Last week, I read an article on the internet site Newsbreak concerning the upcoming healthcare premiums for employees of Madison County, Virginia. This caught my eye since I am a resident of Madison County.

The article indicated that the County is facing a 16.7% increase in premiums over the past year. Currently, the County contributes 89% toward the cost of coverage for a single individual, 71% for dual coverage, and 68% for family coverage under its most expensive plan—the KeyCare Advantage 500 plan with comprehensive dental coverage. The new monthly premiums amount to $1,049 for a single individual and $2,832 for a family.

This stood out to me because, 30 years ago, we provided healthcare coverage for all of our employees at our family farm, and the cost averaged approximately $95 per month per employee. Is it any wonder that small businesses today find it difficult to provide healthcare as a benefit to their employees?

I decided to do some research, and I must admit that what I found confirmed my belief that neither this Administration nor Congress truly understands what is happening in healthcare today. They certainly have no effective plan to control healthcare expenses in our economy.

In my research, I reviewed materials published by the Kaiser Family Foundation, as well as studies conducted by the Human Resources Management organization. On average, employers pay approximately 84% of the cost of coverage for a single individual and 75% for family coverage.

In 2025, the annual cost of a healthcare plan averaged approximately $9,325 for a single individual and $26,993 for a family. Obviously, these figures vary based on geographic location and other factors.

The research indicated that in 2025, nearly all organizations with more than 1,000 employees provided healthcare coverage as an employee benefit. However, only approximately 51% of businesses with 10 to 24 employees offered healthcare benefits. This percentage has continued to decline in recent years as costs have increased.

This trend has certainly contributed to increased enrollment in Affordable Care Act health plans. Even these plans are becoming unaffordable, as deductibles before coverage begins have increased significantly. In some cases, deductibles exceed $10,000.

I then decided to model the financial impact of healthcare costs on both small and large businesses. To do this, I reviewed average sales per employee and average net income across various industries.

I found that average revenue per employee in manufacturing, healthcare, and professional services ranges from $150,000 to $250,000. Retail and the leisure and hospitality industries average between $100,000 and $150,000 per employee. The technology and software industries average $200,000 to well over $1 million per employee.

For my analysis, I used $250,000 as revenue per employee and modeled two organizations—one with 100 employees and another with 500 employees. I assumed a 21% income tax rate and a 10% net income margin. Net income represents revenue remaining after deducting all expenses, including operating costs, interest, and taxes. Naturally, net income varies significantly by industry.

The blog Wisesheets has analyzed net income across many industries and reports a mean net income margin of approximately 13.7%.

Using these assumptions, the following illustrates the results for a 100-employee organization and a 500-employee organization:

100 Employees

• Revenue: $25,000,000
• Operating Costs: $21,835,443
• Pre-Tax Income: $3,614,557
• Income Tax: $664,557
• Net Income: $2,500,000

500 Employees

• Revenue: $125,000,000
• Operating Costs: $109,177,215
• Pre-Tax Income: $15,822,785
• Income Tax: $3,322,785
• Net Income: $12,500,000

For healthcare costs, I assumed that 75% of employees at the 100-employee firm would enroll, with 30% selecting single coverage (30 employees) and 45% selecting family coverage (45 employees). I applied the same percentages to the 500-employee organization—150 employees with single coverage and 225 with family coverage.

For healthcare expenses, I used an annual cost of $13,200 for single coverage, with the company contributing 80%, and $25,650 for family coverage, with the company contributing 75%.

The annual employer portion of healthcare costs—reflected in operating expenses—amounts to $1,471,050 for the 100-employee organization and $7,335,250 for the 500-employee organization. This represents approximately 6.74% of total operating costs.

For organizations that do not achieve at least a 10% net income margin, healthcare costs represent an even greater percentage of operating expenses.

It is clear that small businesses with fewer than 100 employees continue to struggle to provide healthcare as an employee benefit.

Where does this end? Healthcare costs continue to escalate, and it appears that little is being done to control them. The ripple effect will be that healthcare providers will increasingly struggle to deliver necessary care because fewer people will be able to afford it.

I am not smart enough to propose specific solutions. However, I do know that serious discussions must take place among insurers, providers, Congress, and consumers regarding the future of our healthcare system. We cannot continue to sweep this issue under the rug. Positive action must begin now.

Jess Sweely
Madison, VA
March 2, 2026