The only difference between self-insured companies and companies that buy insurance is who is bearing the risk. Self-insured companies are bearing the risk of employee high health costs, because they’re paying their employees’ doctors bills. To be sure, they (unless they are idiots) reinsure against very high claims, but they can still end up having to pay large amounts if an unexpectedly large number of employees have health claims. Or they can end up very little out of pocket if all employees are healthy.
In related news, just it case this comes up again, no, employee wellness programs do not save money on health care costs. It would be nice if wellness programs incentivized healthier behavior, and thus reduced health costs, but it turns out that doesn’t happen. This has been studied.
@JHS - I’m not nearly as well-versed on insuring small businesses as I need to be. H and I are in that danger category you noted - self-employed, age 56. We are in the process of scaling our business and will most likely add employees next year. I thought that would put us in the safe zone because we could now purchase a small group plan (at high cost, of course, but a group plan nonetheless.) What exactly do you mean when you said it looks like your 60-person organization can’t get an employer plan next year? Why is that, and what are the ramifications to the employees and the business? Appreciate any insights you have, so I can start my quest to be more knowledgeable now that the potential impacts of policy changes could be devastating if one is not paying attention.
@Embracethemess I’m not responsible for getting my firm’s health insurance, and I don’t use it anyway (I get health insurance through my wife’s employer), so I am not well versed in the details. But I know as of now no company we or our broker has approached is willing to give us a group policy, or willing to write one at anything like a rate that would be competitive with the ACA pool. So it looks like when our current policy expires, our broker will help us person-by-person buy ACA policies.
My understanding is that we don’t have enough people on the health insurance to form a diverse risk pool on our own, and we are relatively heavy on 60+ men and women over 30 having children (or their spouses). But fundamentally, the problem is that the insurers are getting out of the business of supplying insurance for companies this small.
60+ men and women over 30 having children? It’s not that insurers are getting out of the business of writing insurance policies for terrible risk pools. It’s that insuring a terrible risk pool costs a lot of money, and the insurers know you won’t buy from them because ACA is going to be cheaper.
@Embracethemess If you want to provide employee coverage, I would start looking at two areas. The ACAs SHOP marketplace. They will give you some ACA type plans. You can check out healtcare.gov for details.
The other would be association plans. They just finished the rules and you might have a business association you’re familiar with offer a plan. I know our state manufacturing association is looking to put something together.
Thank you, that’s helpful. Not comforting, but helpful. I will schedule an appointment with a broker to become better educated about where we go from here.
Well…we heard that BC/BS is considering re-entering the individual market in a bunch of counties in Georgia for 2019. We are so hoping DD will have that as a choice in her County for 2019.
"Yourmomma: It’s interesting. Most of you are talking about catastrophic events – the heart attack, cancer, etc. Life changing events that you’re fearful about. And that’s what true “insurance” is for. Yet today’s “health insurance” is bogged down with mandates, requirements, and “freebies” which helps drive the costs up. It’s the old $30 copay mentality. Seems to me our thinking on healthcare/insurance needs to change. But we can’t have a real conversation about changes because people freak out.
For example, what would happen if we did away with employer provided coverage? It makes zero sense to tie healthcare to your job when we have such a fluid working situation. People change jobs, freelance, start business, etc. all in a lifetime. But suggest it, and people freak out."
You are right about the “freebies”. But we would do better to pay for that annual exam for $100 or whatever and then have lower insurance costs. These pay for a lot of things that people should cover themselves, like birth control. Buy your own birth control. The flu shot is nearly useless, but it appears to be free. That’s millions every year right there.
Doing away with employer provided coverage would cutting a huge chunk of salary, since that is a lure for employees. For most families, it is tens of thousands of dollars that the employer covers, and the the employee covers tens of thousands more. Americans are just getting screwed on health care costs. Something has to be done.
I regret to say you’re zero for two here. Annual exams have not been shown to decrease costs or increase health. Flu shots, on the other hand, are one of the public health interventions that pay for themselves.
“Flu shots, on the other hand, are one of the public health interventions that pay for themselves.”
Also true, several times over, of prescription birth control. Check out recent experiments on the public health effects of free prescription birth control in Colorado and Delaware.
Free long-acting birth control is fantastic. Many women and girls are not good at remembering to take birth control pills every day, but they can’t afford the up-front cost of an implant or an IUD. Unwanted pregnancies cost a lot of money as well as being terrible for the girl or woman who is pregnant and doesn’t want to be.
Nothing could be further from the truth. Especially if you or anyone you live with or come into contact with has heart disease, obesity, diabetes, lung disease (including asthma), or any other chronic condition. Unfortunately, the vast majority of the public does not know how to interpret the “effectiveness” rate. The short version: The more people who get a shot that is, say, 30% effective or 10% effective, or whatever it is, the less influenza will spread in the community. It works logarithmically.
@thumper1 – BCBS dropped individual plans for my county in GA last year and we were forced into Kaiser HMO at almost double the rate. I thought I could keep our existing doctor and plan???
MODERATOR’S NOTE:
Subtle snark and/or passive/aggressive comments don’t do a lot for me. If one wants to make a comment, please make one that does not require one to read one’s mind. Since I also did not “get” the birth control/unwanted pregnancy comment, I deleted it and the accompanying responses.
Actually, it is, so I deleted the post and the 6 responses that served only to hijack and then debate.
Additionally, IIRC (but I’m not planning to look), we had a whole thread a while ago about the need/wisdom of flu shots, so there is no need to revisit.
^^^ This is good, but the fact that they were abruptly suspended at all will have its destabilizing effect on the insurers, which know that they can’t count on the administration to fulfill its obligations. A lot of the damage has been done.
Really sad that one more reason not to count on subsidies has made insurers more skittish and given them more reasons to raise rates and keep them high, to the detriment of the public. Really sad that personal agendas wreck so much havoc on folks’ options.