We are in the busiest time of year for health insurance and employee benefits. The vast majority of companies have their employees make benefits elections from October 1st to December 31st. So that means that it’s 4th Quarter baby! It’s go time!!!

So, why the exclamation points, Ray? What’s that?

What do you mean? You’re not excited about insurance and employee benefits? Well you should be. We all should be thankful that we have insurance and good employee benefits options. We all take a lot for granted, myself included.

I recently read a heart-wrenching story in the New York Times (https://www.nytimes.com/2017/10/14/us/union-jobs-mexico-rexnord.html). It depicts the struggle of a woman, Shannon Mulcahy, who against all odds made it in a predominantly male work force. Shannon made steel bearings and honed her craft for over 20 years. She had an important job and took pride in the hard work that she did to make a quality product. She was paid a fair wage and had good benefits. And then, her company, Rexnord decided to relocate her factory to Mexico where labor and manufacturing costs were cheaper. Now, Shannon is forced to reinvent herself. What is a single mom to do? Can you imagine yourself in that scenario? Maybe, like Shannon, you started out in your mid-twenties learning a trade and honing your skills. Perhaps you never finished high school or furthered your education after high school. What do you do when you want to work, have something to offer and there are simply no jobs available? The answer is that you do what you have to do to survive. Shannon strikes me as a survivor and I am confident that she’ll bounce back from this. I would imagine that it won’t be easy though. And as difficult as her predicament may be, I am sure that there are others who have even fewer options and whose prospects for the future are grim.

So, now that I’ve set a cheery tone for this blog, what’s does Shannon’s story have to do with benefits? Well if you read the article you’ll see that one of her greatest concerns was having health insurance for her and her family. It seems that Shannon provided for her children and granddaughter, Carmella who has a rare genetic disorder. [In the midst of Carmella’s many surgeries, Shannon’s hair had fallen out in clumps. “Stress-related balding,” she said.] It is difficult to fathom the amount of stress that Shannon is under now to provide for her family, but many men and women live with this stress every day.

The number one cause for bankruptcy in the United States is a medical crisis which creates a downward spiral for families who ultimately are forced to make unthinkably difficult choices with respect to paying the rent or the insurance bill. Crazy!

Being employed and having options is in, and of itself a blessing. Let’s be thankful for what we have.

As I write this blog on October 24th, 2017 we are now seven years into the introduction of the Affordable Care Act, a.k.a. Obamacare. Former mayor Ed Koch was famous for saying, “How am I doin?” I took that as his humorous way of poking fun at himself while asking for feedback from his constituents (God rest his soul). So, let’s try that with Obamacare. How’s Obamacare doing? It is doing some good for sure if you ask the millions of people who were in that middle ground of earning too much to qualify for Medicaid, but too little to be living the dream – that’s an understatement – I’m being ironical. However, Obamacare failed to “fix” the underlying problem.

What problem is that? In a nutshell: The problem of overutilization due to a lack of education. One of the core tenants of insurance is that if people use it because they have it everyone pays more. We are abusing the privilege. Ray, what do you mean, “Privilege? I am paying thirty-thousand dollars per year to cover my family. If I need to go to the hospital I’m going to go”. Yes, by all means, if you need to go to the hospital, go. However, our emergency rooms are filled with people who do not have an emergency! This overcrowding goes from the folks who are uninsured to those who are on Medicaid to those who have the best coverage going. Overutilization is a major problem and it stems from a lack of education, caring or a combination of both.

Another major contributor is drug companies, insurance companies and lobbyists. Our political system is being manipulated by those with deep pockets, and influence and we are all paying a very dear price for the nonsense that is taking place right under our very noses. The stock prices of these companies are at all-time highs. I wonder. Is there any correlation between the language drafted in the ACA and the stock prices of these companies? Is that what Obamacare intended?

Where is Doctor Hogue when you need him with a can of Coke to cure a bad case of indigestion?

I can go on and will in future blogs, but for now let’s focus on the present. If you are an employer in the NYC market with under 100 employees your two best options today are United HealthCare/Oxford and Emblem. Care Connect was a viable option and can still be had under certain circumstances until the end of 2018 until they were forced to pay over $120M into the pool to support the losses of competing insurance companies. Any entrepreneurs out there? How’d you like to start a business, turn a profit and be forced to pay all of the profit back until you end up with a loss? Does that sound like a business you’d like to get involved in? Well that’s what happened to Care Connect. New York State allowed it to happen and now we all have less of a choice and a greater expense in paying for our health insurance.

Sorry, I went off the rails there for a minute! OK, so Oxford and Emblem. The good news is that both offer broad networks where most providers and hospitals can be found. If you are in good health and young, taking on more risk with a high-deductible plan will be rewarded with lower premiums. The starting point for individual coverage is in the $600/month range. If made available on a pre-tax basis you’ll save an average 30% on these premiums (more or less based upon income and tax filing status). There are other coverage options out there starting at under $400 per month. (These options are better than nothing but you do get what you pay for. Shoot us an email and we can get you more information on what’s available if you are interested.)

There are more options than Oxford and Emblem but they are the two primary players in the NYC Metro market with 2-99 employees as of this writing. In the large market serving employers with over 100 employees other notable providers include but are not limited to: Aetna, Cigna, Blue Cross & Blue Shield.

Costs are increasing, exposure is increasing and services are decreasing. It’s a sad state of affairs when it costs less to send our children to state university than it does to buy health insurance for our families, but that’s kind of where we are.

I’m going to end there. On behalf of our team thank you for reading and do reach out if we can help you make sense of your benefits.