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Commentary: Health care law will benefit small businesses

In health insurance, size matters way too much.

In this marketplace, the sharpest dividing line between the haves and have-nots hinges on the size of your employer. Among Texas companies with at least 50 workers, 95 percent offer health insurance to employees. Among smaller companies, 31 percent offer coverage.

That means that most small employers don't even try to compete on this benefit. And after the Supreme Court upheld the Affordable Care Act last week, they won't have to.

This is one of the great breakthroughs of health reform: By 2014, everyone gets access to health insurance, whether employers are on board or not -- and whether they're sick or healthy.

For workers, it's protection against one of America's top financial risks. If they lose their job, they don't have to lose their insurance. And if they want to take a flier on a small company or their own startup, they won't have to go naked. They may even get subsidies to help with the premiums.

For small businesses, the pool of potential employees should grow significantly. Workers won't have to stay put just to maintain their insurance, in what's known as "job lock."

More small companies will be able to offer coverage, because tax credits will offset some of the costs and they're expected to get better deals through small business exchanges. Others will depend on individual exchanges to provide insurance for their employees, a backstop that doesn't exist today.

This should open the door for a wave of freelancers, independent contractors and early retirees.

In 2012, bridging an insurance gap can be tougher than covering a drop in income. In two years, health insurance may be just one more expense for the self-employed, not a do-or-die proposition.

This assumes that healthcare reform works as designed, and the health exchanges create affordable options. The path is certain to be rocky, at least in Texas, where leaders have fought the law from the beginning. The state hasn't started to build an exchange, for instance, so a federal plan may have to be in place here initially.

Meanwhile, opponents are pushing for repeal, fearful of government expansion and rising costs. The National Federation of Independent Business, whose suit went to the Supreme Court, says the law creates many problems for small companies, including higher expenses and administrative burdens. It objects to new taxes on families that earn more than $250,000, and new levies on health insurers and medical device-makers. This is part of the financing puzzle that covers the cost of expanding healthcare to about 30 million uninsured nationwide, including an estimated 4 million in Texas.

It's a complex plan, and the business group says that small companies don't have the resources to keep up with the paperwork and red tape. Tax credits phase out, for example, for workers whose salaries top $50,000.

But the status quo has problems, too, because health insurance is already complex and expensive. Most important, many small businesses are walking away from it.

In the past decade, the share of the smallest companies offering insurance has dropped 20 percent nationwide, according to the Urban Institute. Over the same time, more than 99 percent of the biggest employers (with more than 1,000 workers) continue to offer insurance.

It's like two different worlds. At small companies that do offer insurance, workers usually pay higher deductibles, often $2,000 for a single person, and they're more likely to pay at least half the costs of family coverage.

In a survey of small businesses in Texas, 74 percent said they didn't offer insurance because they couldn't afford it. But most said they would consider using a state health exchange that lets small companies pool their buying power. And there was strong support to review insurers' rate increases and cap administrative expenses, two other cost-saving provisions in the law.

Most respondents also said they wanted Texas to apply for federal funds to set up an exchange, according to Small Business Majority, an advocacy group in California and Washington.

"We shop for new insurance every couple of years, so we're eager to see an exchange," said Camilo Munoz, owner of Translation Source, a language company in Houston. "We're always trying to do something about the costs."

Munoz has 11 employees in Houston, and many are degreed professionals, so it's important to offer insurance, even with higher deductibles. But he's hoping that an exchange will give him the same economies as large companies.

Historically, small businesses paid premiums that were 18 percent higher than large customers, and administrative expenses were up to four times higher.

By 2014, health exchanges should close the cost gap, and new community rating rules should end the risk of sky-high rates. Most workers won't have to worry about getting health insurance, even if they launch their own business.

That necessity can be covered. Call everything else benefits.