In the midst of the ever-changing healthcare environment I find that small business employers are having a more difficult time keeping standard healthcare plans in place. The definition of a small business employer is 50 employees down to 2 employees. What I have found is that small business employers are continuing to increase deductibles and out-of-pocket costs for their employees. This is all well and good due to the fact that the rising cost of healthcare is something that small business employers cannot afford but keeping strong health plans intact is important.

While Health Savings Accounts (HSA) are something the small employer can take into account for their businesses I find that many employers could pay more for an HSA than a standard healthcare plan. The reason is HSA’s can actually end up being more expensive in the long run if their employees happen to have a catastrophic or chronic illness or the premiums are high because the insurance company prices the plan high due to their liability after the deductible is met.

I recommend that employers put into place a $1000, $1500 or $2000 deductible with an out of pocket maximum anywhere from $4-$6000 on an in-network basis and keep the office visit and prescription drug co-pays in place.

I do like the utilization of a Health Reimbursement Account (HRA) as well. You could implement an HSA or a high deductible plan and put in place an HRA, but I would recommend this only if you have 25 or more employees, otherwise the employer loses money if the HRA is used to often by the employees.

Healthcare reform has helped employees recognize the importance of wellness visits by implementing no-copay for wellness visits. Also there are no maximum lifetime limits and the benefit increasing the age for child and military coverage.

I do not see that healthcare reform will be the way of the future. Why? Because it takes away the free enterprise of insurance. I say the government needs to back away from the involvement and let the insurance companies do what they do best (but implement further guidance) which is manage healthcare and provide healthcare benefits for the population. This overplay by the government does not lead to a democratic society, it is our responsibility as citizens to manage our own healthcare and to utilize the system that may be slightly broken at this time, but with improvements definitely can be beneficial for the long term. Keep healthcare reform at bay and let free enterprise continue.