Nationwide, the proportion of companies offering health insurance fell from 68 percent in 2001 to 63 percent this year, the Kaiser Family Foundation said. That pattern will continue, Moquist predicts. Next year, Raven's share of health insurance premiums is expected to jump from $3 million to $3.6 million. "At that rate of increase, we will see it double in five years and double again in 10," he said. "With those kind of increases, all of us will bail out."
Although the trend in the corporate world is to drop coverage, Raven Industries has moved in the opposite direction, immersing itself in efforts to provide more affordable care. The result has been upheaval and uncertainty.
Some workers, such as Illa Biteler, 65, have put off retirement. She cannot afford health care without Raven's insurance and paycheck. Others, such as Cheryl Scholl, were forced to change doctors when Raven switched plans within the past few years. And when Darnel Cuperus delivers her third child next month, it will not be in the familiar surroundings of Avera McKennen Hospital, said her husband, Don Cuperus. Raven's insurer, Sioux Valley, provides newborn care only at Sioux Valley Hospital.
Yet the disruptions are minor compared with the frustration Don Cuperus feels when the talk turns to cost. Workers here paid a total of $903,000 in premiums over the past year and expect to pay $975,000 next year. "On the one hand, the company says [premiums] only went up 8 percent," said Cuperus, an engineering manager. "Yeah, right, if you don't use it. But then add in the deductible and copayments. It's probably fair to charge people who use it more, but it's definitely misleading."
Like his workers, Moquist is frustrated -- by government, by providers and even employees, who seem to expect stellar care at no cost. He gets irritated when hospitals and physicians claim to be efficient.
"They haven't even scratched the surface," said Moquist, who took over Raven in 2000. "They have no electronic files, no standard protocols, no evidence-based medicine. There are huge costs that can be rung out of providers."
It is ridiculous, he said, that "I know more about the rollover characteristics of a Korean SUV than the outcomes of heart surgery at the local hospital."
But what most infuriates Moquist -- and virtually everyone else here -- are drug prices. Without prompting, employees rail against drug companies that often charge Americans double the Canadian price.
"I'm very mad at the pharmaceutical industry," Moquist said, acknowledging that he is at odds with friends in the Republican Party and the National Association of Manufacturers.
Moquist understands the industry's need to invest in research and development. All he wants is for U.S. consumers to be given the same low prices the drug companies have negotiated with other countries. "Let's not play the fool here," he said.
Del Jerke could not agree more. At age 60, two years after suffering a stroke, Jerke spends about $120 on medications every three months. "All that money for a little aspirin or something? It's outrageous," said Jerke, a large man in shorts and sneakers who delivers parts to several Raven plants in the area. "The drug companies don't need it."
Like many companies, Raven has begun shifting more costs to employees, raising copayments and imposing, for the first time, deductibles of $500 for individual and $1,000 for family coverage. The decision was in part about money -- but also, more significantly, it was aimed at what Moquist describes as a long-term change in employee behavior.
"We want healthy employees because they are productive employees," he said. At the same time, "we need to get employees to take ownership of these issues. When people are in control of their dollars, they spend wisely."
But the concept is not so simple when a nervous parent is dealing with a sick child.
