According to findings published in health policy journal Health Affairs, few small businesses are likely to take advantage of two options allowing them to avoid new regulations under President Obama’s Affordable Care Act. Researchers believe that most small employers will likely eschew the two rules because opting to self-insure or maintain grandfathered insurance plans would leave them open to substantial financial risk should the medical expenses of their employees surge unexpectedly. Furthermore, researchers predict that the majority of small businesses won’t be able to grandfather existing health plans after 2014, as they will fail to meet the necessary requirements.

A report released by the Center for American Progress points out the momentous challenges small employers face in providing affordable, high-quality health insurance plans for themselves and their employees:

Small businesses, which employ 42 million Americans, continue to struggle with the rapidly escalating costs of health insurance. Over the past decade, small-business owners have watched their health insurance premiums rise 133 percent—the same kind of premium growth large businesses have experienced. But because of their smaller scale and thinner margins, they are less able than larger businesses to absorb these increasing costs.

Other factors make it more difficult for small businesses to offer coverage than large businesses. For instance, on average, small businesses pay 18 percent more than big businesses for the same coverage—often due to high broker fees, fixed administrative costs, and adverse selection, which is the upward price spiral that occurs when one plan or market disproportionately attracts high-risk employees.

To combat this obstruction, the ACA has introduced the Small Business Health Options Program (SHOP), which is intended to create a marketplace for small business owners to purchase health insurance for their employees. These proposed SHOP exchanges will allow small businesses to consolidate their buying power so they can purchase high-quality insurance with substantially reduced premiums. By spreading the financial risk associated with insuring high-cost enrollees across a wider pool of employers and employees, the exchanges will keep costs affordable, limit the burden posed by the insurance process, and reduce administrative expenses.

“The exchange is the most important component of health care reform for small businesses and it’s critical states set them up correctly so small businesses get the relief a strong exchange can provide,” said Terry Gardiner, Vice President of Policy and Strategy for Small Business Majority.

Under the ACA, open enrollment for SHOP exchanges should commence sometime in late 2013, while small employers and their employees can expect the exchanges to officially open for business on January 1, 2014.

– Fatima Najiy

Rick Santorum has been outspoken about his Catholic faith on the campaign trail, explaining how his faith and personal values have influenced his political positions. But at a campaign event at Oral Roberts University in Tulsa, Oklahoma today, Santorum had trouble rationalizing how he reconciled his opposition to health care reform with the Catholic Church’s support of the plan. A questioner asked Santorum, “With you lining up with the Catholic faith on so many issues, why not the Catholic Church on health care since it is a value and a human right?”

Santorum offered a rambling answer, first saying that church’s teachings had shaped his life and then insisting that he also has to consider reason as a politician. “I always say if your faith is true and your reason is right, then you’ll end up in the right place,” he said. “And of course why would God create something where reason would bring you one place and your faith would bring you another if your faith is true?” And as a public official, he said, he had an obligation to talk to people who share his faith and those who don’t:

My conscience was formed as a result of my life experiences and primarily through faith and through the moral values I was taught through the teachings within the Bible and the church. Yes, I bring that to the table. That’s who I am. [...]

I look at the Affordable Care Act and say, both from the standpoint of faith, do I believe that people should have the opportunity to purchase health care? Yes. Do I believe that it is the right that the government should impose and control? No. It’s one thing to say that people have an opportunity to access of care. It’s another to say that the government should be the implementer of that. And something tells me that government is the least effective tool to make that the best possible care.

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Of course, Pope Benedict XVI has called health care an “inalienable right,” and added that it is the “moral responsibility of nations to guarantee access to health care for all of their citizens, regardless of social and economic status or their ability to pay.” The Catholic Health Association supported the Affordable Care Act, and during the debate about health care reform, Catholic nuns broke with the U.S. Conference of Catholic Bishops to support it. But Santorum will continue to twist the logic to fit the position he wants to support.