By Bill Rusteberg
There exists among almost every group health insurance plan a Fifth Column, a small group of insiders whose quiet activities work against the principal of the greatest good for the greatest number.
High-cost family coverage that no one can afford attracts higher need family members, especially spouses. Healthier spouses often decline coverage causing the dependent pool to be skewed towards higher utilizers.
Chronic conditions including diabetes, cardiac conditions, cancer history and high cost specialty drugs draw high need dependents to the group’s “pool of last resort.”
This cancerous pool of high utilizers drives up cost for the entire group.
With health care financing at a tipping point in this country, plan sponsors whose financial backs are against the wall, are open to new ideas like never before. This mindset has been made easier by the growing realization that no likes their health insurance anymore. It doesn’t matter if a plan makes a change that no one likes because no one liked the plan before the change was made. So what’s the difference?
A change a plan sponsor might consider is to purposely structure a plan member’s family payroll deduction premium to levels that do not meet federal affordability rules. That is not hard to do since we suspect 90% or more of plan sponsored health plans already fail to meet federal affordability rules. If your curious what the government thinks about your group health plan go here to find out.
By purposely ensuring unaffordability plan sponsors would be doing families a favor since they would then become eligible for free or discounted health insurance through the ACA Marketplace. In most instances coverage through the Marketplace can be similar or even better than the group plan through their employer.
This commonsense solution is just one of many to consider. It’s all about pragmatism and thinking outside the box.
This is a Half Pregnant Idea! Why bother doing this when all a plan sponsor has to do is replace their old status quo plan of yesteryear with an ICHRA offering?
