New Report From Thumbtack Finds Majority of Small Business Entrepreneurs Want Congress to Keep Affordable Care Act in Place
As Congress grapples with repealing—and replacing—the Affordable Care Act (ACA), Thumbtack surveyed 14,393 entrepreneurs to see how congressional changes will harm or help small businesses across America.
Other analyses from institutions like the U.S. Department of Health and Human Services, Bank of America, and the Journal of Business Venturing have provided glimpses into how health insurance policies can either empower or inhibit small business owners. Our comprehensive survey of Thumbtack professionals, also known as “pros,” finds:
- A majority of pros (55 percent) want Congress to keep the ACA in place.
- More than 2 in 3 pros surveyed believe the federal government should help all Americans access affordable health insurance.
- Over 90 percent of Republican pros on Thumbtack approve of President Trump’s handling of healthcare policy, while just five percent of Democrats approve.
- One in four full-time Thumbtack pros surveyed say health insurance was a factor in the decision to start their business.
- Over half of pros reported they cannot afford to take time off from work in the event of a childbirth or adoption.
- A strong majority of Republican and Democratic pros think the federal government should try to lower drug prices.
Healthcare Approval Strongly Divided on Party Lines
A majority of the Thumbtack small business owners working full-time we surveyed currently have health insurance (75 percent). 28 percent obtain their coverage through the ACA. An additional 18 percent are covered by government-funded plans, such as Medicare or Medicaid. The rest are insured through a spouse’s or family member’s coverage or under a plan provided by an employer other than themselves. This means a majority of insured full-time pros are covered under the ACA or government-funded plans; many of them will likely be impacted by any healthcare reforms.
Access to health coverage is a significant factor for many individuals who are considering starting their own small business. For the 67 percent of pros whose Thumbtack business is their primary employment, 25 percent say access to benefits like health insurance affected their decision to start their business.
The number of potential entrepreneurs for whom health insurance is an obstacle in the general population is likely greater than among Thumbtack pros, who have already taken the plunge into entrepreneurship. In other words, among the broader public, there may be many individuals who have deferred starting their own businesses given the uncertainty surrounding healthcare reform and, correspondingly, the availability of benefits for self-employed workers. This hesitation contributes to our nation’s healthcare “job lock”: an employee’s inability to leave their job given a consequential loss of health insurance.
When it comes to the politics of healthcare, 57.5 percent of Thumbtack pros disapprove of President Trump’s record on healthcare thus far, while 42.5 percent approve. Approval ratings in healthcare remain divided on party lines; 91 percent of self-identified Republican pros with an opinion approve of President Trump’s handling of healthcare policy, while only 5 percent of Democratic pros say the same. For independents, this share is 38 percent.
Majority of Small Business Owners Want to Keep ACA
The future of healthcare reform in the United States extends beyond the ACA—though this debate is most pressing in the Beltway—to values about the relationship between the government and healthcare coverage. Seventy-one percent of Thumbtack pros believe the federal government should help all Americans access affordable health insurance, though there’s a clear partisan split on this issue. Only 43.1 percent of self-identified Republicans feel this way, while 95.0 percent of Democrats do. This partisan split over the role of the government in facilitating access to healthcare has important implications for the ACA.
In terms of Thumbtack pros’ views on Republican plans to repeal and replace the ACA, a majority of pros (55 percent) would actually prefer to keep the ACA—either with modifications to the law or no changes whatsoever. 45 percent of pros want the ACA repealed, with 23 percent wanting a replacement policy to coincide with repeal, 12 percent wanting an immediate repeal and a replacement policy passed later, and 10 percent wanting the ACA repealed without a replacement policy.
When asked about individual ACA provisions for future reform, our pros overwhelmingly favor keeping each of them:
- 82.3 percent want to keep the provision prohibiting insurance companies from denying coverage to patients with pre-existing conditions.
- 70.1 percent want to keep the provision requiring businesses and companies with more than 50 full-time employers to offer health insurance coverage.
- 76.2 percent want to keep the provision making subsidies for health insurance available to low-income Americans.
- 67.5 percent want to keep the provision requiring health insurance companies to cover prescription birth control.
- 73.4 percent want to keep the provision providing funding to states to expand Medicaid programs for low-income Americans.
- 77.3 percent want to keep the provision allowing adults under the age of 26 to stay on their parents health insurance plan.
Family Leave Inaccessible for Most Small Business Owners
Though not as prominent a debate as healthcare reform, family leave is also a concern to Thumbtack’s small business professionals, as it is largely out of reach for many of them. In fact, 60 percent of pros feel they couldn’t afford to take time off from work in the event of a childbirth or adoption. And even among those who can take time, the length of time is often insufficient. Thirteen-and-a half percent could only take off less than one month, 8.3 percent could take off one to three months, 2.4 percent could take off four to six months, 2.4 percent could take more than six months, and 13 percent are unsure or undecided. For reference, the average full-time employee in the US takes off 3.5 weeks for a childbirth or adoption and the Family and Medical Leave Act requires covered employers to offer 12 weeks of unpaid leave.
Of Thumbtack’s small business professionals that are employers, 41.9 percent believe the government should not play a role in employers’ decisions to provide paid leave. Conversely, a majority believe the federal government should require employers to offer workers paid leave, although they have mixed views on how to do so.
On one hand, 29.7 percent of employers believe the federal government should provide financial support to employers providing paid leave while 28.4 percent feel the government should simply require employers to offer leave without providing any resources to do so.
Bipartisan Support for Policy to Lower Drug Prices
Prescription drug pricing is top of mind for many Americans, especially small business professionals. The vast majority of Thumbtack pros, 86.1 percent, believe prescription drugs are too expensive. A similar percentage, 84.9 percent, feel the federal government should act on that issue and try to lower drug prices.
These findings hold across partisan and drug spending patterns. For those who spend a substantial sum of their family budget on prescription drugs, 95.1 percent of Democrats and 84.3 percent of Republicans believe the federal government should try to lower drug prices. For those who do not spend a substantial sum, 94.2 percent of Democrats and 70.7 percent of Republicans want the federal government to act. This has important implications for potential congressional action and offers a reform opportunity that stretches across partisan and socioeconomic lines.
Our survey suggests that small business professionals have strong views on healthcare that Congress should consider when debating healthcare reform. By incorporating these views, policymakers can help ensure that our country’s healthcare system promotes entrepreneurship and the creation of small businesses.
Our survey results also uncovered bipartisan demand for federal policy solutions on family leave and prescription drug prices among small business professionals. Whatever Congress does, America’s small businesses will be watching closely.
These data were collected in the January and February versions of our monthly Economic Sentiment Survey, which captures the economic attitudes and perspectives of small business owners from across the country who use Thumbtack, an online marketplace for local services, to find new customers. Originally designed in coordination with economists at Bloomberg, Thumbtack’s Economic Sentiment Survey uniquely captures a ground-level view of the economy in all 50 states.
In the last two months (starting on January 20th), we received responses from 14,393 business owners through our online, in-product survey portal. These business owners work in a variety of service-based industries, with occupations such as general contractor, interior designer, photographer, and personal trainer. They are demographically and politically diverse: over 30 percent are non-white, 40 percent are female, and there are a near-identical number of self-identified Democrats and Republicans (23.9 percent and 23.5 percent, respectively).