Type: Research
Topic: People-Environment Relationships
Methodology: Literature Review
Status: Ongoing
In the five years since President Barack Obama signed the Affordable Care Act (ACA) into law, millions of previously uninsured Americans have gained access to health care coverage. However, the effect of the legislation on small business operations has been acute. Without the buying power of large corporations, small businesses are faced with costs that are between 8 to 18 percent higher than those paid by big employers for the same health insurance policies, a premium that has been shown to impact business operations. According to a survey conducted by the Society for Human Resource Management, "more than four-in-10 small business owners have delayed hiring due to uncertainty about the effects of the Affordable Care Act" (Rocco, 2013). At a time in which local economies are depending on small business growth as a catalyst for revitalization, the cost of health care is a major factor in decisions to open, grow, or relocate company activities.
Under the ACA, community ratings prevent insurers from varying the cost of health care coverage within a region based upon age, gender, or health status. The resulting geographic rating, determined by price of service and utilization, tie the fate of neighboring communities’ economic and physical wellbeing to one another in a more direct way and to a greater degree than ever before. The purpose of this study is to explore how and why geographic ratings are set and whether adjustments can be made, through improvements to the socio-spatial infrastructure of a community, which offset the potential negative effects of low scores, including loss of business development activity.
The "Prospective Process" methodology developed by Elzbieta Krawczyk and John Ratcliffe for forecasting economic scenarios within urban planning was used to assess the impact that active living and environmental remediation best practices would have upon an urban area undergoing economic revitalization. The study isolates the health impact strategies towards which our nation has invested the most resources and compares the economic consequences of these community scaled interventions with the reinvestment attributed to recent healthcare reform.