States and Employers Duel Over Health Care

By REED ABELSON

The relentless rise in health care costs is causing states and businesses to fight over whose job it is to insure workers. And nearly two dozen states, struggling with the growing burden of providing public assistance to people with jobs but no insurance, are looking to shift more of the financial burden onto the workers' employers.

Last month, for example, Maryland, which spends roughly $350 million a year on health care for the uninsured, passed a bill requiring the state's very largest employers to spend at least 8 percent of their payrolls on health benefits for their workers. Lawmakers elsewhere, including Connecticut, are considering legislation that may also require some companies to provide coverage, either directly or by paying into a state fund.

Some measures, as with a New Jersey proposal, would let companies bid on state contracts only if they provided health insurance for their workers.

At the very least, some states would embarrass companies whose workers are on Medicaid or other forms of state assistance by publishing the employers' names - as Massachusetts has already done with a list of companies including Dunkin' Donuts, Stop & Shop and Wal-Mart Stores. Dunkin' Donuts says individual franchised stores, not the company, are responsible for coverage, while Wal-Mart challenged the findings. Stop & Shop declined to comment.