Business Savior – Self Insurance & Shifting Sick Workers To Exchanges

If those healthier individuals are outnumbered by an influx of relatively sicker enrollees, the risk pools will be unbalanced. Exchange risk pools must be broad enough to balance out the proportionally higher medical costs of the sicker and older individuals who were likely among the first to sign up.

No provisions to prevent employers from shifting sicker employees to the individual exchanges were written into the Affordable Care Act. “It’s almost like they forgot to include that clause on the exchange side of the equation,” Barlament told Bloomberg.  However, a spokesperson for the Centers for Medicare and Medicaid Services, the agency responsible for the operation of the exchanges, told the publication that an existing law  – the Employee Retirement Income Security Act — does govern employer health care and pension benefits.

That statute prevents an employer from discriminating between workers in offering health benefits, but it does not bar the company and the employee from making agreements in which the worker voluntarily declines coverage in return for a stipend to purchase coverage through an exchange. Of course, the company would have to offer the employee an incentive for declining the company coverage, not force that person to leave.