Bernie Horn is policy director at the Center for Policy Alternatives. CPA is the nation’s only nonpartisan organization working to strengthen the capacity of state legislators to lead and achieve progressive change.

For two months, the media has covered the Fair Share Health Care controversy as if it were a fierce storm sweeping across the nation, with Wal-Mart and labor unions supplying the thunder and lightning. Reporters have all but ignored the larger story—that Fair Share has altered the climate of the health care debate.

That’s a big claim for such a modest law. Maryland’s Fair Share Health Care Act merely requires companies with more than 10,000 employees to pay at least eight percent of payroll expenses for health care, or pay any shortfall to the state. Yet look at the reaction nationwide. Similar bills have been introduced in two dozen states, an unprecedented response to the enactment of a single law. Legislators in a dozen other states have vowed to sponsor Fair Share and strong coalitions are forming which will carry on the battle for years.

What’s the big deal? Fair Share affects only a few companies and a relatively few employees. It can’t put a dent in our nation’s healthcare problems, can it?

We all know that our nation’s health care system is dangling precariously between crisis and catastrophe. Forty-five million Americans are without health insurance. Thirty million more are underinsured. Health insurance costs are skyrocketing. No, Fair Share Health Care does not fix our nation’s health care system. But the system won’t be fixed—every American won’t have access to quality, affordable health care—without some version of Fair Share.

The very foundation of our current system of employer-based health coverage is crumbling. Today, only 60 percent of working-age Americans have health coverage through their employer, compared to 69 percent in 2000. Of the 45 million uninsured, about 80 percent are employed or live in working families. Before we can build on our healthcare infrastructure, we have to stabilize it. We have to stop the hemorrhaging. Fair Share acts like the minimum wage—it blocks a corporate “race to the bottom.”

This is a race that has been led by Wal-Mart. For 50 years, nearly all large American companies provided health insurance to employees. But of Wal-Mart’s 1.3 million workers in the United States, only 48 percent are covered by the company’s health insurance plan. The employees Wal-Mart does cover receive only paltry benefits—the company spends a mere $2,660 annually per covered employee for health benefits. In contrast, Wal-Mart’s leading competitor, Costco, covers 80 percent of its workers and spends $5,735 per worker for health benefits.

We haven’t had a national discussion about requiring companies to pay a fair share for health insurance costs since 1994. That year, both the Clinton health care plan and Democratic congressional candidates were soundly defeated. From that point on, until just recently, bills that mandate some level of health care spending by employers—also called “pay or play” measures—were seen as bad politics, even by progressive officeholders. The only health care expansions considered politically viable were funded by federal and state tax dollars—like Medicaid, SCHIP and Medicare Part D.

A dozen years later, Fair Share Health Care has blown those political assumptions away.

Progressives now see that Fair Share can be a terrific political cause. It is popular: Nearly 80 percent of Marylanders, including 65 percent of Republicans, supported it. It is a coalition builder: Over 1,000 Maryland groups, including businesses, faith groups and all factions of the labor movement, worked hard to win this fight. And Fair Share is a great campaign wedge issue: Conservatives are forced by their financial backers to oppose the public will.

Businesses are also beginning to understand the importance of a Fair Share policy. Companies which already provide decent health insurance benefits are unfairly subsidizing corporations that don’t insure their employees. When uninsured workers or their families go to the hospital, the costs are shifted to all those who buy health insurance or to state health programs funded by all taxpayers. In Wal-Mart’s case, 27 percent of employees’ children are enrolled in Medicaid or SCHIP and another 19 percent are entirely uninsured. Nationally, companies that provide insurance pay $31 billion annually to insure other companies’ workers, and state programs pay $8 billion to cover low-wage workers.

While Wal-Mart’s behavior is egregious, Fair Share Health Care was not designed as an attack on that company. In fact, the measure was crafted by the Maryland Citizens’ Health Initiative more than five years ago as just one element of a statewide universal coverage plan. 

The full Maryland Health Care For All plan, HB 1510, provides a blueprint for politically-feasible state universal coverage. It is built on existing private-sector coverage, requires all employers and individuals to contribute a fair share, and sets up a quasi-public health insurer to cover every resident who is otherwise uninsured. An analysis by the Lewin Group found that the Maryland plan works—it is both effective and affordable.

Although Americans overwhelmingly favor universal coverage, it will be years before we have a president and Congress willing to enact such a program. Until then, the action is at the state level. Simply by unleashing a storm of debate over how we finance health care in America, Fair Share has propelled the nation in the direction of real reform.