Health Care Reform: Co-Ops Could Change Small Business Insurance

When it comes to the Affordable Care Act or Obamacare, apparently there is no end to partisan political sniping in Washington even when the casualties include one's own voters beyond the Beltway.

Last month, five senior Senate and House Republicans fired a broadside at a heretofore relatively noncontroversial provision of the Affordable Care Act, one that provides federal start-up loans to qualified organizations across the country to establish health insurance cooperatives. The co-ops could be an appealing nonprofit alternative for individuals and small businesses, many owned, it is reasonable to say, by Republican-leaning entrepreneurs. These small-business job creators, lacking the bargaining power of big companies, have been saddled with double-digit health- insurance rate increases in recent years by for-profit insurance companies.

But the five senior Republicans, including Senators Orin Hatch (UT) and Michael B. Enzi (WY), sent a warning letter to Health and Human Services Secretary Kathleen Sebelius expressing a laundry list of "our concerns" about the viability of the $3.8 billion Co-op program. "There appears to be little evidence that the Co-op program will promote greater competition and lower costs . . . [and] that HHS may be significantly underestimating the financial risks that these new entities pose to the Federal Treasury." Shades of a Solyndra-like boondoggle was their thinly-veiled political message.

Since the ink is barely dry on the first round of federal loans awarded since January to 16 nonprofit organizations, the real-world "evidence" of the co-ops' success or failure is not yet in and won't be until the co-ops are operational beginning in 2014. The goal is to have co-op coverage available to consumers in every state. But already there is considerable optimism and bipartisan support in the real world if not in Washington for a co-op alternative to the staus quo.

"There is tremendous enthusiasm across the country," says John Morrison, president of the National Alliance of State Health Cooperatives. "The makeup of the co-op teams in each state differs but in general they represent a broad cross section of the community politically and in terms of expertise. I would say across the country roughly an equal number of Republicans and Democrats are working on co-op projects. "

A good example of the broad political appeal of the co-ops is in the Milwaukee area, where a large-scale, grassroots community organization, Common Ground, received one of the first federal start-up loans, $56.4 million, in January. The president of the new Common Ground Healthcare Cooperative is Bob Connolly, co-owner of a small fundraising consulting business in Milwaukee. A self-described political independent, he has equal disdain for liberal and conservative ideologues. The co-op's vice president is Jim Wesp who lives in staunchly Republican West Bend. He's co-owner of a family hardwood distribution business, a leader in his church and, as he puts it, "I tend to vote heavily Republican."

As small business owners, both Connolly and Wesp are frustrated and angry about the never-ending insurance rate increases and high deductibles that depress the salaries of their employees and put them at financial risk. "Over the last three years, the rates on our plan went up 67.7 percent," Connolly says. "I was paying $104,000 a year for four employees. That's also a health insurance plan that has a $5,000 family deductible." At a recent Common Ground roundtable discussion on health care, other small business owners, Republicans and Democrats, talked about their sense of powerlessness in dealing with big insurance companies. Connolly notes that escalating costs are a major reason that only 39 percent of small businesses in Wisconsin provide health insurance for their employees.

Connolly and Wesp believe that small businesses in a seven-county area in southeast Wisconsin will be receptive to the Common Ground co-op if they see the prospects of more affordable coverage, stable pricing, better service and quality health care. "I'm optimistic," says Bob Devita, the co-op's new CEO who spent 38 years as an executive in the health care industry. DeVita, 63, came out of retirement to run the co-op because "it's a fight worth having, to get affordable, accessible health insurance to small businesses and individuals. I feel this is doable, with the team we have and my experiences. I'm not bragging but as Dizzy Dean said, 'It ain't braggin' if you done it.'"

With a goal of starting with at least 10,000 enrollees and growing to more than 50,000, Devita thinks the member-governed co-op, which will have far less administrative overhead than its corporate competition, also has "a huge advantage" over the for-profit insurance companies concerned with short-term quarterly returns for shareholders. The co-op will be able to partner with receptive health care providers, he believes, and develop long-term strategies for improving health outcomes and controlling costs especially through innovative primary care and prevention programs.

While the Common Ground Healthcare Cooperative may be typical in many respects to other co-op start-ups around the country, it has a distinctive pedigree: it's an outgrowth of the increasingly influential, multi-issue Milwaukee-area community organization Common Ground, an affiliate of Saul Alinsky's Industrial Areas Foundation.

That affiliation may make it controversial in some circles thanks to the fabrications of Newt Gingrich and others about Alinsky's pragmatic populism, but in the heartland Common Ground--both the community organization and the co-op-- is building bridges across partisan lines because, for most Americans, even in politically divided Wisconsin, practical solutions trump rigid ideology.