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Steven Rosenberg would love to offer his employees full health coverage.
It's the smart thing to do in today's tight labor market, and it's the right thing to do, said Rosenberg, owner of Liberty Heights Fresh, a specialty grocer in Salt Lake City. "But it's not realistic."
Soaring health costs passed on to employers in the form of higher insurance premiums are causing businesses nationwide to rethink how they provide health benefits. Some, such as Liberty Heights, are switching to health-reimbursement accounts. Others are asking workers to pay a bigger share of the premiums.
More alarming, a growing number are jettisoning their health plans, and Utah is leading the way.
In Utah, the share of workers under 65 with employer-provided coverage fell 8.9 percent from 2000 to 2006 - the sharpest decline in the country, shows a new study by the Economic Policy Institute, a nonprofit, nonpartisan think tank.
Full-time work no longer equates to full medical coverage, writes Elise Gould, an economist and the report's author.
Employment-based coverage is still the most prominent form of health insurance in the United States, at 60 percent of all Americans, writes Gould. The portion of Utah workers with employer-based insurance is still above the national average.
But, she said, the rate at which workers and their families are joining the ranks of the uninsured is "alarming."
The dramatic rate of Utah's drop, as shown in the study, surprised groups such as the local chapter of the National Federation of Independent Business.
"I know a lot of businesses have scaled back coverage, but not many have dropped it," said chapter director Candace Daly.
Insurance broker Rep. Jim Dunnigan says in the past five years, only one of his client companies disbanded its health plan.
"I'm not saying the study is wrong, but anecdotally, it's not what I'm seeing," said the Taylorsville Republican. "Maybe we need to take a harder look at some of the core data."
Allison Rowland, an analyst at Voices for Utah Children, said the study, which uses U.S. Census data, has a small margin of error, plus or minus 1 percent.
It could be that employers have retained health benefits for senior staff, but no longer cover entry-level employees, said Rowland.
But in Utah, as elsewhere, it's the young, ethnic minorities and low-wage workers who are losing coverage the fastest, according to the Economic Policy Institute.
Children also lost ground - and at a faster rate in Utah than in any state except Vermont.
Since 2000, 43,000 Utah children lost coverage, the report states.
Most come from poorer families and were picked up by government plans, such as Medicaid, shifting the cost to the public sector.
Such a shift may be desirable, because it guarantees children have reliable, ongoing care that is less sensitive to fluctuating market forces, said Gould.
It also may force policymakers to take notice of the problem.
Count Rosenberg among those business owners who are frustrated by the lack of political will to fix the country's ailing health system.
Health reimbursement accounts have been criticized as watered-down health coverage. But Rosenberg says they are a great option for small employers.
He pays $200 a month into accounts for his workers to purchase health coverage on the open market or to spend on a trip to the dentist or chiropractor.
The accounts are more affordable, give consumers more choices and put more responsibility on an individual to make wise health choices, because the employee is more aware of what things cost, said Rosenberg.
Rosenberg said he used to pay about $900 a month "for crap coverage" for himself, his wife and two children.
Every time he went to the doctor or purchased medicine, he was hit with a $50 co-pay.
"Now we actually get what we pay for," said Rosenberg. "And we still have some catastrophic coverage."