ROBERT SIEGEL, host:
More now on what small business owners want to see or not to see in a revised health insurance system.
Joining us is Amanda Austin, director of federal public policy for the National Federation of Independent Business. Welcome to the program.
Ms. AMANDA AUSTIN (Director, Federal Public Policy, National Federation of Independent Business): Thank you for having me.
SIEGEL: Under various bills on Capitol Hill, Mr. Arriola - whom we just heard from - first of all, would be required to insure himself. He'd be mandated to do that. Does NFIB support or oppose the idea of that so-called individual mandate?
Ms. AUSTIN: Well, certainly we think there is a sense of personal responsibility in this system, not just jumping in and out of the system. Most importantly, affordability is going to be key. If it's unaffordable, how can we mandate something that someone or a business, frankly, can't afford?
SIEGEL: But if Congress were, in fact, to guarantee affordability, it would also, under the proposals on Capitol Hill, be requiring insurers not to cap benefits, not to preclude people because of prior conditions. So, in effect, such a bill would require the insurers to offer more risky insurance to people. At the same time, you say, it would have to be affordable before you could accept the personal mandate.
Ms. AUSTIN: It certainly is a balancing act between the insurance industry and significant changes that they want in the insurance market. And certainly, like the story we heard before, guarantee issue being denied for preexisting conditions. Certainly, we think they should be changed. People should be able to get insurance and not be precluded from getting it because of various health problems.
And I think, certainly, Congress is looking towards that way. It is a matter though of balancing out, how do we keep people on the system versus jumping in and out.
SIEGEL: Now it happens that Mr. Arriola's crew, there is some reference to it, number is just three people right now. And he describes them as independent contractors. If his business thrived, and let's say he got up to having a couple of dozen employees, will the National Federation of Independent Business support the idea that he, as their employer, should be required to provide insurance for them, health insurance?
Ms. AUSTIN: Certainly this is a sensitive topic for small employers. And I think the ability for them to offer coverage is really dictated by the profits and in the ability to pay. I mean, currently only half of the small employers out there today have the ability to purchase coverage. And I think we've got to focus on how to insure competition in the marketplace, the ability to have more choice and, frankly, to have more predictability in their premiums each year.
I think a mandate would be very scary for some small employers. And it could actually harm them in the long run. And frankly, the biggest burden on the most vulnerable employers out there today are looking for us to create jobs in this economy.
SIEGEL: But the NFIB, your organization, says that the all Americans should have access to quality care. If indeed mandates are scary and are controversial, one could say, all right, the government should step in then and it should offer insurance. But you're also opposed to that.
Ms. AUSTIN: Well, small employers out there and our members certainly believe that that there is innovation in the private market. And we do have concerns that something that looks like Medicare for all may not be the best choice down the road.
I think it's important to know that the two most broken marketplaces out there today are the individual and small group market. And there are a number of things, including various proposals out there that allow for across the state lines pooling(ph), these exchange proposals. And certainly, many of the reforms to the individual market that we think can provide access to individuals.
SIEGEL: But aren't the very problems that people are trying to solve right now in Washington, creations of the marketplace for health insurance. We've been letting the market do the job so far and it's all of the flaws in the market that have people so upset.
Ms. AUSTIN: I think taking a heavier hand to the insurance industry is certainly a big first step. Certainly, we've let them get away with too many reclusions and ways to get around denying coverage and recessions and whatnot and I think that that must be stopped.
We (unintelligible) there is an ability to provide some competition with some new federal roles being put in place and let the states expand on what they're already doing.
SIEGEL: Amanda Austin, thank you very much for talking with us.
Ms. AUSTIN: Thank you.
SIEGEL: Amanda Austin spoke to us on behalf of the National Federation of Independent Business.
MADELEINE BRAND, host:
And tomorrow on MORNING EDITION, families with so-called Cadillac health care.
Unidentified Man: I know there are people out there that have little or no insurance and need something better. On the other side, I don't want to give up what we've got personally for something significantly lesser to try to equalize.
SIEGEL: And there is more about Americans and their health care at npr.org. Transcript provided by NPR, Copyright NPR.