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JJ Ramberg

JJ Ramberg is the anchor of “Your Business,” MSNBC’s weekly show on small business. In addition to her extensive television reporting experience, Ramberg has a background as an entrepreneur and co-founded GoodSearch.com. She has an MBA from Stanford Business School.



Health care headache for small businesses

Posted: Wednesday, January 28, 2009 2:38 PM by Eve Tahmincioglu
Filed Under: , , , ,

It's getting ugly out there for small business owners that have been struggling to keep on paying high health insurance premiums for themselves and their workers. So ugly, in fact, that more and more are just dropping coverage.

Because of ever-escalating premiums and falling sales, Craig Sumsky, director of Philadelphia-based DJ company Cutting Edge Entertainment, had to put the kibosh on health insurance for his office manager this year.

In response, Sumsky's office manager handed in her two-week notice. She needed a job that could get her benefits, he said.

Sumsky is not alone. One recent poll put out by credit card company Discover uncovered a disturbing trend:

"Eighty-five percent of small business owners say they do not offer health insurance to their employees, up significantly from 77 percent a year ago and 74 percent in January 2007. Among small business owners who do offer health insurance, 36 percent say they have considered discontinuing coverage because of high costs.”

These statistics are not so shocking. Faced with the ridiculous cost of health insurance and a lousy economy, small firms are looking at what else they can cut to make ends meet, and too often they turn to cutting health insurance.

"Over the last two years, the number of small business owners who offer health insurance to their employees has fallen significantly," said Ryan Scully, director of Discover's business credit card unit. "While small business owners are finding ways to stay afloat in this tough economy, eliminating healthcare benefits could be another measure of the cost of that resiliency."

Not all small firms are getting rid of coverage. Some are trying creative ways to hang on, notes Donald Mazzella, editor of Small Business Digest.

He said some firms are asking their employees to take on more of the burden of the premium. And they're cutting back on coverage and increasing deductibles. (Of the 1,024 employers that responded to a recent Small Business Digest survey, 55 percent said they had increased the deductible, while 34 percent said they had made family coverage more expensive.)

Mazzella offers some words of advice to entrepreneurs who are struggling to keep up with insurance premium payments:

1. Look at health savings accounts, or HSAs, as a way to reduce costs. In many states the overall costs to employers and employees are greatly reduced, and employees can use the funds for retirement. (This could be useful because many companies are cutting back on their 401(k) contributions.)

2. Some smaller employers are providing stipends to employees to purchase their own insurance. (One caveat is that some employees may not qualify for individual plans.)

3. Shop around diligently and look at alternative offerings as some less well-known insurers -- some are offering bargains.

When it comes to healthcare costs, Cutting Edge Entertainment's Sumsky seems to be at his wits end.

"We have been quite successful, which is why it kills me," he said, referring to his company's inability to afford healthcare for his office manager. "Health insurance seems to have become more of a luxury than a necessity."

Sumsky is even considering dropping his own health coverage, and that would be quite a dicey proposition since he's an amputee and needs insurance for maintenance of his prosthetic, without which he wouldn't be able to work.

The cost of health care is one of the most frustrating things I have written about. Paying for health insurance shouldn't be stomping on the entrepreneurial spirit in this country.

What do you all think? Do we need to start knocking some heads together in Washington?

Hope ain't going to fix this!

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Comments

Bush spent 3000 BN for nothing in Irak. That was enough to cover all Americans with a medical plan for 10 years.
If we have enough money for that we have it for covering us all.
I am for Universal Care for many reasons, but top on that list is the fact that the current system is discriminatory. Many people just can't get insurance no matter what, at any cost, and for no fault of their own. Other than being at the mercy of our employers, all you have to do is need insurance to become uninsurable thereafter...it could happen to anyone at any time. Until it happens to you, you can't imagine.

I have two children with chronic medical needs. My husband lost his job and then I was laid off in November. As an alternative to cost-prohibitive  COBRA, I tried to find individual family coverage and learned that we are not eligible for any private coverage because of our childrens' medical conditions. Living without coverage is not an option for us. Fearing it will only get harder to find work in this environment, I recently took a job at nearly half my previous salary because they at least provide insurance coverage...for now. They are not a large company and I fear they too may have to make cuts in benefits.

I am incredulous towards those who believe that taking care of the most basic needs of our fellow citizens by providing health care accessible to all is un-American. It's our current system that often does not provide any options and/or dictates where you work (if you can find work) that goes against the basic principals of this otherwise great nation.

Isn't it better to have higher taxes and less money in your pocket, with no risk of losing it all due to an illness, than to have more money in your pocket but be afraid of losing it all at any moment?  In our current system, you are only safe if you are very poor or very wealthy. Everyone else it at risk.
The real problem is that nobody is seeing the fact that all of these problems are intricately intertwined:  the healthcare crisis, the Wall Street meltdown, the foreclosure crisis, subprime mortgages, opaque financial trades, pharmaceuticals, etc.  I have been predicting the collapse of our economy for over a decade; I didn't know when it would happen, but I knew it would.  This all started with Reagan and his upward redistribution of wealth that he pegged as "trickle-down economics."

What started to happen was that small businesses began to suffer.  Competition was fierce, as corporations grew into massively conglomerate giants.  We now see the result, as the largest retailer in history just went into liquidation, and as businesses across the globe are closing their doors, some of which are more than a century old.

The only way to stop any of this is for consumers to change their habits:  stop supporting the huge corporations with greedy CEOs.  How that can be translated to the healthcare industry, I am not sure.  But if consumers get serious about this on a grassroots level on a large-scale basis, you can bet people will start listening, including the people in Washington.
It boils down to simple economics; supply and demand.  The demand for medical care is too great.  People equate health insurance to health care, it is not.  After WWII companies began offering health insurance as a benefit to attract employees, the cost of insurance then was very cheap.  Now employees have come to expect that the employer be required to provide insurance.  I suspect that most business owners would like to provide this for their employees, but it is not there responsibility to do so.  True health care is the responsibility of the individual, forgo the crap fast food and start eating healthy, people need to educate themselves on the proper care of the body and then maintain it.  We live in a country where too many are obese, these weight problems will result in many long term and very costly medical costs.  When people start getting their health back, ( which in most cases does not require a doctor or drugs ) there will be less demand for hospitals and doctors.  Demand goes down, prices will follow.  This may sound cold hearted and there are always exceptions but the only people that will survive the high cost of medical intervention are those that have taken care of their health and have not needed it.
 Eat, Drink, and be merry for tommorrow we die.  But when A person has followed this life style and has destroyed their health, when the die part comes too soon, they want someone to step in and fix things.  Health care is just one more area the baby boomers have screwed up for generations to come.
Universal Healthcare is the only way.  11% of your income - regardless of how it is paid.  Add a few private healthcare systems in place for choice and those that have money can buy a better choice. For those on Universal Healthcare, there should be rules - smokers would not be treated for smoking related illnesses, obese people would not be treated for obesity related illnesses, in other words, if you are going to benefit from a Universal System in which EVERYONE pays in one way or another then have strict boundaries - like not letting anyone use the system who doesn't pay - or requiring workers to have paid into the system for a minimum period before benefiting from the service. The unemployed are taxed currently on their unemployment insurance payments, why not for health too?  How about a Universal co-pay for visiting nurse practioners, doctors, specialists and for operations and treatments.  
I could go on forever but alas I must sleep because I have renal failure caused by diabetes that has gone untreated for 6 years owing to the fact my employer only offered a "preventative" insurance and as I had a pre-existing condition I didn't qualify.  I will probably die leaving a wonderful man,  four beautiful children and grandchildren.  As a daughter of a veteran US Army Colonel, having been well educated and a good, clean living US citizen all my life, I will welcome Universal Healthcare of some sort, if only so I can be treated before it's too late.
I'm a family physician who strongly believes in a single payer system, preferably an expansion of Medicare, with part D coverage. When you consider the amount of waste in our current system it is mind-boggling.  The employer spends time every year researching, and then negotiating with the insurance comanies to get the best rates, then has to educate the employees about the coverages etc.  They may have to have an accountant set up HSA deductions or part of a cafeteria plan.  The employee has to find a new doctor on the list of the "new" insurance company, transfer records, and if they have existing health problems, set up an appt with the new Dr. to get acquainted, refill meds with correct prescriber, etc..  Maybe take time off work because they work 1st shift, just for this office appt.
The insurance companies are taking time to market and contract with multiple employers, always making sure to have someone check the demographics of the employees( how many may get pregnant, have risks for heart attacks, pre-existing conditions etc.) Lets not forget the stockholders, CEOs, and big buildings needed for each competing insurance co.  Also, on the end side of the contract, don't forget about utilization review, prior authorizations for meds, tests, and treatments such as PT, or referrals.
On the physicians side, we have contract negotiators, medical records transfers, nurses who have to waste 20-30 minutes on the phone with a prior authorization or referral, committees to okay out of network referrals, Billing and coding for specific insurance companies.  (Some codes are not accepted for one versus another insurance co. Doctors usually have the the patients come back for a procedure, when it could be done that day, because you can't get paid for freezing a skin lesion at the same day that you have someone come in for a diabetic recheck.  It wastes the patient's time to come back, and requires another co-pay.  Otherwise the doctor has to give one of the services away.  It sounds petty, but when you call a service person to come fix the plumbing in your house, they will charge you time, parts, and if you add on just to unclog an extra sink, you can be sure you'll be charged and pay for it.  Many doctors are against a single payer system because we would have no say in how or what we get paid, (the current medicare payment doesn't keep up with cost of doing business, and medicaid may as well be volunteer work.)
We obvioulsy have some kinks to work out, but our current system is unsustainable.  Also, with everyone covered with something like medicare, the pool of patients would be bigger, and risk more spread out.  The pool of people paying premiums would be bigger, so presumably the payment may be smaller.
    There is no problem with the health care delivery system in this country.  The problem lies with the health insurance system.  The actual monies per dollar that goes to defray patient care are in pennies while the rest goes to executive pay, bonuses and overhead to the insurance companies! No wonder the premiums are outrageous!
JSC in SLC, your thinking is so simplistic.  My sister is a nurse who was just laid off from an administrative position that was eliminated because the hospital is in economic distress.  Another local hospital just laid off 90 nurses for the same reason.  She got a 5-minute notice.  Three of her patients are young Medicaid junkies in kidney failure getting dialysis three times a week plus the occasional ER visit.  The hospitals have to eat whatever costs Medicaid doesn't pay.

Don't blame this on baby boomers!!!  We're paying the premiums for those junkies too.
OK, I've thought about it.  5% of my total income for the entire year is about what I would pay commercially for ONE MONTH on a lousy-coverage limited policy just for myself!  My husband and son are disabled and DO NOT QUALIFY for coverage AT ALL from commercial insurance companies.  SO THIS IDEA SOUNDS LIKE A BARGAIN FOR PEOPLE WHO NEED HEALTHCARE COVERAGE.  What's so damn hard to understand about that?!?  Besides which, we'd no longer need Medicare and Medicaid, so those Federal & State
deductions would disappear from our W2 statements!
Out of one pocket, into another....

"Think about the taxes that will need to be raised in order to sufficiently provide health care for not just these 6.8 million without healthcare coverage, but the other 36 million as well.  And that is just for California.  Are you interested in having your employer fund a new tax section for insuring not just themselves but a portion of the universal healthcare reform law for all Californians?  Therefore, seeing not just your salary decrease from this but decreasing from yet another tax bill?

Also, the Clinton administration originally proposed that the universl healthcare is REQUIRED.  But it's not as simple as walking into the doctors office, getting a check-up, and leaving.  You will be required to buy the insurance.  REQUIRED.  Originally, the maximum you would pay is 5-10% of your total income.  All I ask is think about that number for a minute."
Wow! is all I can manage.  I have the benefit of having been well employed and well covered by health benefits and complained about the $37 a week I had to contribute to premiums.  Looking back now, I realize that that was less than 10% of my annual income.  I now have the honor of being 5 years into launching a small business with my husband. Our healthcare premiums last year totaled $9,926.00 and we received an 18% increase, so we'll pay $11,748.00 in 2009 and we're in a group plan w/BCBS through our local chamber. If we had children, we'd pay another $1200.00 annually.  You do the math...not many folks out there will be able to afford anything like that if they lose their jobs.  Even you republicans - we'll see how you view these "socialist" programs then...these companies don't seem to be making those kind of distinctions when it comes time for pink slips.  
Everyone so far has made valid points except for; JSC, SLC, UT. I'm sorry, but again, I reiterate, emergency rooms, ambulances, fire departments were and are in existence in handling sudden, unexpected emergencies and trauma.

Preventative helps people live longer healthily, but not live to infinity. Sometime, somewhere we will get ill, or injured. 9/11, the plane in the Hudson are great examples of accidents that were not foreseen. Many people are injured and die in automobile accidents daily.

Preventative care does not EVER prevent someone from getting ill EVER in their life. It may save someone from getting it early, but if cancer runs in the family, there is no guarantee all the preventative actions won't stop cancer from affecting that individual somewhere down the line. If diabetes affects a family, there is no guarantee that an individual will ever NOT contract the disease. If someone doesn't smoke, there is no guarantee that someone won't contract lung cancer.

Preventative medicine will go ONLY so far. Yes, it can prevent the onset EARLY, but, sooner or later, someone, somewhere will experience illness, accident and injury. As one ages, we get more frail and unless you count yourself as one of the ones that lives forever, we will encounter illness.

Christopher Reeves ("Superman") was in excellent health and had taken preventative measures. He was paralyzed in an accident. What many don't realize is there was a cap and/or limit regarding his benefits as to how much care and treatment he would receive as a parapalegic regarding his healthcare insurance.

He reached it appoximately two years before he died. How he managed to continue treatement was that it was his friends and family that contributed out-of-pocket to his medical expenses along with TV appearances and speaking engagements that kept him receiving needed treatment. If he hadn't been famous, imagine the lower quality of life he would have had to endure? His family was stretched financially paying for his care and could have lost their home if it hadn't been for the paid appearances and friends.

If he had been anyone else, he may have very been put on medicare/social security and placed in a nursing home. In addition, his health needs would have suffered dramatically because in order to keep costs down, the nursing home would have forcibly reduced  treatments to the bare necessities that had kept him as healthy as he had been in his condition.

Health insurance bought by the insured is to cover HEALTHCARE that is needed when a situation arises. Yes, it's bought by the insured because it a deductibble that is deducted out of the employee's salary when hired, or, is a contributing co/pay with the company.

Nowadays, the company can't handle the increasing premiums and pushes the majority of the cost onto the employee.

Let's face it, preventative meaasures or not, the older we get, the more weaker, frail and tired we become. Not everyone can do the same job they did at 20 at 90 years of age. Therefore, the costs involved in upkeeing healthcare will increase when people are no longer able to work as easily or can't.

Not all employee healthcare plans are equal in regards to how they handle chronic illness. If a parent has a chronic or ill child, it can be detrimental to the entire family's financial status. If the insurance does not cover all meds, or any part of the treatment, parents have no recourse put to pay the expense themselves. That can put their credit status in jeopardy if they must apply all monies to treatment of that child and forsake other bills.

If someone becomes injured on a job and is unable to work over a period of time, they can lose the healthcare provided with the job. They may no longer have the ability to pay for medical treatment, or, have to cutback on the range of treatments.

Someone that ages, may no longer be able to work (Altzheimers), and depending on their age, may receive medicare. Note: YOU DO NOT WANT TO GET ONTO THAT SYSTEM UNTIL YOU KNOW HOW IT WORKS! Otherwise, you could end up losing your retirement pay towards your healthcare and going months trying to pay meds and other treatment while attempting to pay on your other bills (utilities, rent, transportation costs oh and yes, food).

Universal would assist in ALL phases of life from infant, teens,college age upwards to middle age and elderly. Many of the areas that the current system does not cover easily.


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