COVER STORY

Bill Hurley, the President of Infinite Imaging, says there are few "choices" when it comes to health insurance competition in New Hampshire. Michael McCord photo

In the midst of a presidential election cycle, health care cost has become a leading domestic issue for voters and, not surprisingly, for candidates. There's no shortage of plans or philosophies from hopefuls in both parties.

Perhaps they would learn a lot more about the real issues at stake if they talked to local business owners William Hurley and Mark Galvin.

"It's getting out of control," said Hurley, the founder and president of Infinite Imaging, a high-tech printing and copy company with five locations and 25 employees in the Seacoast region. "When it comes to health insurance, there really aren't any (competitive) choices. When they (insurance companies) aren't raising premium rates, they are cutting coverage and making co-payments higher."

When I first talked to Mark Galvin a few years ago about his perspective on the heath care crisis and what he thought was necessary as an employer, the founder and president of Whaleback Systems in Portsmouth was enthusiastically to the point.

"We need a better model and I believe that HSAs (Health Savings Accounts) are the best solution because it puts (financial) control in the hands of my employees," Galvin said back when he had 17 employees, and the policy change led to a saving of $22,000 for his company "" while covering 100 percent of his employees' health savings account (a tax-free $2,700 for individuals and $5,400 per family to be used for health-care expenses) and the entire $1,000 deductible.

Galvin has not changed his tune and has become an educated advocate of an approach that he thinks is necessary for businesses to survive and thrive.

"Overall, making the costs and options associated with health care understood by employees is healthy for businesses that want to provide health care coverage and employment," said Galvin, whose company has grown to more than 40 employees. "If the employee doesn't become a �responsible consumer' and the system runs on �cost plus,' then all factors simply drive health care costs up with no assurance that there is any quality.

Mark Galvin, President & CEO of Whaleback Systems. Michael McCord photo

"Insurance regulators have proven ineffective in controlling costs. A consumer-driven system makes absolute sense."

Galvin's passion is exactly what the architects of HSAs hoped for when the law establishing them as part of the Medicare Prescription Drug bill in late 2003. Simply defined, HSAs are an account that allows individuals to pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis.

They allow employers and/or employees to contribute to a tax-deferred personal savings account which is used to pay smaller and routine medical expenses. HSAs must be linked to a high-deductible health insurance policy with a minimum $1,000 deductible for an individual or $2,000 for a family.

One of the main enticements is that it allows members to shop around for health care services, and money not used can be rolled over to the next year or invested in a retirement account.

The federal government estimates that as many as 10 million Americans will be enrolled in some form of consumer-driven plans by 2010. And new insurance companies such as Patriot Healthcare in Bedford have been created to serve this market.

But Hurley has yet to take the HSA option. He said his company took a close look at the HAS option but passed.

"It was too complicated and we couldn't identify any real savings," he explained.

The main assessment was one of rolling the dice.

"It could be (financially) devastating if you're wrong in your choices," he said.

Hurley is one of a national chorus of HSA doubters. Critics claim the HSA movement is a cost-shifting sleight-of-hand that benefits the wealthy and the healthy. Further, they say, it will cost far too much ($59 billion annually from the U.S. Treasury) to make a difference in driving down health-care costs and will lead to even more uninsured workers who cannot afford the high deductibles.

Galvin, like Hurley, doesn't care much for health insurance companies that are paid a lot for "limited services." But he thinks the HSA option is the best solution to repair a system with a limited number of good choices. He knows that education is the key and it's easy to prefer the old system that demands less research into medical purchasing choices.

"The impediments to rapid adoption of HSA are, first, that the current health insurance organizations that have market share would have to shrink to deal with the reduced premiums that high deductible health insurance has," said Galvin.

Anthem Blue Cross-Blue Shield of New Hampshire, the state's largest health insurer, earlier this year added consumer-driven health care products due to market changes. Spokesperson Chris Dugan said the new programs already represent a "growing number of new enrollees."

For his part, Hurley thinks national universal health care coverage is a minimum must and that it's vital to extend coverage to everyone under 18 years of age. The reason? It's smart economics because we pay for it one way or another in higher insurance premiums or reduced services, he said, and it's better to pay less at the preventive stage than when problems show up at the emergency room.

On the business side, he said he's being forced to make tougher and tougher choices. He pays $5,000 monthly for health care premiums and said the health of the potential employee matters more than ever before because he can't afford to make a costly hiring choice.

"I'd hire the one who didn't come with obvious health care needs," he said, with resignation.