Small-business health care: a win for owners, employees and the bottom line | GUEST COMMENTARY

We have learned many lessons over the past two years — and one that stands out is the importance of ensuring that every Marylander has access to affordable health insurance. Even before the pandemic exposed weaknesses in our economy, workers sought out jobs that provided both good pay and good benefits. Today, as employers are finding it difficult to hire workers — and workers are wary of going back to jobs because of the ongoing pandemic — ensuring that businesses can offer health insurance is more important than ever.

Unfortunately, many small businesses in Maryland can’t afford or absorb the enormous cost to offer coverage to their employees. Only 37% of small businesses in the state provide health coverage, compared to 95% of large employers. Workers at those small businesses must either pay for coverage themselves or go without, leaving them exposed to major health costs. This is a matter of equity. Maryland has the highest per capita rate of small businesses owned by people of color in the nation. As a state, we also see profound disparities in health outcomes for people of color.


A recent national survey of more than 1,030 small-business owners found that lowering health care and prescription drug costs was their top priority, with 73% saying it is important to their business. Maryland has made major progress in expanding access to affordable health insurance, but there is more to do to help ensure our small businesses are able to provide coverage to employees.

In the 2022 legislative session, we will introduce legislation in the General Assembly to help ensure that small businesses in Maryland can afford to offer their employees health insurance. We thank the Maryland Health Care For All Coalition for supporting this proposal.


Our current system provides some support through federal tax credits for small businesses purchasing insurance through Maryland Health Connection, the state’s online insurance marketplace created through the federal Affordable Care Act. Unfortunately, we have seen few small businesses take advantage of them, often because they don’t know about the option and the federal tax credits don’t make the cost affordable over the long term.

To encourage more small businesses to provide health care to their employees, we will propose that the state commit $45 million of federal funds received by the State to help small businesses pay for health insurance for workers through Maryland Health Connection. Our legislation will also commit $3 million to help educate small businesses about the new state subsidies. We have learned that such outreach efforts are absolutely vital to make sure small-business owners know about these kinds of programs.

These funds will subsidize premium costs, making it far more affordable for employers to provide the benefit. This will lead to more working people signing up for health insurance. This not only protects them, it brings down the cost of health care for everybody. When uninsured people go to the hospital, we all pay through higher health insurance premiums for the increased uncompensated care.

This is a bill where everyone wins. Small businesses benefit by making their job openings more attractive to job seekers looking for a strong benefits package. Employees have access to more options for high-quality, affordable health coverage. Racial inequities in access to health coverage will be reduced. And, last but not least, we leverage federal dollars to reduce the cost of health care premiums for everyone across the state of Maryland.

Maryland has taken many important steps to expand health coverage for our residents. We created a reinsurance program to bring down premium costs in the individual insurance market and launched a pilot program to provide subsidies to bring down the cost of coverage for young adults. These efforts will continue to pay dividends. At a time, however, when the State of Maryland is receiving an additional $7 billion of federal funding and when we already have a $2 billion General Fund surplus, now is the time to do everything possible to support small businesses and the people who work for them.

Katie Fry Hester ( is a member of the Maryland Senate representing District 9 in Carroll and Howard counties. Robbyn Lewis ( and Brooke Lierman ( are members of the Maryland House of Delegates representing District 46 in Baltimore City.