Introduction The Denver Metro Chamber of Commerce believes the business community has a role in the health care system and supports the employer‐based model of coverage. Our members want to provide health benefits to employees, but it becomes more difficult each year because of increasing costs. We support the discussion and dialogue around national health care reform, and we are in agreement that our system requires review and attention. With an issue of this size, scope and importance to our country, we believe it is necessary to take the time to thoughtfully review all proposed changes to ensure we are making choices that will serve our country well. The impact of such an effort must be measured not just in short‐term outcomes, but in long‐term implications. All possibilities and consequences – intended and otherwise – must be vetted. This issue is too important to rush – and fail. Specific to Colorado, it is important to note that our health care infrastructure is fragile. The diversity of the state – in geography, demographics and tax policy – plays a role in how our systems of care, both public and private, are financed and managed. Our federally elected officials must take these unique needs into consideration as we discuss reform proposals and how they will impact Colorado and its citizens. Health Care Reform Principles Cost Reduction Concerns regarding the ever‐increasing cost of providing health care coverage to employees is the number one issue for business when asked about health care. To fully gain the business community’s support, true cost containment and overall cost reduction strategies must be part of any federal health care reform solution. This could include, but is not limited to, payment reform measures, health information technology advances and tort reform activities. Of equal importance is acknowledging that the current health care system simply shifts costs to the private pay sector, and any Congressional proposal must directly address this issue. (See the Denver Metro Chamber’s White Paper: Medicaid, the Uninsured and the Impact on Your Business.) Mandates Health care coverage is a benefit – not a mandate. The majority of Americans receive their health care as a benefit through their employers. At present, the U.S. Chamber of Commerce places that number at more than 177 million individuals. Business sees this voluntary activity, as well as other employee benefit programs, as a competitive recruitment and retention tool. The Denver Metro Chamber supports a voluntary system and the competition that it creates. The Chamber does not support an employer mandate, which we view as an arbitrary payroll tax that is regressive in nature and ultimately stifles business growth and opportunities. Regarding an individual mandate, a recognition exists regarding the importance of having as large a pool of persons as possible should community rating and guaranteed issue be required. True insurance reform will not be possible without everyone being in the system. Therefore, we support an individual mandate. However, questions remain regarding the enforceability. Additionally, concerns exist that such a change will simply places the current cost shift “directly” on business, as it may be required to raise salaries in order to ensure individuals have the resources needed to take up mandatory coverage. Should that be the case, such an effort does not address the basic concern of business, which is cost containment. These issues must be addressed as part of any reform plan which includes an individual mandate. Government‐Run Plan Competition is key: Team owners can’t also be referees. The business community believes in competition and is confident it can be successful when a system is fair and equitable. Employer‐sponsored coverage would be decimated by a government‐run plan, which would have an unfair advantage as both a participating provider and as the regulator. Consequently, the Chamber opposes this approach. Eight out of 10 workers are satisfied with their employer‐ sponsored health insurance. We must keep them in mind when reforming this system. Financing National Health Care Reform Who is picking up the check, for what and for how much? Who pays, how that cost structure will be implemented and regulated, and what is the total bill for national health care reform are all fair and important questions that must be addressed prior to agreeing to support a reform proposal. Agreeing to a model – without knowing the financing mechanism, benefit structure and actual cost – simply does not make good business sense. Major changes to the tax policy of our country, such as removing the pre‐tax status of health care benefits, mandating that a certain percentage of payroll be allocated to cover the cost of health care coverage, or an across‐the‐board tax or penalty system, will affect all Americans and are all large‐scale changes to our system that require thoughtful discussion and debate. Businesses do their homework before making investments or proceeding with what they would consider a calculated risk. Conclusion Health care reform is critically important – but the devil is in the details. As with any full‐scale reform effort – be that in a business setting or in the legislative arena – there are often more questions than answers as the process begins to unfold. That is certainly the case today in the discussion over national health care reform. In the private sector, businesses take the time to fully vet and test their assumptions prior to executing a new plan. This due diligence allows them to recalibrate or retool, if they should require a mid‐course correction. With that in mind, the Denver Metro Chamber urges Colorado’s Congressional Delegation to do the same as they review health care reform options: Take the time to ensure that all the critical question regarding a new model of health care coverage and delivery are raised and fully answered. Having a clear understanding of the total cost of reform and who is covering the bill, the benefit plan’s structure and the regulatory climate in which this system will go forward are all key to understanding how this plan will relate to millions of American workers and their employers. Additionally, it is critical to have this information to understand how it will relate directly to each state. There is no need for an arbitrary time frame to help us make the right decision. The Chamber supports taking the time that is required to find the right prescription for health care reform.
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