The National Federal of Independent Business (NFIB) laid out its latest principles for health reform. This “voice of small business” says that universal access to health care is especially important to small businesses in the US.

The NFIB believes that the most important issue facing small business for the past twenty years has been access to quality, affordable health care. NFIB cites several reasons for supporting universal access. Access to affordable health insurance options has been a particular problem for small business in the US, which employs so many of the millions of uninsured workers in America. This segment of employers is especially vulnerable in the current health system.

1. Universal. This would include a safety net for the neediest Americans.

2. Private. NFIB supports a private-based system, not a government-run single payer model. NFIB points out that the government has a poor history of innovation, and that the new-new health system must embody a culture of “rapid innovation” with an entrepreneurial spirit (remember, this is the small business association).

3. Affordable. NFIB well knows the cost-burden of health care on small business and individuals, and health costs depressing impact on wages. This principle emphasizes the importance of controlling health care costs.

4. Unbiased. Small business believes it has been given the short end of the health insurance stick versus larger employers, who benefit from pooling large numbers of employees across state lines. Tax laws benefit larger employers when it comes to health insurance provision. The NFIB also rejects mandates and the concept of “play or pay” in being forced to provide health insurance to employees.

5. Competitive. NFIB values consumer choice and innovation. The small-group health insurance market has lacked competition at the local level, which is where small business plays.

6. Portable. Given the mobility of American workers, the NFIB wants to ensure that employees are not job-locked in their health insurance plans.

7. Transparent. To ensure a smooth-operating market, the free flow of useful information on quality and pricing in health care is paramount. The NFIB emphasizes that the private sector should develop this information and not depend solely on the government to do so. Information technology is a linch-pin to this objective.

8. Efficient. Here, the NFIB says that, “Health care policy should encourage an appropriate level of spending on health care.” Financial incentives must be aligned toward this end.

9. Evidence-based. Adopting evidence-based medicine will address the efficiency challenge. Providing and acting on comparative information on provider and clinical cost-effectiveness will help to more rationally allocate health care resources.

10. Realistic. The NFIB cautions that, “reform is a delicate balancing act.” They support a go-slow approach to ensure that no Americans “slip through the cracks.”

Health Populi’s Hot Points: Small business is indeed burdened with health insurance challenges. In The Uninsured: A Primer, Kaiser Family Foundation found that employees of small businesses (with fewer than 100 employees) are less likely than people working in larger firms to have health benefits offered to them. The gap widened between 2001 and 2005, with employees of the smallest firms (less than 10 employees) experiencing the greatest change. The NFIB’s principles for health reform reflect the nature of the association’s constituency: in particular, the value of entrepreneurship and primacy of the private sector. The voices of the 350,000 NFIB members will be heeded by some of the 2008 Presidential candidates; for example, Senator Clinton’s health reform outline excludes firms with fewer than 25 workers from her proposed employer health insurance mandates. Still, the NFIB’s 10th principle of “realism” (political and economic) comes to mind when one considers employers with, say, 40 employees. At some point, those employers — and their workers — could fall through the cracks about which the association is so concerned.