Thanksgiving is my favorite holiday, and I enjoy Christmas because I refuse to let it take over my life. But there is one thing that ramps up the stress at this time of year: health insurance decision-making.
I’ve been on my company’s benefits committee for most of the past 20 years. Most of what we do is decide whether to stay with the same health insurance provider for another year — which sounds so simple, but I suspect Arkansas Business readers know that it is anything but.
This is an Opinion
Last week, Publisher Mitch Bettis and I were going over competing insurance proposals from Arkansas Blue Cross & Blue Shield, QualChoice and UnitedHealthcare. Arkansas Business Publishing Group has for several years allowed employees to choose between low and high-deductibles, which adds to the difficulty factor. Plus, some only need coverage for themselves, while others need to cover a spouse and/or children.
Immodestly speaking, I’m pretty smart and I’m way above average in understanding how insurance works. Still, I was getting tongue-tangled talking about premiums, per-person deductibles (embedded and non-embedded), out-of-pocket maximums, and whether copayments for four different tiers of prescription drugs applied to the deductibles or just to the out-of-pocket maximums.
One proposal would cost everyone a bit more than they have been paying; one proposal would cost some people less and others more. Another proposal would save on premiums but increase the maximum risk for one group — while making it less likely that members of that group would actually reach the out-of-pocket maximum.
Minutes later, with my head still spinning, my 29-year-old son called for advice on a flexible spending account. Except he first called it a health savings account, which is a different animal, so we ended up having to go through the decision-making process all over again. My younger son’s employer has been sold to a giant national company, so he and I walked through his new choices a few weeks ago, both of us glazing over.
Health insurance is crazy complicated. How many of your employees truly understand one of their biggest expenses?
It’s also crazy expensive. The Kaiser Family Foundation reported in September that the average cost for employer-sponsored family coverage nationally has reached $20,576, almost $10 for every hour a full-time employee works in a year. The average for an individual employee is $7,188, almost $3.50 an hour. How those costs are shared by the employee and employer varies widely, but money spent on health insurance premiums cannot be spent on anything else. And that doesn’t include the deductibles and copays.
Since I’m not ideological about these things, the idea of “Medicare for All” doesn’t offend me any more than Medicare for seniors. I don’t buy the idea that private insurance is more beloved than single-payer government coverage would be, especially if Americans never again had to wonder if or how they would access insurance. But politically, I think it’s a nonstarter.
I remain intrigued by the universal catastrophic coverage idea, but it doesn’t seem to be getting any traction. Ed Dolan, a health care analyst for the traditionally libertarian Niskanen Center think tank and a UCC proponent, has written positively about the Fair Care Act introduced by U.S. Rep. Bruce Westerman, R-Ark.
“The Fair Care Act is much more than another repeal-and-replace effort,” Dolan wrote last month. “It would retain, but reform, all of the major building blocks of current health care policy: the [Affordable Care Act], Medicare, Medicaid, and employer-sponsored health insurance” — although no employers would be required to offer insurance.
I would prefer to decouple health insurance from employment altogether — I’m tired of making these annual decisions for my co-workers — but only if an affordable alternative was guaranteed.
Westerman’s bill “retains but modifies the ACA’s approach of making coverage in the individual market affordable through income-based premium assistance and cost-sharing reductions,” Dolan wrote. That’s a striking acknowledgement that Obamacare was right about the necessity of government subsidizing private health insurance for vast numbers of Americans.
If employers opt out of sharing the cost, as the Fair Care Act would allow, the number of Americans accessing those subsidies could balloon. It sounds to me like a no man’s land, in which Americans have no guaranteed coverage, public or private, but a lot of the heavy lifting will still fall on the government. Another complicated patchwork with cracks for sick people to fall through, all because a simpler, universal system of government insurance is political poison.
Email Gwen Moritz, editor of Arkansas Business, at GMoritz@ABPG.com and follow her on Twitter at @gwenmoritz.