Is there a doctor in the house?

That's what many companies are tempted to shout when dealing with the rising costs of healthcare. It's a huge issue, both in Sarasota-Manatee and across the country, and it's one that's especially a burden for small businesses, which make up a big part of this region's economy.

According to the National Federation of Independent Business (NFIB), which represents about 600,000 small business members, 46 million Americans have no health insurance, and 27 million of those Americans are small business owners, their employees, and their dependents. Healthcare has been the No. 1 concern for NFIB members for at least 20 years, and it's become the association's No. 1 priority.

Amanda Austin, NFIB's manager of legislative affairs, says that small businesses have seen larger premium increases than big companies and individual customers over the last five years. And because small businesses have a tighter profit margin than large companies, the high cost of insurance often prevents them from offering any kind of healthcare coverage to their employees. Those that do offer insurance are forced to either pass increases on to their employees or absorb the rising costs elsewhere in their budgets, sometimes by eliminating pay raises and bonuses or canceling plans to hire additional employees.

But there are steps companies can take to deal with the rising costs of healthcare.

Support small business health plans

The NFIB supports this idea to allow small business owners to band together across state lines through their membership in a trade association to purchase health coverage for their families and employees. "It's a big priority for us," says Austin. "Small businesses would be able to negotiate like large businesses do on behalf of their employees." Many other organizations also support this idea, including the U.S. Chamber of Commerce and the National Association of Realtors.

Though the U.S. House of Representatives has passed legislation eight times to allow for the creation of Small Business Health Plans, it has yet to get through the U.S. Senate. Austin expects the Senate to take it up again this fall or in early spring. "It's got some legs on it," she says.

Work with a PEO

Many small and medium-sized companies use a professional employer organization (PEO) to administer their employee benefits. This often allows them to offer benefits they might not be able to on their own. Sarasota-based Charter One Hotels & Resorts, which manages hotels in New York and Florida, has approximately 1,100 employees and has found that working with Advantec, a Tampa PEO, has helped the company manage costs and increase its ability to attract and retain employees.

"We are able to leverage Advantec's large number of participating companies to offer benefits packages that are not customarily available in the hospitality industry," says Cusic Daniels, corporate director of sales and marketing for Charter One. "And they actively continue to negotiate contracts and look for enhanced benefits for us, which for a medium- or small-sized company makes it fantastic to have someone out there who is looking at reducing costs all the time."

Regularly review your current plans

If employee benefits are handled internally, companies should regularly examine their health insurance plans and make sure their current provider is offering the best deal. If not, look elsewhere. "Employers need to shop their plans frequently," says Marc Lazarus, president and CEO of R&L Healthcare Advisors, a Sarasota firm that works with hospitals, health systems and physician practices. "My own company switched plans this year because [our provider] jacked its rates."

Consult an expert

A consultant can also help businesses find health insurance options that best benefit both their bottom line and their employees. "We understand the factors that go in to building a rate," says Richard D. Klima, senior vice president at Aon Consulting in Baltimore, Md., which works with companies around the country on insurance, risk management and human capital issues. "And we're able to tear it apart, help clients understand what's happening, and have an impact in reducing costs."

Empower your employees

Employers are increasingly encouraging their employees to take a more active role in their own health and welfare. "It's stemming from the realization that the actual health status of the employees is the ultimate determinant in what the costs are," says Klima.

According to the Wellness Councils of America, more than 81 percent of American businesses with 50 or more employees currently have some form of workplace wellness programs, such as classes and workshops, discounts on gym memberships, health screenings and incentive programs.

As part of Sarasota County Government's Living Well Program, established a decade ago, employees can qualify for incentives by completing health risk assessments and attending classes and workshops on everything from using a pedometer to smoking cessation.