Let’s Make Promises We Can Keep
Uninsured: Health Coverage Options Forum - A Resource of Information

Let’s Make Promises We Can Keep
Guest Opinion by Sam Smith, CFP
Principal Genesis/Smith-Benton Insurance & Financial Service

Guaranteeing health care for all is a moral imperative. Complicating this goal, however, is the simple fact that health care is big business – about 15 percent of the nation’s economy. California is currently considering several health care proposals that offer strikingly different views of how to address the problem. These range from relatively minor tune-ups, such as the plans put forth by Speaker Fabian Nuñez and President Pro Tem Don Perata, to complete tear-downs, like the single-payer plan advocated by Senator Sheila Kuehl. It is important to realize that the current system works well for the vast majority of Californians. While it certainly needs major improvements, we don’t need to throw the baby out with the bathwater to achieve universal coverage.

Real health care reform represents one of the greatest challenges we face as a state, and we owe it to ourselves to pursue reforms that enhance the health and financial security of Californians. The California Association of Health Underwriters (CAHU) has authored a Healthy Solutions reform proposal that would achieve universal coverage in a realistic and responsible manner. As the state’s largest association representing health insurance agents, CAHU’s members view our health care system from a unique perspective, dealing directly with both consumers and large insurers. We see what works and what doesn’t, and we see firsthand the financial stress that the system places on working families and small businesses.

The first objective of Healthy Solutions is to make sure that the state keeps its promises to its citizens. Today, one million uninsured Californians are eligible for existing public programs, yet fail to participate in them. Healthy Solutions compels the state to reach out to these individuals and enroll them in the available programs, reducing the ranks of the uninsured by 15 percent. Once this is achieved, Healthy Solutions would examine the resources available and, if feasible, expand public programs to cover the most vulnerable Californians: low-income children and adults.

As everyone knows, health coverage is just plain expensive. Even middle-income Californians could use help in the form of premium subsidies. Healthy Solutions includes such subsidies, but requires the state to identify the sources of those funds before promising financial assistance.

Gov. Schwarzenegger’s plan also provides premium subsidies to individuals, but forces those eligible to purchase coverage through a state pool. This is unfair and simply bad policy. Subsidized individuals should have the same rights as their unsubsidized neighbors. That means they should be allowed to make choices in finding coverage that is appropriate for their unique situations. We don’t require food stamp recipients to shop at state-run supermarkets and we shouldn’t force those who receive “health stamps” to do so either.

One value that Healthy Solutions and the Governor’s proposal share is the promotion of personal responsibility. Those with health insurance pay, in part, for those without it. Currently, 80 percent of Californians have health coverage. Once participation reaches 90 percent, insurers should be required to accept all applicants, regardless of preconditions (until then, an existing state program for those declined for coverage due to existing medical conditions should be greatly expanded to serve as an “insurer of last resort”). The reason for the participation trigger is that a mandate to issue coverage without an effective mandate to purchase coverage will force Californians to pay astonishingly inflated premiums. Such a situation exists in both New York and New Jersey; the citizens of these two states pay surcharges of 350 percent or more for individual coverage.

Achieving universal coverage would be a huge accomplishment, yet it’s not enough. The key to solving our health care challenges is to constrain rapidly rising costs. To do this, California needs to encourage healthier choices and promote innovations that increase efficiency.

Single-payer systems address the issue of cost by forcing people in need of care to wait for weeks and months in some situations. In Canada, this problem has gotten so out of hand that their Supreme Court has declared that the health system’s waiting lists are unconstitutional. Access to a waiting list is not access to care.

The Canadian experience also illustrates the major of flaws of Sen. Kuehl’s proposal. While the Senator and other single-payer advocates claim that turning over health care to the state would save $20 billion, the facts don’t support it. Tax revenue would decrease, as the private health insurance industry would disappear overnight. To compensate, general taxes would need to be raised, and if the history of other government-run programs like Medicaid and the Canadian system means anything, health care spending will occupy an ever-increasing share of the state’s costs. Sen. Kuehl’s bill compounds this problem by trying to impose a single-payer system in one state, a change that would turn California into a magnet for critically ill people from the rest of the nation and beyond.

Placing the state in control of all medical matters in California presents political dangers, too. It was not so long ago that conservative Republicans controlled the legislature and the governorship. If a single-payer system becomes law, a conservative majority could prevent abortions or even life sustaining HIV medications from being covered by the state plan. Health care should be apolitical. A single-payer system assures it is primarily political.

The Healthy Solutions proposal provides a sensible and affordable approach to achieving universal coverage for all Californians.  It builds upon what works and reforms what needs to be changed.  While it encourages shared responsibility, it provides subsidies to those least able to afford coverage.  It encourages the expansion of employer based health insurance coverage and provides a sound approach to make it possible for individuals to purchase health insurance regardless of their health history. 

As a state, we need to have an honest dialogue about our health care priorities, how we’re going to pay for them and specific procedures we’re going to cover. In the meantime, proposals like Healthy Solutions aim to make the system fairer. Promises matter. And so does delivering on them. The state should only make those promises it is able to keep.

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Uninsured: Health Coverage Options Forum - A Resource of Information

Health Coverage Option
Presented by Phil Lehberz, Executive Director
Foundation for Health Coverage Education

Understanding California’s State Health Programs
Presented by Greg Clure, Director, Broker Sales
State Health Program Health Net of California

An Entrepreneur’s Guide to Cutting Health Insurance Costs
Six Quick and Easy Rules to follow to keep your costs down!
Presented by MD Sam Smith, CFP
Registered Administrator, State of California License No. 0596920
(323) 850-8811 mdsamsmith@genesisfinancial.biz

Rule #1 A Claim is a claim is a claim is a claim
Rule #2  Everything else is negotiable
Rule #3  Shop Brokers First, then health plans!
Rule #4  Have a Strategy
Rule #5 Monitor Your Results
Rule #6  Stay Ahead of the Curve
Disclaimer
Select Trade/Professional Associations

Rule #1 A Claim is a claim is a claim is a claim

There are no “deals” in health care or health insurance.  Don’t be misled by inexpensive or cheaper health insurance schemes. Health insurance is the means by which we finance approximately 50% of the health care in the United States.  At the end of the day, a given group of people with a given demographic in a given geographic area will have “X” amount of claims during the course of the year.  For example, according to the 2006 Milliman Medical Index (MMI) the average health care spending for a family of four is $13,382.  The Kaiser Family Foundation Employer Health Benefits survey reports that the average annual premium for health insurance is $12,155 (2005 premium adjusted +9.6% 2006 trend).  Though different plans do achieve various degrees of cost concessions through provider networks and contractual arrangements, most cost differentials between health insurance plans are driven by benefit reductions, limitations and cost transference.

The only way to effectively lower the cost of health care in this country is to improve the health of the American people. In 2006, health care spending in the United States will exceed $2 trillion and account for 15.9% of the gross domestic product (GDP).  This is up from $1.3 trillion and 13.3% of GDP in the year 2000.  Health insurance rates have gone up because health care costs have gone up.  Any strategy to reduce health insurance costs must clearly differentiate between insurance costs and health care costs.   Any long range plan to stabilize or lower health care costs must include an aggressive program to address lifestyle related health care costs.

The “Devil” is in the details. Remember what your father taught you, “If it looks to good to be true, it usually is!”  This is especially true in health insurance.  Beware of any plan that won’t provide an EOC (Evidence of Coverage) in advance.  Attractive brochures don’t explain health insurance coverage, contracts do.  Also, beware of any plan that has the word “Association” in it and is domiciled outside the State of California.  Californians have grown accustomed to the protections and guarantees afforded consumers by California laws.  Never assume the same protections apply to other plans.  This does not mean all association plans are bad.  California has a long list of legitimate association plans.  A partial reference guide is included at the end of this report or you can review them at:  www.healthcoverageguide.org.

Rule #2  Everything else is negotiable

Rates are negotiable. Rates for health insurance in the State of California are published and they are the same for every similar risk in a specific area, for a given age demographic, for a given plan, for a given carrier.  However, rates may deviate from the published rate by 10% above the standard rate and 10% below the standard rate.  That represents a 20% differential in rates and various underwriting rules and company guidelines affect these variances and they change constantly.  You must be able to rely on your consultant to achieve the best results for your company at the time you are negotiating your rates.

Benefits are negotiable. This may seem a bit obvious, but it is one of the trickiest of all.  Don’t buy what you don’t need and don’t expect what you don’t buy.  Simple benefit realignments can reduce overall premium costs by as much as 50%.  It is important to invest a significant amount of time and effort in determining what benefit levels are most appropriate for you and your employees.  Both the company’s budget and the employee’s family budget must be realistically considered when considering benefit levels.  Too much emphasis on premium savings could result in too much burden on the employees and their families and thereby defeating the purpose of an employee benefit program entirely.

Fees are negotiable. Nearly all plans have a built in fee or commission for the consultant, broker or marketing organization (association plans).  Ask your consultant or broker to disclose these fees in advance. Although the majority of broker/consultant compensation is usually determined as a percentage of premiums, there can be significant income generated through bonuses and expense allowance arrangements.  Insist your broker/consultant disclose all sources of compensation. Unless you bring it up, the “Don’t Ask, Don’t Tell” rule usually prevails.  How can you know if you are getting your money’s worth unless you know what you are paying? Many employers make the mistake of thinking that “if I go direct to the insurance carrier, I can save money”.  This is not the case.  The rates are the same and all you have accomplished is losing the ability to use your broker/consultant as a valuable resource for your business.  Try and get an insurance carrier to spend their marketing margin on your employer resource needs!

Services are negotiable. Once you have determined what you are paying in the form of commissions, fees and other compensation, you must be willing to negotiate how much will be invested on benefit related services that your company needs.  Don’t be shy about spending your broker’s money!

Rule #3  Shop Brokers First, then health plans!

Interview prospective brokers/consultants. Health insurance plans in the State of California are required by law (AB1672) to publish their rates and sell their plans to qualifying California businesses at +/-10% from those standard rates.  Each broker/consultant has access to the same carriers and the same rates.  Broker “A” gets the same rates as Broker “B” when they put your company “out to bid” (small group market 2-50 employees).  You can’t control the price, but you can control who you choose as your broker consultant.

Brokers/consultants can direct you to products offered by a wide range of companies.  This is in contrast to a health insurance agent who works with only one company and promotes that company’s products.  If you do not use a broker/consultant, you may choose to work with a separate agent from each company you want to consider.  If you have the time and the expertise to evaluate the proposals, it is an option.

The services of brokers and consultants vary as greatly as does their level of expertise.  It is wise to look for one that is active in their professional association (National Association of Health Underwriters) and in their business community (Chamber of Commerce).  Once you have found two or three good candidates, invite them to an interview at your place of business and ask them to bring their portfolio of services offered for you to review.  During the course of your interview, be sure to ask for references of other business they have worked within the area.

Some of the services you should expect from your broker are:

Benefit Strategy Planning Services

Bid Specifications Preparation and Analysis

Complete Market Survey and Analysis/Mid term and Renewal

Feasibility Studies including Alternate Funding Arrangements

Employee Communications and Enrollment Services

On Site Education, Wellness Programs, Health Fairs

Public Sector Plans Outreach and Coordination

Physician Plan Change Coordination

Claims and Risk Management Analysis

Advocacy and Assistance to Employees

Quality and Outcome Analysis Resources

Provider Network and Facility Comparisons

Compliance Audits for Local, State and Federal Requirements

    HIPPA, COBRA, Cal-COBRA, FMLA, GLBA, Cal-GLBA

    Women’s Health and Cancer Rights Act, Mental Health Parity Act

    notices and staff training

Summary Plan Description preparation and annual review

Summary of Material Modification preparation

Section 125 Plan Administration

COBRA and HIPPA Administration

It is important to also keep in mind that your Broker/Consultant will be interacting on a very personal basis with you and your staff during the course of the year.  Observe how well they interact with your staff as much as with yourself.  Make certain you have a clear understanding just what services the Broker/Consultant is going to provide during the course of the year.

Once you have decided on which broker/consultant you would like to work with, then you are ready to begin looking at plans.

Rule #4  Have a Strategy

Develop your strategy. The average premium per month for comprehensive health insurance in California last year was $335 for a single employee and $906 for a family (Kaiser Family Foundation Employee Health Benefits 2005).  In most cases both the employer and the employee share in the cost of their health insurance plan.  Employers typically pay from 50% to 80% of the cost of insurance.  Some plans will allow the employer to pay as little as 25% of the total cost of insurance.  Obviously, this participation percentage is an important key in determining the overall budget for employee benefits.  It is also important to keep in mind that insurance carriers require minimum participation levels to approve coverage (usually 70%).  Placing too high a burden for cost sharing on the employee will adversely affect your participation level and keep your plan from being approved.  Look to your broker/consultant for advice in the regard.

For many employers, it is unrealistic for them to shoulder the entire cost of health insurance premiums.  In fact, employee participation in the cost of their health insurance plan tends to develop a greater appreciation for and a feeling of ownership in their plan.

Strategies
Strategies for mitigating health insurance costs come in several forms and vary in both methodology and time horizon.

Cost sharing (re-allocation):  This method does not generally affect the basic benefit structure of the plan, but rather shifts a greater share of the burden from one party to the other.  Increasing the percentage of premium paid by the employee is an example of cost sharing.  Other examples would be:

1. Increasing copayments on physician office visits.

2. Hospital admission co-payments.

3. Outpatient surgery co-payments.

4. Prescription drug co-payments and tier deductibles.

5. Increase in deductible

6. Increase in out of pocket maximums.

All of these are examples of shifting cost from the plan to the employee.  The 2006 Milliman Medical Index Report showed that of the $13,382 in total medical spending for a family of four, the family would pay $2,210 of that amount out of its own pocket through cost sharing.

Cost reduction: This method involves the reduction of benefits, services, access or quality (or all of the above).  Elimination or restriction of benefits is becoming more and more common as employers look for more aggressive avenues to lower their costs.  Limitations (or elimination) of prescription benefits, limitation on the number of physician visits covered are two of the most common tactics.  Though these strategies are very effective at reducing insurance costs for the employer, they are cruel and harsh for the employees who need benefits most.

Risk Sharing: Where the employer or employees assume a greater share of the risk though higher deductibles and coinsurance levels.

Time Horizons
When considering strategies to reduce your costs you can employ any combination of three different time horizons depending on your objectives:

Immediate:  Cost shifting/sharing methods such as increasing the share of premiums paid by employees, increasing copayments for services and prescriptions and increasing deductibles and out of pocket maximums will result in immediate cost savings. Cost reduction methods such as eliminating or reducing pharmacy benefits, preventive care services, durable medical equipment will also yield immediate cost savings.  Elimination out of network benefits, reducing network facility access and network size will also achieve immediate results. When considering immediate cost reduction strategies, consider the impact each action will have on overall costs.  The best indicator of the effect a benefit action will have on overall costs is to consider its relationship as a component of overall health care spending.

Basic 5 Components of Health Care Spending in 2006 (Milliman):

1. Physician Costs – 36%

2. Inpatient Hospital Costs – 30%

3. Outpatient Costs – 16%

4. Pharmacy Costs – 14%

5. Other Costs – 4%

The greater the share of cost the component represents, the greater the impact a benefit reduction in that category will have on overall costs.

Intermediate:  These strategies are more complex and savings are achieved over a longer time horizon.  These include many of the now popular Consumer Directed Health Plans that employ high deductible health plans with a variety of health spending accounts such as:

1. Health Savings Accounts

2. Health Reimbursement Arrangements

3. Flexible Spending Accounts

4. Self Directed Health Plans

The overall savings on these accounts occurs over a longer period of time as the health care consumer takes on greater responsibility and control of their own health care expenditures.  Though the jury is still out on the long term affects of these plans, a recent three year study (2003, 2004,2005, reported July 2006) by United Health Group of 40,000 individuals in HRA plans as compared to 15,000 individuals enrolled in traditional PPO plans, some of the notable findings include:

1. Preventive Care: In each of the three years, up to 5 percent more of the CDHP members sought preventive care than did their PPO counterparts.

2. Acute Care: Individuals enrolled in a CDHP showed an annual reduction in the use of acute care services (22 percent fewer hospital admissions and 14 percent fewer emergency room visits) without adverse health effects or outcomes.  The relative utilization of these services actually increases year-over-year among the PPO members.

3. Chronically ill: CDHP enrollees with a chronic illness also used acute services less (8 percent fewer hospital admissions and 12 percent fewer emergency room visits) but continued to visit their primary care physician at the same rate as chronically ill members enrolled in traditional PPO plans.

4. Overall Costs: Costs per CDHP member decreased by 3 percent to 5 percent in the CDHP plan over the 2004-2005 periods as compared to their 2003 baseline level.  PPO participants during the same period increased 8 percent and 10 percent during those years.

While not conclusive, these preliminary findings support the idea that consumers, when given more control of their health care decision making, will make good choices when pursuing optimum care.

Long Term: These costs saving strategies affect overall health care costs over a longer period of time and require consistent effort and communication.  These would include weight control programs, smoking cessation programs, on going wellness programs, exercise gym benefits and the like.

Over time, effective use of these strategies will dramatically affect the cost of health care.  For example:

1. An employee who smokes consumes, on the average, $400 more per year in health care resources than an employee who doesn’t smoke. 

2. An employee who leads a sedentary lifestyle will use $500 more per year in health care resources. 

3. Obese employees have 75% higher median annual health care expenses than employees who are of average weight.

When considering plan options and selecting benefits, work with your broker/consultant to use all of the available strategies and consider options from each of the time horizons.  The more components you consider and use, the more effective you will be in controlling costs.

Purchasing Alliances. Another strategy in controlling costs puts more of the choice (and therefore the burden of choice) on the shoulders of the employees.  In this scenario, the employer decides his contribution level, in dollar amount or percentage of premium, and gives the employee a wide array of benefit plans to choose from.  This approach is available to the smallest employer as well as the larger firms.  This is possible through “purchasing alliances” through which an employee is given the opportunity to select several different plan designs from several different carriers.  The employer fixes his contribution amount and the employee chooses the plan based on their individual needs and wants.  The richer the benefit package they choose, the higher their contribution.  Individual carriers now also offer this approach with their “pick-a-plan” benefits packages.

Rule #5 Monitor Your Results

Listen to your employees. During the course of the year, keep an ear to the ground and a close eye on your employee family.  When an employee or dependent complains about benefits or care, make a note and remember to discuss this with your broker/consultant during your next meeting. Don’t “stockpile” problems!  Talk to your broker/consultant often about how things are going.  Report your problems and concerns before they become a crisis.  Always remember they call them “employee benefits” for a reason.  When that ceases to be the case, take action now!  Don’t wait for your renewal to address a problem.

Listen to your Broker/Consultant. Insist your broker keep you informed of the legislative and regulatory landscape.  Know what’s coming around the bend!  If your broker/consultant is not communicating this information to you on a regular basis, get a new broker.

Listen to the Market. Know where your carrier stands in the current market cycle.  If you engaged your carrier at the bottom of an underwriting cycle, be ready to ride the wave to the next rate increase and act accordingly.  What looks like a great “deal” today may very well be the bottom of a rating cycle when you climb on board and a 30% rate increase at the next renewal!  Have long range vision when choosing carriers.  Short sighted choices today may prove to be costly in time, money and morale tomorrow.

Rule #6  Stay Ahead of the Curve

Mid Term Analysis: Know where your carrier stands relative to the market by insisting your broker/consultant give you a mid year market analysis.  This report will show where your plan stands in comparison to similar plans in the market.  If you came on board with your carrier at the bottom of an underwriting curve, it is better to know in advance so you can begin to think about the changes you may want to make.

Annual Renewal Analysis: Have your broker/consultant begin your renewal evaluation at no less than 90 days in advance of your renewal.  Even though your carrier won’t issue your renewal until usually 45 days before your anniversary, have your broker deliver your comparative analysis well in advance (90 days).  This should prevent you from having any surprises at renewal and give you plenty of time to make any changes you need to and to communicate them to your employees and their families.

Keep your Broker/Consultant current: Your relationship with your broker/consultant is an important one.  You should always be able to depend on them to be an important member of your management team.  If you are ever in doubt, have another round of interviews!

In summary, for any plan to be effective, you have to execute the plan.  The suggestions in this report are general suggestions that will go a long way towards helping you keep a close eye on your health insurance costs.  Just as every employer is different, so is every broker/consultant.  They will all have a different twist to how they handle your business.  These guidelines, however, will give you some very real guideposts on how to evaluate brokers and the services they provide.

Disclaimer: The information contained in this report is comprised of the personal observations and opinions of the author and are in no way intended to reflect or to be construed to be the opinions or recommendations of the Hollywood Chamber of Commerce or the Health Care Committee.

Some important websites to visit:

to find an agent: www.CAHU.org

to compare health plans: www.HealthCoverageGuide.org

to investigate prescription costs: www.MyFloridaRx.com

Medicare Part D prescription costs: www.gateway.destinationrx.com

to learn more about health care costs: www.milliman.com

to learn more about health care in general:
www.chf.org

www.healthaffairs.org

www.healthpolicy.ucla.edu

www.healthcare.pwc.com

www.coverageforall.org

to learn more about state sponsored programs: www.healthyfamilies.ca.gov/hfhome.asp

The author gratefully acknowledges these sites for their contribution to the content of this report.

Select Trade/Professional Associations

American Booksellers Association. Founded in 1900, ABA is a not-for-profit organization devoted to meeting the need of its members of independently owned bookstores nationwide. (800.637.0037) www.bookweb.org

American Electronics Association (AeA). The nation’s largest high-tech trade association, AeA represents more than 3,000 companies with 1.8 million employees. (800.284.4232) www.aeanet.org

American Institute of Graphic Arts (AIGA). Supports more than 15,000 design professionals through more than 40 local chapters and 80 student groups nationwide. AIGA offers access to health insurance options to members in many states, including California. Call TEIGIT, AIGA’s insurance provider, at 800.886.7504. Dental plans are also available. www.teigit.com

Artists’ Health Insurance Resource Center. Sponsored by the Manhattan-based Actors’ Fund of America, this site describes health insurance coverage choices and regulations in every state and provides links to artists’ groups offering health insurance plans as well as other public and private health care resources. www.actorsfund.org/ahirc/

Bar Association of San Francisco. Founded in 1872, this group represents more than 9,900 prospective, current, and retired lawyers in the San Francisco Bay Area. (415.982.1600 or 800.862.4243) www.sfbar.org

California Asian Restaurant Association/AIS. This non-profit organization, located in the San Francisco Bay Area is a broker able to provide small and mid-sized businesses as well as agents and brokers the services and benefits afforded larger businesses at competitive prices. (510.893.5331 or 800.788.6524) www.ais-insurance.com/cara1.html

California Association for Health Services at Home (CAHSAH). Represents more than 500 members that are direct providers of health and supportive services and products in the home. (916.641.5795) www.cahsah.org

California Association of Mortgage Brokers (CAMB). Represents more than 1,800 mortgage brokers and affiliated service providers across California. The association provides education, legislative and regulatory representation, and public relations for its membership and the mortgage industry, while serving as a forum for the development of common business interests. (916.448.8236) www.cambweb.org

California Association of Realtors (CAR). A trade association representing more than 105,000 realtors statewide. (213.739.8265) www.car.org

California Building Industry Association (CBIA). This is a statewide trade association representing nearly 6,000 businesses – homebuilders, remodelers, subcontractors, architects, engineers, designers, and other industry professionals. (916.443.7933 ext.336) www.cbia.org

California Grain and Feed Association (CGFA). A nonprofit agricultural trade association, which has served the grain and feed industry since 1924. (916.441.2272) www.cgfa.org

California Grocers Association. Represents more than 500 retail members operating more than 6,000 food stores in California and Nevada, and approximately 300 grocery supplier companies. (916.448.3545) www.cagrocers.com

California Hotel & Lodging Association. With more than 1,550 members representing more than 182,000 guestrooms, this is the largest and most influential state lodging trade association in the world. (916.444.5780 or ASAIB-800.420.4678) www.asaib.com

California Medical Association (CMA). This group represents more than 34,000 physicians and is dedicated to promoting and protecting the science and art of medicine, the care and well being of patients, and to improving access to health care for all Californians. (888.233.2937) www.cmanet.org

California Restaurant Association. This is the oldest restaurant trade association in the United States representing more than 20,000 foodservice businesses statewide. (800.765.4842) www.calrest.org

CAN Insurance Services (CIS). This wholly owned subsidiary of the California Association of Nonprofits has provided insurance and employee benefit solutions and resources to California nonprofits for more than 20 years. Their mission is to provide quality insurance products, excellent customer service, and insurance education to the California nonprofit sector. (888.427.5222) www.caninsurance.com

Graphics Artists Guild. A national union of illustrators, designers, Web creators, production artists, surface designers, writers, editors, multimedia, broadcast, marketing, and other creatives. www.gag.org/benefits/insur.php

National Small Business United (NSBU). This is a volunteer-directed association, the primary mission of which is to advocate state and federal policies, which are beneficial to small business, the state, and the nation; and to promote the growth of free enterprise. (NSBA: 800.345.6728 or Mutual of Omaha: 800.223.6927) http://www.mutualofomaha.com/nsba/

National Writer’s Union (NWU). Represents more than 6,500 members in 17 local chapters nationwide. NWU is the trade union for freelance writers of all genres who work for American publishers or employers. www.unionwriters.org

Painting & Decorating Contractors Association/California Council. Represents anyone with a C-33 license; covers anyone who’s applying coating to a surface. "Painter’s Advantage" (888.812.7322) http://www.pdca.org/ccpdca/main.htm

Printing Industries Association of Southern California (PIASC). This is the trade association for the graphic arts community in Southern California. It was founded in 1935 and today is the largest graphic arts trade association in the nation. (323.728.9500 ext. 242) www.piasc.org

Printing Industries of Northern California (PINC). A nonprofit trade association that serves several industry segments in Northern California, primarily the print production and print buying segments. (800.659.3363) www.pinc.org

Western Growers Association (WGA). Founded in 1926 to provide growers of fresh produce in California and Arizona with support programs that could not be generated by any single grower alone. (949.863.1000 or 800.333.4WGA) www.wga.com