While this time consuming process is important, it is also maddening for two very different reasons. And I don’t think either of them are addressed very well by the Affordable Care Act set to be fully implemented in 2014.
First off, the annual benefits planning is maddening because I don’t think it should be my role as an employer to define the benefits being made available to employees. The needs of employees are very different. I don’t believe I should be dictating the parameters of their individual coverage. The options for small businesses aren’t all that flexible. Choices are limited, so we provide a higher cost traditional plan with moderate co-pays as well as a high deductible plan with a Health Savings Account. And we hope that we are providing at least two solid options that reflect different ends of the spectrum.
Under reform, the state insurance exchanges being readied for 2014 are not a great option for our employees, who typically make more than 250% of the poverty level. They will not be eligible for the Federal subsidies that would allow them to purchase better coverage at lower out-of-pocket cost than they would be able to from us. And it remains to be seen how customized the offering within the exchanges will be.
One innovation that would address some of our needs is now being offered by an entrepreneurial start–up based right here in Minnesota - Bloom Health. Their configurable offerings would address the flexibility required by most of our employees, and it doesn’t require the Affordable Care Act to work.
The second and equally frustrating part of employee health benefit planning that will not be enhanced by the Affordable Care Act is the lack of substantive incentives to make insurance policy holders behave like good consumers. At least with high deductible health plans and health savings accounts that were implemented in the last five years, there is an incentive for consumers to compare price and quality of procedures, doctor visits, hospitals and/or prescriptions. Unfortunately, the health care system doesn’t make it easy for us consumers to make these comparisons. (When was the last time you tried to compare prices at different pharmacies for a prescription covered under your insurance?)
Only in the last couple of years have we started to see some improved options for comparison shopping. But the incentives for comparison shopping are tied to the consumer having a direct vested interest in the outcome. This happens to some extent with a health savings account because the money belongs to the employee/consumer. It’s not clear what incentives, if any, consumers who buy their insurance through exchanges will have to comparison shop for their care.
And, of course, the Affordable Care Act does nothing at the system level to reform the fee for service structure of health care payments.
So what is our company planning to do this year to prepare for open enrollment for health benefits next month? We’re maintaining our benefit levels and have managed to find a third plan choice for our employees, expanding their range of options a bit. And we’re adding a new benefit - Long Term Care Insurance.
Please don’t misunderstand my intent. I fully support the idea of the Affordable Care Act to extend access to health care to the millions of uninsured and underinsured. I also think that employers with lower wage workers and more part time workers will adopt the insurance exchanges at a fast pace. It’s just that none of this actually addresses the true cost of care at a system level or make us better consumers of our care at an individual level.
Robin Carpenter of Edina is the vice chair of the Independence Party of Minnesota 3rd Congressional District.
...here's the operative quote: 'When underdogs choose not to play by Goliath's rules, they win.'
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