Health insurance is not tied to employment status. Anyone can go to healthcare.gov and buy an equivalent BCBS or Kaiser or whatever gold/silver/bronze insurance. Unless you are in a particularly shitty state.
What employers do have is the ability to sell you health insurance with pre tax dollars, which is also available to self employed individuals. But the people who are screwed are those who are employed by employers that do not offer health insurance. They have to buy insurance with post tax dollars.
There is similar bullshit with retirement funding, where employer sponsored retirement account limits are drastically more than individual ones (401k vs IRA), and especially if you are a married couple with 1 spouse with 401k access and one spouse without.
>Health insurance is not tied to employment status. Anyone can go to healthcare.gov and buy an equivalent BCBS or Kaiser or whatever gold/silver/bronze insurance. Unless you are in a particularly shitty state.
Out of curiosity, I went and looked up the plans in NJ for a 32 year old person(56k salary). This is someone in a lower risk pool. The bronze plans are in the upper ~280$/month and include a $6000 deductible. There are three plans out of 36 that are ~380 a month that have a $2500 deductible. Everything else is more. This is NJ, one of the better states and definitely not a shitty state. These plans are garbage. Every time someone on HN extols the virtues of Healthcare.gov, I recheck my options and they always come back much worse than what I get working for a private employer (typical S&P 500 corp). I wish people would look up their possible plans on Healthcare.gov before tossing it out as something other than a scam.
ACA compliant health insurance pricing is pretty commodified since all the rating factors are codified in law (age, location, smoking status, and that is it I think).
Edit:
>These plans are garbage
The plans simply reflect the cost of healthcare. The companies that sell the healthcare have profit margins in the sub 5% range. Mechanisms to bring the cost down would be to have taxpayer funded medicine in the public domain so the medicine is sold without patent, increasing number of doctors by greatly expanding residency positions and reducing training requirements so that you can start practicing before age 28, reducing the need for "certificates of need" so more hospitals can open and compete, etc.
> The plans simply reflect the cost of healthcare.
Anyone who works in healthcare and looks at billing can tell you this is not actually the case, prices are not based on any reasonable metric and are rarely actually paid by insurers anyway.
>The companies that sell the healthcare have profit margins in the sub 5% range.
Point of contention here, these companies aren't selling healthcare, they're reselling it. Which is a service which should ideally not have any profit margins, and would be best suited for a large, collective entity that everyone paid into according to their financial ability, as opposed to smaller social-class exclusive pools.
What you are talking about is taxpayer funded healthcare, with the large collective entity being the government.
Seeing as how that is not politically possibly, middlemen with sub 5% profit margins was the compromise. Obviously not the best situation, but still better than before.
5% profit isn't the whole story here - If you can't increase profit, increase revenue. These middlemen have a lot of power and an incentive to use it in making the system less efficient.
All businesses would like to increase profit and revenue, but they cannot just will it. There are at least 7 major publicly traded competing managed care organizations (MCOs, aka health insurance comapanies) plus Kaiser Permanente among many others.
Is there any evidence that these companies are concluding to increase revenue by making the system less efficient?
Low profit margins plus multitude of competitors generally means there is not much juice left to squeeze.
Correct, that was what I was alluding to. There's lots of good reasons to move to such a system, and no good reasons to keep our current system.
>Seeing as how that is not politically possibly
Basically every other liberal democracy has taxpayer funded healthcare, and even many US states have successful programs. It's extraordinarily silly to call that impossible, or to call what we have now a "compromise" rather than a clear case of corporate welfare being put before the welfare of the citizens.
There literally was a compromise in 2009 during the passage of ACA that nixed the “public option” (taxpayer funded) healthcare in order to win the votes of necessary Senators to pass the bill.
Seeing as how Republicans have zero interest in taxpayer funded healthcare, and they have held enough Senate seats to stymie any Democrat led effort for the past 20 years and probably next 20, I do not see why it is “silly” to call it politically impossible.
Seems like Texas will go blue as the population changes. They almost elected one in 2018. They may also flip North Carolina and Pennsylvania to permanent blue as well.
> Your employer is probably just paying a lot for your coverage.
Yes but they get to deduct this, unlike an individual for whom no such deduction exists. Repeat after me: "a tax deduction is a subsidy." That is, welfare. An extremely biased, discriminatory welfare at that.
This just feels like a ‘well ackshually’ retort to health insurance being tied to employment. This is an extra added expense and often times the barebones insurance is garbage with high deductibles and out of pocket maximums.
How is it an “extra added expense”? Just because you do not pay for 50% of the premium out of your own pocket directly does not mean you are not paying implicitly. Your employer is obviously counting it in the total cost of employing you, and the figure is given to you in box 12 code DD on your W-2.
You can also buy a platinum level BCBS health plan yourself, without an employer, and get the same low deductible and low oop max.
It is still a headache to have to register for a plan after losing your job and possibly transfer/link your information to a new account. COBRA is better than nothing, but it is often more expensive than makes sense.
Furthermore you cannot use the exchanges if your employer offers plans IIRC. So your employer can control which plans you have access to.
The subsidies should just be given directly to the person who needs healthcare. There is no need to involve a third party. It just complicates the situation for no gain.
> Furthermore you cannot use the exchanges if your employer offers plans IIRC. So your employer can control which plans you have access to.
I do not think this is true. Everyone can sign up on healthcare.gov. Employers will want you to opt into the subsidized plans they offer, especially if you are a lower compensated employee, in order to pass their non discrimination testing requirements, but they have to make the portion they are paying for high enough to make it enticing enough, they cannot force you.
> The subsidies should just be given directly to the person who needs healthcare. There is no need to involve a third party. It just complicates the situation for no gain.
Absolutely. The whole employer tax benefit situation should be abolished, and all individuals dumped on healthcare.gov. Same with retirement benefits. Employers should not receive any beneficial tax treatment for providing benefits, and it would make compensation much more transparent and easier for employees to compare from one employer to another.
Hmm you're right on that first part. I don't know where I got that from. I seemed to remember playing around on CoveredCA and it said I couldn't get a plan because my employer offered plans, but I can't reproduce that now.
What employers do have is the ability to sell you health insurance with pre tax dollars, which is also available to self employed individuals. But the people who are screwed are those who are employed by employers that do not offer health insurance. They have to buy insurance with post tax dollars.
There is similar bullshit with retirement funding, where employer sponsored retirement account limits are drastically more than individual ones (401k vs IRA), and especially if you are a married couple with 1 spouse with 401k access and one spouse without.