If you own or manage a small or medium size business, maintaining or even obtaining health insurance for your employees is one of your leading concerns, just as it is for your employees. According to a brochure put out by the Georgia Small Business Development Center, employees overwhelmingly consider health insurance to be the most important fringe benefit a business offers them.

Kaiser’s Health Tracking poll for June 2013 found that more than 70% of young adults aged 18 to 30 surveyed said that health insurance was very important to them and worth the price. Of uninsured Americans, “obtaining insurance” was very important to them. Cost was the biggest barrier to obtaining it, either on their own or from their employers. And with reason: the national average cost of employer-sponsored health insurance for an individual is $468 a month and $1,312 for a family of four.

Most small and medium size employers must look their employees in the eye and answer to their communities. As human beings, we want to do right by others even as we know it is also in our best interests. According to the Department of Labor, recruiting and employee turnover account for about 30% of small businesses their salary expenses.

America is one of the few developed countries that link health insurance and health care to employment. Until this changes here are some tips to help you save money when purchasing health insurance for your employees.

  • Go to http://www.hhs.gov/healthcare/ and navigate to the Insurance Marketplace. This marketplace is meant to allow individuals and small businesses to compare health care plans, ask questions and learn about eligibility for tax credits on insurance and health care plans. Open enrollment will begin in October for January 2014.
  • If you employ up to 25 employees, you’re probably eligible for a tax credit of 35% to offset the costs of insurance. Links to further information are here.
  • Go to your state’s insurance commissioner’s website for similar information tailored to your state.
  • Your state may have a plan to subsidize or reduce the cost of employee health insurance.
  • If you can join a cooperative in your state or city, do so. Cooperative associations allow businesses to negotiate more favorable rates for purchase health insurance by creating a larger pool of insured, lowering the insurers’ risk and lowering premiums.
  • Ask if your professional or trade association allows you to purchase coverage through it for you and your employees. Your local Chamber of Commerce may offer such a service to their active members as well.
  • Talk to your employees and find out their needs. If the fit is right, consider a non-traditional arrangement, such as high-deductible insurance plans combined with Flexible Spending Accounts, Health Savings Accounts or Health Reimbursement Accounts. These plans allow you and your employees to contribute pre-tax dollars and may accumulate from year to year.
  • Find an honest insurance broker who cares about finding the best plan for her/his clients. One excellent way to do this is ask business people you know: word-of-mouth referrals from people you trust are advertising money can’t buy.
  • Contact your state insurance commissioner to check for sustained complaints, both about your broker or about whatever insurers and plan(s) you are considering.
  • Any company that you decide to purchase a plan from must be licensed in your state. In addition to your state insurance commissioner, an excellent resource for consumer information about health plans is the National Association of Insurance Commissioners.

You may also choose to self-insure your employees but you should do this without having a risk analysis and a cash-flow analysis performed. Even if both analyses indicate that self-insurance is prudent, you should buy a stop-loss plan that limits your loss if claims—whether by an individual or in the aggregate—exceed a pre-determined limit. The Self-Insurance Institute of America is a good place to begin your research.

The larger solution is to become politically active and work towards the health care solution you believe in, be it single-payer health care, fee-for-service, or something in between. “Becoming politically active” however, does not mean engaging in the vitriol, ignorance, cruelty and vulgarity that has so contaminated America’s political discourse and dead locked the political process. Rather, it means reasoning as a citizen with other citizens: speaking to each other in civilized, dignified, rational language about the country we share, the lives we want to lead and how we wish to live together.