Is there a future for employer based health insurance?
This is not a rhetorical question.
This is not an anxious question from an employee benefits professional.
This is not wishful thinking by a single payer advocate.
In the Call to Action by the Senate Finance Committee, Chairman Senator Max Baucus (D-MT) calls for “Strengthening the Employer-based system. We must ensure the continued viability of the employer-based system – the principal source of health coverage for most Americans.”
Fine words. But the weak point in the statement is the phrase “continued viability”. It is fair to ask whether the current system is viable and whether it can continue.
Both the percentage and the number of people covered by employer provided health insurance and the percentage of firms offering health insurance has declined over the last two decades.
There are fundamental contradictions in the commitment of conservatives and employer groups to employer based health care plan. And the two are not entirely in sync.
Conservatives for ideological reasons cling to things “private” and abhor government intervention, even when it makes markets work better.
Employers are a bit more practical in their approach. But for the most part don’t seem able to see their way out of the box they are in. They may have an ideological aversion to government action, or they may just not be willing to give up their current way of doing things.
But some employers are willing to question the current system. Jonathan Weber, CEO of New West, challenges the assumption that employers should have a responsibility to pay for the health care of their employees.
Why is this my responsibility?
Quality health care is a societal good, so why should it be the obligation of private-sector entities to provide it?
A recent Reuters article by Andy Sullivan describes how “job lock” inhibits entrepreneurs, an argument also made here. He quotes Todd Stottlemeyer, former CEO of the National Federation of Independent Businesses (NFIB).
“There are lots of factors that go into why somebody starts a business or doesn’t start a business: Do I have a good idea, do I have capital, do I have risk tolerance?,” said Stottlemeyer, now an executive at a hospital chain. “Being able to get health insurance … should not be one of those determinant factors.”
But even if they acknowledge the box they find themselves in, employers are schizophrenic about their way out of the box. Few employers would go as far as Jonathan Weber.
A 2007 article in USA Today by Julie Appleby observed discussions in Congress at that time to de-couple health insurance from employment.
The measures can be lumped into differing philosophies about the direction the USA should move: either toward a health insurance market in which people buy policies on their own while armed with tax credits or deductions, or one in which people are able to buy insurance through group-like “exchanges,” with some government oversight. Some of the plans likely would encourage employers to drop coverage because the employers would lose all or part of their ability to write off insurance as a business expense.
Noticeably absent is a public plan alternative, either the single payer proposal or the public plan option.
Employers also speak by their actions. Two very clear trends indicate what employers really think about their obligation to provide for the health care of their employees. The first is cost shifting to employees in the form of increased out of pocket expenses at point of service and increased deductions from pay for health care premiums.
The second trend is toward something resembling a defined contribution approach to health care financing. This is characterized by High Deductible Health Plans and Health Savings Account, a favorite concept of conservatives in the last administration. The theory behind the practice is that by giving employees cash instead of benefits, they will become wiser shoppers for health care services and thus help to constrain health cost inflation.
What is the conclusion?
Employers don’t want the responsibility for the health care of their employees. They occasionally admit this. They will concede that it is not good for small and new businesses. Their practices clearly tell the true tale.
They just won’t admit it. The just can’t get past old practices and ideological constraints.
But employers need to let go. Health care needs to be de-coupled from employment.
Julie Appleby quotes Sara Horowitz, founder and director of the Freelancers Union whose members are independent workers in finance, non-profits, domestic services, publishing, advertising and health care – says something needs to change, because the working world has.
“The nature of work is changing: Jobs are much more short-term and flexible,” Horowitz says.
Employers need to catch up. Maybe Congress will catch on.