Toby Stark is a Past President of the New Jersey Association of Health Underwriters (NJAHU), a consumer advocacy organization of professionals and brokers in the health insurance industry.

What is the biggest challenge for a small or medium size business in purchasing health insurance?

The cost is the challenge, especially for small companies of between two and ten employees. For them, it’s very difficult. If you have premium increases of 12 to 15 percent each year, businesses can’t increase their services or the products they sell by that much. It can be a real hardship. Some even decide to opt out.

So what’s your advice for these employers?

I would say they should take a hard look at their benefits. I would tell businesses to look at what they one hundred percent have to do every month: pay the premiums. But they’re not going to the emergency room a hundred percent of the time. So I might suggest a higher deductible and put in some type of reimbursement arrangement for employees to help cover the high deductible.

But it depends on the age group. Some older business owners don’t want to play around with a higher deductible. So they will pay the higher premiums. So every situation is unique. There’s a lot of education behind what plan to purchase. That’s where we, and the brokerage community, help.

Open enrollment for the Affordable Care Act and many plans begins soon. How do you see the current New Jersey health insurance landscape?

For individuals, we will see the cost-sharing reductions re-implemented for those eligible through the Affordable Care Act. You have people who can afford their premium but not the deductible or co-pay, even with a subsidized plan.  And the premium increases originally predicted to be around fifteen to twenty-five percent are actually coming down to about five to seven percent.

And there are people in New Jersey who make more than 400% of the federal poverty level and, therefore, get no assistance. We have not made health care more affordable for them and they are struggling to pay the premiums.

How do you help those individuals trying to find insurance they can afford?

We literally have hundreds of individuals who call our office, especially during open enrollment, looking for other plan options when their premiums rise. We are certified to enroll people in the ACA and the first thing we do is determine if they are eligible for a subsidy. If they are very low income, brokers may guide them toward Medicaid for themselves or their children.

What can members of the Quality Institute do to get more people covered during open enrollment?

I think the individual mandate the governor (Phil Murphy) implemented is a good start to keep our population in New Jersey covered. Quality Institute members can help get the word out. The federal money to advertise the ACA and encourage people to sign up was significantly reduced and the enrollment period has shrunk to November 1 through December 15. So getting the word out is important. … And as long as people are listening, I would urge them to get to their primary care provider for a check-up. It’s like maintenance on your car. Neglecting your health eventually increases the health care spend, which increases health insurance premiums. Health insurance is a direct reflection of the cost of health care.