As the Obama administration and lawmakers in Washington debate the scope and details of comprehensive health reform, they might consider talking to two small-business owners in New Hampshire who embody the frustrations, difficulties and gut-wrenching business decisions that are a daily part of the nation’s patchwork health-care system.
When it comes to providing health benefits to his employees, Bill Hurley of the Seacoast print firm Infinite Imaging says that with each passing day he feels more and more like the character Howard Beale in the movie, “Network” — he’s as mad as hell and can’t take it anymore.
“Our (health insurance) rates increased 30 percent last year, and this is unsustainable. It’s making all small businesses less competitive every time we go through this,” said Hurley.
Hurley, who has been an outspoken advocate for health reform, covers 55 percent of his employees’ premium costs. “When our premiums go up $50,000 or $70,000, that is money we don’t have to hire new employees or buy equipment. Only an idiot doesn’t know that (the current system) is a disincentive to investment.”
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Hurley, who has 27 employees, said that he has always attempted to pay a “livable wage” to his workers but is finding it harder to do so because of rising health insurance premiums. Often, the employees’ cost is so high that, particularly younger workers, decide they can’t afford to pay premiums and will roll the dice and go without coverage.
“We’re a successful company,” said Hurley who has five color printing shops from York, Maine to Exeter. “I pay $16 an hour, and they can’t afford health insurance? What is wrong with that picture?”
Nancy Clark, owner of The Glen Group, a marketing and advertising agency in North Conway, said the rising insurance premium costs are leading her to the brink of what was once unimaginable – choosing between laying off workers or offering health benefits.
“I’m not the only one who says this is crippling us,” said Clark about the recent 31.5 percent increase in insurance premiums her company of 14 employees was hit with. “I don’t know what the solutions are, but it would not be good for any business if health insurance becomes more of a luxury benefit.”
Clark, who said she scrambled to find the best and most affordable plan possible, decided on a lower-premium, high-deductible heath savings account, which she believes is a tight-wire walk for her employees. And, she said, she’s concerned that it doesn’t provide enough incentives for preventive care.
“I’m forced to change the type of coverage so I can offer something, but what I would like to see is accountability on the part of health insurers who tell us increases are necessary, but I don’t get any explanations,” she said. “(Reform) is beyond my control but I do know it has to start with the insurers.”
As the only employee to try an HSA, Hurley has played guinea pig for his company, but he doesn’t believe it’s a suitable replacement for current coverage.
Hurley said he has given up on the current system because it’s a mirage.
“If you listen closely, the for-profit insurers care most about maximizing returns for their shareholders and throw it in your face when they give multimillion-dollar bonuses to executives as they raise our premiums,” Hurley said. “We don’t have a health-care system as much as health insurance system, and that distinction illustrates the problem we have.”
Growing pressures
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Of course, Clark and Hurley are not alone.
Adrienne Rupp of the Business and Industry Association of New Hampshire said small and large businesses feel the brunt of the health-care crisis daily. It remains among their top concerns.
“How do we go about reducing premiums?” asked Rupp, who added that constant shifting in the system and added legislative mandates to increase coverage (and premium costs) make it increasingly harder to keep premium rates from rising.
“These are all very good proposals,” she said about legislative efforts to expand coverage on a wide range of programs. “But when you start adding them up, who ends up paying for them?”
By most people’s reckoning, the pressures are only going to grow for employers, health-care providers, insurers and the public sector.
According to a recent study by Families USA, almost 85 percent of New Hampshire’s uninsured population of 279,000 are members of working families. As the recession deepens, the number grows daily — more than 14,000 Americans are said to be losing their employer-based health care coverage each day.
“What kind of system and kind of country do we have that depends on a job to have health care?” asked Hurley who advocates for a single-payer system alternative. “We can’t be doing in two years what we are doing today.”
Charles Baker, president and chief executive of Harvard Pilgrim Health Care, has heard all the complaints about health insurance and no shortage of talk about reform during his tenure. Harvard Pilgrim provides insurance to more than a million members in Massachusetts, New Hampshire and Maine and has been consistently rated among the top plans in the country.
According to Baker, prophecies of doom and unsustainability are par for the course. “If someone had told me 10 years ago that we would be basically looking at double-digit (premium) increases over the next 10 years and the number of uninsured would rise 40 million, I would have said, ‘There’s no way that’s sustainable,’ “ he said.
Baker said the recession has taken a toll on health insurers. “We have seen a drop of total membership,” he said. “We think employers are not filling positions and shrinking the size of their workforce.” Harvard Pilgrim itself has had to deal with rising premiums by reducing coverage.
His diagnosis includes the reality that massive government programs such as Medicaid and Medicare are the prime forces in determining health costs and can’t be ignored. He also said he’s skeptical of reforms that would bring public sector plans into a much wider marketplace — and provide a competitive advantage.
“Will there be a public carrier in the commercial market and what will that mean for local carriers like us?” said Baker. “I don’t think the public sector is capable of running a program with a break-even budget, and we already have Medicaid and Medicare with trillions in unfunded liabilities. I have to break even every year.”
nhbr.com
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