisis, and they are looking at ways to cut costs, shift costs,ÿ said Jeff Munn, a senior health care consultant at Hewitt Associates, which advises employers on health care and a range of other matters. þþÿIf history is a guide, a lot of these efforts will fail,ÿ Mr. Munn said. ÿThat said, it does feel like there's momentum around these efforts.ÿ þþOnly a few months ago, it seemed as if any momentum had stalled. California voters narrowly defeated a proposal in November that would have required large employers to pay more to insure their employees, after a campaign by unions and other groups that focused much of their energy on Wal-Mart. þþ
Source: NY Times
