How did you come to the conclusion that employer health insurance doesn't just suck? It's crumbling.

Well, here, maybe it'll help if I explain kind of the origins of why we even started it.

So I'd gotten back from parental leave last year around November.

My wife and I just had our second kid.

And literally the first thing I have to do both of us, we both have to do when we get back is we have to figure out what health insurance plans we're going to enroll for the next year, which, as I'm sure you and every one of your listeners knows, is a miserable experience.

And we cover health care and it's still miserable.

It's tedious, but also it is high stakes.

I

When people, uh, at small to medium-sized companies lose their, their coverage, what do the employers tell them to do? You're on your own?

Yeah, I mean, first of all, a, a lot of the small business owners and workers I talk to, it's, the, it's not an option that they want to do, right? Like, a lot of employers want to provide health insurance to their employees, but it's, the costs have gotten to the point where they, they have to make a choice.

Either we offer it, or our business suffers to the point of, you know, whether it still survives.

And so a lot of employers have said, "Hey, we're gonna give employees money.

Maybe you can go buy coverage on the ACA exchanges, then." Um, but the, it's a tough trade-off for workers because it, as you mentioned, the premiums are much, much higher now.

And, and the ACA marketplaces, we need to start thinking of these as also places where It's, it's almost like a, a, another marketplace for workers.

About half of people who enroll in the AC marketplaces are small business owners or solo entrepreneurs, and the premiums there are, they're incredibly high.

Are there tax, the, the tax advantages that the, that the larger companies have that allow them to do this, could the laws be changed for small to medium-sized companies to get, to offer them the same type of, of incentives and, and advantages so, so that they could, they would be able to do it as well? What, what, why isn't that done? Congress won't do that either?

What have they been telling you about what the experience is like trying to provide coverage and how they're managing this?

Yeah, when I started reporting this, like I said, we knew that employer health coverage was very expensive.

It's been absolutely outpacing inflation for decades now.

What's new? What's different? What's enlightening? And so I looked through surveys and data, and what really shocked me was how bad it's specifically gotten for America's small businesses.

The actual definition of a small business is 50 or fewer employees.

I think most people would say anything lower than A few hundred is a small business.

And the survey data were very clear that fewer employers of that size were even offering health insurance.

If we're thinking of the root causes of why costs continue to go up, premiums continue to go up, who do you attribute that to?