‘The insured and the unsure:’ What will businesses do?


I clicked on an Economist story on the future of employer-sponsored health insurance  to get a sense of what picture it was painting for its largely overseas but U.S.-savvy,  business-oriented audience.  It turned out to be a very good overview.

I thought it may have been a tad heavy on the “lots of small- to midsize-employers will drop coverage” angle but not excessively so. It would have been nice to note that they’ve been dropping coverage for years, one reason that the health law was enacted. But it is fair to worry about how employers will react and how employees will fare under the Affordable Care Act and the article lays out a lot of related issues clearly. (I didn’t see a byline on the online version – so kudos whoever you are.)

Unlike some articles and commentary I’ve seen in the U.S. press, when this piece noted that premiums may go up, it also noted:

  1. they’ve been going up long before Health Policy and
  2. low-wage and middle-income workers will get subsidized, so the sticker price isn’t the same as what they will actually pay.

It drives me crazy that the subsidies are so often neglected. Not everyone will get one, and there will be winners and losers, but a lot of the reporting and the dialogue around it forgets those subsidies altogether.

Anyhow, for those of you who know a lot about the coverage expansion, and the employer angles, the article may not be that helpful (though I loved the subhead: “The insured and the unsure.”) You may still want to give it a quick skim. For those of you who want a one-stop shopping overview of these aspects of the law and the coming changes, the story covers a lot of ground:

  • Obama’s promises that you can “keep your insurance:” We can’t all do that now and we won’t all do that in 2014. Or, as the Economist wrote, it’s a bit like saying, “If you like your husband, I promise he won’t divorce you.” Be sure to pay attention to the graphic that accompanies the article, labeled “If you like your health plan, tough.”
  • Different market analysts have come up with different estimates of how many employers will drop coverage. It mentions the McKinsey estimate but notes the controversy about its high estimates.
  • Employer-sponsored coverage is usually a better deal than buying an individual policy – and the Affordable Care Act will address the problems with the individual market.
  • It cites the rationale for more “skin in the game” as a disincentive for overuse and unnecessarily care (although it doesn’t mention is may be a disincentive for necessary care too).
  • It touched on the new development of “private exchanges” – Sears and Darden (the restaurant company) are starting to give workers a “defined contribution” (AKA voucher, subsidy, allowance, assistance… depending on your point of view) that will cover a portion of their premium –and the worker choose the health plan from a menu of options in the “private exchange.”

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