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Big firms pushed to bear health costs

Dozens of states are debating a Maryland law that requires Wal-Mart to spend more on healthcare.

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Maryland's new healthcare mandate boils down to $1,472.

That's a reckoning of what it means for Wal-Mart to spend 8 percent of its payroll costs on healthcare for a blue-vested associate who works for $10.11 an hour, 35 hours a week.

As health insurance goes, that's a modest fee. But the 8 percent figure has become a flash point in the nation's growing debate about who should bear workers' health costs.

Maryland stoked the fire last month. The legislature moved to require companies with 10,000 or more employees in the state to spend at least 8 percent of their payroll on health insurance. Long Island's Suffolk County passed its own version last fall: For each hour a worker is on the job, $3 must go toward healthcare.

Businesses are fighting back, filing lawsuits this week against both measures.

The stakes, in one sense, are hardly monumental. Even if the laws succeed, no one sees them as a cure-all for America's uninsured workers. Yet the legislative battles in 30 states, from Colorado to New Jersey, suggest that healthcare accessibility is gaining political traction.

That could mean a range of incremental changes, especially at the state level, to a healthcare system that largely depends on employers.

"Everybody can agree that it's flawed," says William Custer, director of Georgia State University's center for health services research. But while sharp political divides stymie prospects for a wholesale replacement strategy, he says, "trying to shore up the employer-based system seems to be a good 'second best.' "

Currently, most US families have health insurance through the workplace. Others are covered by government programs. But 16 percent of Americans - some 45 million - don't have insurance, and a large majority of those live in households with at least one full-time worker.

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