Health insurance options for small businesses in Alaska: despite high costs, 'robust market of insurers' exists.

• Author: Weinstein, Joshua
• Position: SPECIAL SECTION: Healthcare

Alaska is different. We know that, and that's why many of us choose to call this state home. The same goes for healthcare in our big state with a small population. Surprising to many, most Alaskans pay a small fraction of the total healthcare spent statewide out of their own pockets. Financing the bulk of the healthcare expenditure largely falls into the laps of both the public and private sectors. Governmental employers fund it for their active employees and many retirees. The public sector also pays for healthcare through programs such as Medicare, Denali Kid-Care, Medicaid, Indian Health Service, Veterans Administration, Tricare, and, to some extent, the new Marketplaces created under the Affordable Care Act (ACA) via federal subsidies in the form of tax credits and payments to insurers to reduce out-of-pocket costs for some consumers meeting household income guidelines.

Small Employer State

Most private sector employees, though, get their coverage through their employers, and Alaska is, by large and far, a small employer state. It's also a very expensive state in which to buy health insurance, which is the predominant mechanism for the financing of our fragmented healthcare system. Alaska employers are struggling to find options that meet the needs of their employees at a palatable price point. Additionally, for the many Alaskans that can't access public sector or employer-sponsored options, coverage options are extremely limited, with only one Marketplace carrier in 2017, and the premium chart alone is enough to cause cardiac arrest. These Alaskans are faring the worst following the ACA's passage in 2010, with some families paying more than $3,000 a month for high deductible plans, others going uninsured, and some finding solace in ministry-based programs that aren't insurance. Fortunately, the employer-sponsored market is somewhat competitive, with an abundance of options for employers of all sizes.

Fewer than Fifty

Small business health insurance policies are offered to employers that average fewer than fifty employees on their payroll. This segment represents the vast number of Alaska employers. Most of these employers do not have to offer coverage, unlike larger firms that need to offer coverage to full-time employees or pay a penalty to the IRS, but they do so to recruit, retain, and reward the employees that make their organizations successful. Nationally, 53 percent of these businesses offered health benefits to their employees...