Small Business Healthcare

[goldberry]

If things go on the way are, I wonder how long it will be before only really large companies (with hundreds or thousands of employees) are able to offer health insurance.

 

The company I bookkeep for and have for years has always offered health insurance.  They go between 50 and 75 employees, but only 11 out of that take the coverage (which I think is weird anyway).  For 11 people it was costing $13K per month, and just went up October 1st to $18K per month.  PER MONTH.  The owner is a good guy and wants to take care of his people, but we were just talking about how this is crazy and can't continue this way.  He is going to have to up deductibles even further.

 

Those employees that have good or even decent employer coverage often don't realize what a mess we are in.  We are already seeing less and less jobs that offer health insurance, or that offer it but don't cover very much of it.  If nothing is done, there are going to be more and more jobs like that.  A future where you only get insurance if you work for Amazon or Costco or the government.  Perhaps that's what it takes to make more people notice how broken the system is. 

 

And no, I don't believe reducing covered services to the point of uselessness just to increase affordability is the answer.  We already went down that road, where people found out even much of their hospital stays weren't covered, etc.  EVERYONE deserves basic services covered.  

[nixpix5]

Yeah, it is really sad to see. I worked for a small non profit school for at risk youth prior to our current Healthcare system. It was a small school with a handful of employees. We had amazing Healthcare plans back then. I am still friends with those people and their current plans are abysmal. The school could literally shut down at this point due to the expense of just providing what they always have. I know I am fortunate. My husband works in research for the government and has rock solid insurance. We are so lucky and I don't take that for granted. I have seen too many friends in small businesses go from good insurance to expensive insurance that covers nothing.

 

You are right, something has to change. It isn't right the way it is.

Edited September 20, 2017 by nixpix5

[StephanieZ]

Small business owner here . . . 

 

I'm in knots waiting to see the hell that awaits when 2018 premiums are released. 

 

It's INSANE. 

 

INSANE.

 

Medicare for All. That's the only answer. 

[umsami]

I honestly cannot see a solution other than Medicare for all.  Healthcare needs to be removed from being tied to employment, and especially small businesses.  We need a VAT, payroll tax, or other means to pay for it.  Medicare must have the ability to negotiate with pharmaceutical companies over prices as well.  It's ridiculous that I can buy my branded drug (non Generic) in Egypt for $10 and the generic costs me more in a co-pay here.

[Bluegoat]

If things go on the way are, I wonder how long it will be before only really large companies (with hundreds or thousands of employees) are able to offer health insurance.

 

The company I bookkeep for and have for years has always offered health insurance.  They go between 50 and 75 employees, but only 11 out of that take the coverage (which I think is weird anyway).  For 11 people it was costing $13K per month, and just went up October 1st to $18K per month.  PER MONTH.  The owner is a good guy and wants to take care of his people, but we were just talking about how this is crazy and can't continue this way.  He is going to have to up deductibles even further.

 

Those employees that have good or even decent employer coverage often don't realize what a mess we are in.  We are already seeing less and less jobs that offer health insurance, or that offer it but don't cover very much of it.  If nothing is done, there are going to be more and more jobs like that.  A future where you only get insurance if you work for Amazon or Costco or the government.  Perhaps that's what it takes to make more people notice how broken the system is. 

 

And no, I don't believe reducing covered services to the point of uselessness just to increase affordability is the answer.  We already went down that road, where people found out even much of their hospital stays weren't covered, etc.  EVERYONE deserves basic services covered.  

 

I read a sci-fi novel once where everyone did go to work for Amazon and Costco for healthcare and other things - and over time, as the governments were poorer and poorer, the corporations took over more and more of the social fabric spending for their employees.

[goldberry]

I read a sci-fi novel once where everyone did go to work for Amazon and Costco for healthcare and other things - and over time, as the governments were poorer and poorer, the corporations took over more and more of the social fabric spending for their employees.

 

Not usually a good end for workers.

[Carrie12345]

We will be reexamining dh's company's insurance this year, and I'm dreading it. They are fewer than 50 people, and only contribute 50% to employees, 0 to family members (just the option to be on the policy.

 

We've been going ACA for the small subsidy and wider (haha) coverage options, but we won't get a subsidy next year, and our options have shrunk every year.

 

2018 will be expensive private coverage or expensive and crummy employer coverage. I don't blame his employer, I blame people who refuse to understand health care.

[Scarlett]

What happens to the insurance industry if medicare for all is implemented?

[Laura Corin]

What happens to the insurance industry if medicare for all is implemented?

 

Some people will want top up insurance, and companies could offer that perk, as it will be much cheaper than full insurance.

[umsami]

What happens to the insurance industry if medicare for all is implemented?

 

Just as with Medicare today, they can do quite well selling supplemental and drug plans.  Medicare pays 80%.  Supplemental covers the other 20%.  Similarly, medicare part D plans are for drug costs.  

[lewber]

My family owns a small business. We average 75 employees. Our premiums went up 20% last year and 29% this year. It's crazy. We continue to cover as much as we can but have stopped matching 401k contributions in part due to these expenses. That makes me sad. It's a no win situation for everyone.

The small town I live in offers 100% paid health insurance coverage to all government employees. And just implemented an increase in sales tax.

[Guest]

What happens to the insurance industry if medicare for all is implemented?

They slink back to Hell??

[goldberry]

They slink back to Hell??

 

I feel the same about the people running these companies, at the same time, there are people with jobs there just like everywhere else, so I try to feel sympathy there.  

 

 

[momacacia]

Small biz owner here, too. We think about this quite a bit. I strongly suspect at some point we'll drop our health insurance benefits.

[Scarlett]

They slink back to Hell??

I don't care for them either but I imagine it would affect the economy.

[bettyandbob]

I don't care for them either but I imagine it would affect the economy.

 

 

I think the fact that people would have more job mobility and it would be easier to start new businesses would help the economy more than the losses to insurance companies would hurt. 

[Arcadia]

They slink back to Hell??

Not necessary. My home country has a compulsory healthcare plan for people over 40, no opt out unless we give up citizenship. They just assign each citizen one of the big five insurance companies in the country. I think we are allowed to change one time as in ask for our account to go to another company on that list.

 

These insurance companies also sells top up plans. They still hold a monopoly on the health insurance market with the govt's blessings.

 

The only advantage is that my relatives who are small business owners do not have to worry about insurance costs and employees are free to job hop or take a break as insurance is not tied to employment. The annual insurance premiums are taken from people's health savings accounts (ETA: a person can pay the premiums for parents, spouse and kids from their account, can't pay for siblings).

Edited September 21, 2017 by Arcadia

[FaithManor]

I think the fact that people would have more job mobility and it would be easier to start new businesses would help the economy more than the losses to insurance companies would hurt.

I think there would be short term economic shift and some pain and adjustment with it, but long term economic gain.

[Tina]

We had to offer it to keep our best employees tho.  But rates have climbed and we can only offer 1/2 for the employee only, too.  We are just offering some additional options, but the employees need to cover those themselves.  They are discounted from what the employees could get on their own without the group.

[Guest]

There is zero chance that we'll see any improvements in health insurance pricing for small businesses in the next 4 years.

Edited September 21, 2017 by Moxie

[QueenCat]

I think the fact that people would have more job mobility and it would be easier to start new businesses would help the economy more than the losses to insurance companies would hurt. 

 

I was thinking that the millions who work in the industry would be suddenly unemployed. Even with top of policies and supplements, there will still be a huge number of people out of work.

[creekland]

I was thinking that the millions who work in the industry would be suddenly unemployed. Even with top of policies and supplements, there will still be a huge number of people out of work.

 

Quite honestly, it's worth it.  Their skills will be valued elsewhere - say, small businesses.  I don't foresee a problem other than at the very beginning.  It will smooth over and tip positive very quickly.

[Lanny]

At least 3 states that I can name (California, Vermont and Colorado) have seriously explored having Single Payer Health Insurance for their residents (or most of them).  Each of those states gave up on the idea. I believe among the major reasons they abandoned the idea were that a huge tax increase would be required to pay for it. Also, they had no mechanism to deliver the services to the people who would be covered by their Single Payer system.  

 

One thing I read about (yesterday or today) included the idea of lowering the eligibility age for Medicare to 55.  

 

Things that would help would be Tort Reform (the hospitals and physicians are terrified of attorneys and malpractice suits and a lot of what they do is CYA and that increases costs) and the Prescription Drug thing, which is strange. The Pharmaceutical companies make huge political contributions to politicians on both sides of the aisle and the loyalty of those people is to the Pharmaceutical companies.   The consumer is not benefiting from that. The Politicians are benefiting from that. The constituents suffer with increasing health care costs and deteriorating medical care. 

[SKL]

Medicare for all?  Who's going to pay for that?  Small business owners have a high relative tax burden.  Increasing taxes is not the way to stay in business.

 

I'm also a small business owner.  The amounts mentioned in the OP do not surprise me.  I will say that things got better after our previous provider / HMO ceased to exist.  We switched to Medical Mutual, which is a little cheaper and a lot better as far as what it covers.

[FaithManor]

Quite honestly, it's worth it. Their skills will be valued elsewhere - say, small businesses. I don't foresee a problem other than at the very beginning. It will smooth over and tip positive very quickly.

This. Short term pain, but long term gain. And if millions of people begin regularly accessing health care who have not done so before or at least not regularly due to inability to pay, this will create a lot of jobs for people who process paperwork, records, billing to the state/feds for reimbursement, administrators, medical assistants, etc. so isn't as if replacement positions won't be available. It may not be a one to one ratio, but if you think about it if the government then negotiates bulk drug pricing and more people are now able to get needed meds, this means clerks at pharmacies, pharmacy assistants,...and people who have worked for health insurance companies so already know quite a bit of medical jargon will have a leg up in getting those jobs and be more easily retrained for these positions.

[Bluegoat]

At least 3 states that I can name (California, Vermont and Colorado) have seriously explored having Single Payer Health Insurance for their residents (or most of them).  Each of those states gave up on the idea. I believe among the major reasons they abandoned the idea were that a huge tax increase would be required to pay for it. Also, they had no mechanism to deliver the services to the people who would be covered by their Single Payer system.  

 

One thing I read about (yesterday or today) included the idea of lowering the eligibility age for Medicare to 55.  

 

Things that would help would be Tort Reform (the hospitals and physicians are terrified of attorneys and malpractice suits and a lot of what they do is CYA and that increases costs) and the Prescription Drug thing, which is strange. The Pharmaceutical companies make huge political contributions to politicians on both sides of the aisle and the loyalty of those people is to the Pharmaceutical companies.   The consumer is not benefiting from that. The Politicians are benefiting from that. The constituents suffer with increasing health care costs and deteriorating medical care. 

 

I'm not sure what you are getting at here?

[bettyandbob]

I was thinking that the millions who work in the industry would be suddenly unemployed. Even with top of policies and supplements, there will still be a huge number of people out of work.

A lot of their skills can be generally transferable. Over time other industries have shrunk, people have had to retrain and move to new fields.

 

Everyone should see some fluidity in their skillset and know where there skills apply in other industries.

 

 

Fear of what happens to displaced workers should not be the reason to keep an industry that is not working. Part of change can be to assist with retraining and placement if necessary.

Edited September 21, 2017 by Diana P.

[Lanny]

I'm not sure what you are getting at here?

 

I think in at least one of those 3 states, probably CA, in addition to the enormous tax hike that would be required, they realized that there was no Infrastructure to provide the services to the people who they would cover under their Single Payer system. Possibly that was also a factor in CO and VT dropping the idea. 

[Bluegoat]

I think in at least one of those 3 states, probably CA, in addition to the enormous tax hike that would be required, they realized that there was no Infrastructure to provide the services to the people who they would cover under their Single Payer system. Possibly that was also a factor in CO and VT dropping the idea. 

 

I am just at a bit of a loss to understand what that would mean.

 

Did they expect they would not have to set up a certain amount of administrative infrastructure?  Isn't that the case with any program?

 

If it's the direct services, aren't there doctors and hospitals there now providing services?  

 

I don't really even get the tax hike thing - give the costs that people keep saying they have for insurance, it can't have been worse.

[creekland]

Medicare for all?  Who's going to pay for that? 

it would come from the savings we get by not having to pay for health insurance.  businesses, individuals, etc, would end up paying less in the long run since the cost overall would be less.  hmm, enter key and shift key aren't working.  sorry for that.  :glare:

[creekland]

At least 3 states that I can name (California, Vermont and Colorado) have seriously explored having Single Payer Health Insurance for their residents (or most of them).  Each of those states gave up on the idea. I believe among the major reasons they abandoned the idea were that a huge tax increase would be required to pay for it. Also, they had no mechanism to deliver the services to the people who would be covered by their Single Payer system.  

 

One thing I read about (yesterday or today) included the idea of lowering the eligibility age for Medicare to 55.  

 

Things that would help would be Tort Reform (the hospitals and physicians are terrified of attorneys and malpractice suits and a lot of what they do is CYA and that increases costs) and the Prescription Drug thing, which is strange. The Pharmaceutical companies make huge political contributions to politicians on both sides of the aisle and the loyalty of those people is to the Pharmaceutical companies.   The consumer is not benefiting from that. The Politicians are benefiting from that. The constituents suffer with increasing health care costs and deteriorating medical care. 

the problem with just three states doing it is all the unhealthy folks would move to those three states.  that would unbalance the system too much financially. dratted keyboard.  gotta figure out what's wrong with those keys...  :cursing:

[Bluegoat]

As far as who pays - why would it be different than who pays now?  The cost wouldn't be that different.

[SKL]

it would come from the savings we get by not having to pay for health insurance.  businesses, individuals, etc, would end up paying less in the long run since the cost overall would be less.  hmm, enter key and shift key aren't working.  sorry for that.  :glare:

 

Not sure I trust that the overall cost would be less, especially for small businesses.  Often employees of small businesses participate through their spouse (or even parents) in the plans of larger companies.  That would probably be why such a small % of employees particpate in the OP's company's plan.

 

As much as the healthcare industry is economically inefficient in some ways, I don't trust our government to do it better.

[SKL]

As far as who pays - why would it be different than who pays now?  The cost wouldn't be that different.

 

Who pays now for private insurance/healthcare or who pays now for Medicare?

[creekland]

Not sure I trust that the overall cost would be less, especially for small businesses.  Often employees of small businesses participate through their spouse (or even parents) in the plans of larger companies.  That would probably be why such a small % of employees particpate in the OP's company's plan.

 

As much as the healthcare industry is economically inefficient in some ways, I don't trust our government to do it better.

As bad as it is for so many right now, I'm willing to give it a try.  I doubt it will be worse tbh.  Other countries make it work better than ours does.  Are we Americans really that much worse in what we are able to do? I think we are capable. Those currently making millions off the system like to spread lies about our ability...

[Bluegoat]

Who pays now for private insurance/healthcare or who pays now for Medicare?

 

Well, both really.

 

If you were going to change the system in such a way that it is covering everyone, you would have to also change it in such a way that the funding incorporated much of the money now going to private insurance or through other channels.  And probably other changes as well- you can't necessarily take a system designed for one thing and just apply it in a different way without any adjustments.  But it could still be useful to use it as the basis for a modifies system.

[Bootsie]

The fact that health insurance is tied to an employer in the US is somewhat of an accident.  In many ways it is a result of government intervention in the marketplace; as a way to get around wage controls in the 1940s, employers started offering the benefit of health insurance.  This health insurance was not subject to the wage controls, so it effectively allowed employers to increase pay to attract workers.  In addition, these benefits were not subject to taxation, making $1 in benefits more valuable to an employee than $1 in wages. 

 

What was the result of getting around the wage controls now distorts the labor market.  There is really little reason for health insurance to be tied to employers, expect that is what has been done in the US for the past couple of generations.  It is as odd as it would be for our auto insurance, or our grocery purchases to be tied to our employers.  

 

 

[Lanny]

I am just at a bit of a loss to understand what that would mean.

 

Did they expect they would not have to set up a certain amount of administrative infrastructure?  Isn't that the case with any program?

 

If it's the direct services, aren't there doctors and hospitals there now providing services?  

 

I don't really even get the tax hike thing - give the costs that people keep saying they have for insurance, it can't have been worse.

 

It was in the news recently, (a month or 2 ago?), so probably you can Google for something like "California+universal health care" or something like that (without the quote marks) and find news articles. The Legislature in CA, as I recall, put a lot of time and work into the idea,..  Their estimated costs were staggering and how they would pay for it was one of the problems. Another was they would need to have an Infrastructure in place, to deliver services to the people who they covered.  For example, when I was very young and in CA, we had Kaiser Foundation Health Plan, an HMO.  Kaiser had hospitals. Kaiser had doctors. Kaiser had lots of infrastructure in place.

 

The State of CA, to use the example of the largest state, population wise, to look into this, the state with the 6th (?) largest economy in the World, if it were a country, does not have the kind of Infrastructure that would be required.  Would they seize and  take over ownership of all of the hospitals that exist in CA today? Would they conscript all of the M.D.s who are  practicing there today?  How would they deliver services? That was I believe a major obstacle they ran into and had no pragmatic solution for. 

 

If you Google, you may also be able to find information about this on the web site of the California Senate and/or Assembly and on the State of California web sites. For sure, you will find things in the News.

[Lanny]

Not sure I trust that the overall cost would be less, especially for small businesses.  Often employees of small businesses participate through their spouse (or even parents) in the plans of larger companies.  That would probably be why such a small % of employees particpate in the OP's company's plan.

 

As much as the healthcare industry is economically inefficient in some ways, I don't trust our government to do it better.

 

Google for news articles about the V.A. Medical system...  I believe the last sentence is, sadly, true and correct...  And the Veterans are *supposed* to be taken good care of.   If that is how to take care of Heroes, those who were not in the military are in for a shock.

[QueenCat]

 

Fear of what happens to displaced workers should not be the reason to keep an industry that is not working. Part of change can be to assist with retraining and placement if necessary.

 

I do agree but I think it needs to be done in stages for many different reasons.

[AmandaVT]

I think in at least one of those 3 states, probably CA, in addition to the enormous tax hike that would be required, they realized that there was no Infrastructure to provide the services to the people who they would cover under their Single Payer system. Possibly that was also a factor in CO and VT dropping the idea. 

 

It's not fully dropped in VT - the legislature will be studying it again next year.