Obamacare and the coming Entrepreneurship Boom

Brad Dorsey

2 min read ·

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For ages, the most important asset an entrepreneur could have is a spouse with health insurance. That's about to change as more corporate employees feel free to go freelance.

You think there's a war for talent now?

If Obamacare works–now that the Supreme Court has found the Affordable Care Act constitutional–Corporate America is going to face turnover unlike any it's ever seen before.

Be honest: How many working parents do you know who would ditch their corporate jobs if they thought they could buy decent health insurance for their families in the individual marketplace? What if they didn't have to worry that their kid seems to have asthma and might not be insurable, or that the kidney stone their spouse dealt with six years ago will make it impossible to buy a family policy?

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In entrepreneurship, it's long been said that the single best asset an entrepreneur can have is a spouse with a steady job and health insurance. Now it seems the second half of that qualification is about to vanish.

The Affordable Care Act will impose some costs on small businesses, but it will also make it easier for many, many would-be entrepreneurs to go into business in the first place–including many who are currently holding down jobs at big companies.

Of course, just because the Affordable Care Act has been ruled constitutional doesn't mean it will work–or work like anyone expects. And promising to repeal the act has become one of the easier-to-pass tests of loyalty among Republican candidates, even though Republican presidential candidate Mitt Romney led the passage of a similar bill while he was Governor of Massachusetts.

A big part of making the Affordable Care Act effective rests with the states. They need to build health insurance "exchanges" to provide competition between insurers and to make it easier (and cheaper) for individuals to buy insurance. The states are not exactly going gangbusters. Research by the nonpartisan Urban Institute found that 14 states had made significant progress toward building exchanges, 16 had made no progress, and 20 were in the middle.

To the extent that the Massachusetts law has been a model for the national one, it contains some sobering lessons for entrepreneurs. The law made it easier and cheaper for individuals in Massachusetts to buy health insurance, but made it more expensive for small businesses. That's partly because the Massachusetts law prioritized access over cost–we'll cover people, legislators figured, and then work on getting costs down.

Now they're covering lots more people, but costs are still going up. It's also partly because the pool of uninsured people turned out to be in worse health than anyone thought, driving up costs across the system.

Unemployment is still high. And insurance is still going to be expensive–we won't have a single payer system, such as Canada's, that veils the cost of health coverage behind taxes that everyone pays. So employer-sponsored healthcare, for many, will still be an important perk of holding down a job with a company big enough to offer it.

But for many others, being able to buy health insurance as an individual, without worrying that it will be yanked away or rendered unaffordable by illness, will be the final push out of corporate America and into entrepreneurship.

Come on in. The water's fine.

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Brad Dorsey