Small business expert Eric Tyson presented a sobering picture for small businesses facing the spiraling costs of healthcare benefits (p. xx). Basically, businesses will be forced to cut back on health benefits, he says. At best, workers will have to live with less coverage, more expensive premiums and lowered expectations.

It's a huge national problem. A record 45 million Americans-including many who hold down jobs-do not have health insurance. In the three years from 2001 to 2004, health benefits were cut from 5 million jobs. In Sarasota, more than 45,000 family members of working employees are uninsured.

It might be tempting for employers to give up, to cut back on coverage or eliminate it altogether, but some local employers have found creative strategies. Sarasota Memorial, which provided $50 million in emergency care to the indigent and uninsured in 2003, began offering its own healthcare insurance for small businesses in 2004 (p. xx) in the hopes of reducing the number of workers who had been landing in the emergency room.

Sarasota County government started a wellness program, which includes weight-reduction courses, nutritional counseling, exercise classes and three gyms. The cost is $592,000 for the county's 3,700 employees, says Steve Marcinko, the manager of employee benefits and wellness for the county, but "we think in three or four years it will be a significant savings" out of the county's $24 million in health insurance costs if these programs reduce or prevent chronic conditions such as heart disease and diabetes. "Not doing anything is a recipe for disaster," he says.

And employers shouldn't forget that benefits are a way to attract and retain good workers, says Nick Marazita, the president of Sunset Mold in Venice, who pays 100 percent of his 10 employees' benefits and up to $500 a month in benefits for an employee and his or her family.

"It does eat into my bottom line," he admits, "and if I were a hardcore MBA, I would likely say this is way above what is usually provided." But in the end, it pays off.

"I get the best employees because of the way I take care of them," he says. "I would rather cut somewhere else. To me, providing healthcare is just a cost of business. It costs me a lot of money if I lose a guy, maybe $10,000 to find a replacement not to mention the lost opportunities. When you want good people you've got to take care of them."

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