BLOOMINGTON — Mike Mavec thinks it's great that more people have health insurance coverage.

The challenge is paying for it.

Mavec understands. As a small business owner who provides health insurance for his employees, his premiums have increased substantially in the past few years, especially after the federal Affordable Care Act (ACA) took effect, even as coverage remained about the same.

And even though he moved himself and his family to a high-deductible plan coupled with a health savings account, those premiums have increased astronomically.

This has happened even though Mavec, 46, of Bloomington is healthy and physically active, as are his employees. They include a marathoner, a personal trainer, a mountain biker and a soccer player.

"The law (ACA) helped people who couldn't get health insurance before," said Jeff Gilmore, president of Benefit Planning Associates in Bloomington.

"Which I respect," Mavec said. "It's important that people have health care."

"It's covering pre-existing conditions, which everyone agrees is a good thing," Gilmore said

"There are absolutely more people with coverage today," Gilmore said. "But one reason is because some of them are receiving subsidies" — government assistance that helps cover part of the premiums for people with low incomes.

"That's great for them," said Gilmore, but the problem is small businesses and individuals not receiving subsidies are making up the difference.

"Just because people are receiving subsidies doesn't mean premiums are going down," Gilmore said. "What gets lost is that, regardless of tax credits, premiums are going up 40 percent or higher."

Everyone's talking about health insurance coverage because it's open enrollment time for 2017, not only for people selecting health insurance plans through their employers or on their own, but for people enrolling in plans using the online marketplace under the ACA, more commonly referred to as Obamacare.

Marketplace open enrollment at began Tuesday and goes through Jan. 31. But the deadline is Dec. 15 for people whose coverage is effective Jan. 1. People can use the marketplace on their own or with assistance from a benefit planner, such as those at Benefit Planning Associates, or a certified application counselor, such as the counselor at Chestnut Family Health Center in Bloomington.

For small business owners and people on individual plans, deliberations in the past few days have included sticker shock.

"Individual plans are renewing with 30 to 55 percent increases in premiums," Gilmore said. "We're seeing fewer plan choices and higher deductibles."

"The (health insurance) carriers have decided that the marketplace is not a profitable segment for them and, as a result, they've narrowed down the choices," he said.

Large employers have not been as severely impacted as smaller employers and individuals.

Gilmore said for his own family renewal with Blue Cross Blue Shield, his premiums are increasing from $1,490 a month to $2,106 a month, a 41 percent increase. His deductible remains $5,000.

"That's $30,272 a year before I get a dime in benefits," Gilmore said.

Before ACA, in 2012, his monthly premium was $564 for the same coverage.

For small businesses like Mike's Collision Center — Mavec's Bloomington collision repair business — ACA is allowing them to be on transitional (non-ACA compliant) plans for another year.

Even if Mavec stays with Health Alliance, no-deductible transitional plan for 2017, premiums would increase 20 percent. If he would switch to a Health Alliance ACA-compliant plan with a higher deductible, premiums would increase 28.7 percent. If he would switch to a Blue Cross Blue Shield ACA-compliant plan with a higher deductible, premiums would increase 41.5 percent.

"I think we'll stay with the transitional plan for as long as we possibly can," Mavec said.

Mavec's share of health insurance premiums have gone from $107 a month per employee in 2007 to $260.90 for 2017.

"In those 10 years, the increases have more than doubled," Mavec said. "I don't know any other industry where the price can double and it's acceptable.

"We absorb it," he said. "But as a company, it makes us less profitable."

Mavec moved himself and his family to another family plan with a $5,000 deductible coupled with a health savings account in 2013. His monthly premium was $476 in 2013. Next year, it will be $1,600.

"When you look at a household going from $400 to $1,600 a month, how can the general public shoulder something like that?" Mavec said. "But that's what it is for me. That's what it is for a lot of people."

But Mavec is not considering dropping health insurance coverage for his employees and instead giving them money to buy insurance on their own.

"I know they are insured," Mavec said. "I know they are getting good coverage. It's a benefit. That's why we're a good place to work. It helps us to recruit and retain employees."

"I think it's important for people to have health care," he added. "But I don't understand it (ACA). I don't know what the fix could be."

Follow Paul Swiech on Twitter: @pg_swiech


Health Editor

Health Editor for The Pantagraph.

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