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My Deep Dark Secret

By Dr. Mona Mangat
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Four years ago I decided to fulfill a dream I’d had for many years – to own a solo private practice. My reasons were similar to thousands of other doctors that make that choice – I wanted flexibility in my schedule, I wanted to be my own boss and I wanted to make my own rules. I wanted to see a dream grow from nothing but an idea. Despite my hesitation – rooted in the knowledge that I knew nothing about being a small business owner – I began the journey.

It started with finding an appropriate building to purchase and meeting with architects to properly build-out for a medical office. I read endless guides and spoke with other colleagues. Credentialing and insurance contracts took nearly a year to have in place. I bought exam tables, waiting room furniture, computers, and an EMR. I finally hired employees – the last missing piece of the puzzle. Each one asked if I offered benefits. I quickly responded that I planned to be able to offer health insurance as a benefit within the 1st year of practice. That single statement was a clue to my naiveté.

Fast forward to 3 years later. I have three employees. One female employee is young and remains on her parents plan which now, thanks to the Affordable Care Act (ACA), she can remain on until she is 26 years old. That leaves two other female employees – one has only one kidney and the other is a hypertensive smoker over the age of 50. Searching for a policy to cover the two of them was as arduous a process as I imagine climbing Mt. Kilimanjaro would be.

I spent months poring over pages of spreadsheets with insurance plans – each had a different deductible or copay or coinsurance. Each had different levels of prescription drug coverage.  I was so overwhelmed that I can only imagine what a non-medical business owner must feel. They may as well be sifting through the Dead Sea Scrolls. Bottom line – a good policy with a $1000 deductible/year was going to cost approximately $550/month per person. I was planning on contributing a quarter to half of the premium, but they were unable to afford their portions at this rate.

You must believe me when I say that I lost many nights of sleep knowing that my own employees were uninsured. It was my deep dark secret; that while I advocate for a health system in which everyone has access to health care, my dearest and loyal employees were uninsured. Sure, I could treat the simple UTI or pharyngitis or refill blood pressure medications, but is this how health care should be delivered? What happens to those uninsured that don’t work for a doctor? How would we deal with a hypertensive crisis or a flare of diverticulitis? What about mammograms or pap smears? Neither has had one in over 5 years.

It is very hard to offer health insurance to your employees if you are a small business owner. From 2000 to 2007, the percentage of small businesses offering coverage dropped from 68% to 59%, while large firms held stable at 99%. Of the uninsured, nearly 1/3 (13 million) work for small businesses with less than 100 employees. Here in Florida, the situation is even more dire. Only 36% of small businesses offer health insurance. Cost is the reason.

I recently attended a female small business owner’s forum hosted by the Small Business Majority and Florida CHAIN. I heard female business owners talk about how the rising cost of insurance premiums is the largest expenditure on their profit & loss statement – second only to payroll. This is where I shared my deep dark secret; in a room full of women that face the same struggle I do. Happy, loyal, competent & healthy employees are vital to the success of any business.

I am so pleased that the ACA addresses the struggles of small business owners. The 35% tax credit this year (on the money spent on premiums) will rise to 50% in 2014. I am so excited to know that in 2014 when I shop for insurance plans I’ll be shopping through a new Small Business Health Options Program (SHOP) Exchanges that will allow me to easily compare plans and harness the purchasing power of hundreds of other small businesses. The CBO estimates the Exchanges will reduce costs and increase competitive pressure on insurers, driving down premiums by up to 4 percent for small businesses.  These changes alone will help small business owners remain competitive. I’ll be able to offer quality health insurance plans to my employees ensuring their health, productiveness and loyalty.

The story has an ending. Last year I purchased two individual policies on the open market for my employees. The plans have high deductibles (>$5000) but they offer us both a sense of comfort that should they have a catastrophic illness, they won’t be financially ruined. I am looking for a happy ending in 2014.

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