We still get calls on a regular basis from people who are shopping for individual insurance because adding dependents to their employer plan is prohibitively expensive. We estimate that roughly 20 percent of the people who contact us are in this situation.
Unfortunately, due to a “glitch” in the ACA, they are not eligible for premium subsidies in the exchange if the amount the employee has to pay for employee-only coverage on the group plan is deemed “affordable” – defined as less than 9.78 percent of household income in 2020.
I've referenced Families USA several times before (and I've attended their annual conference for the past three years), but for those not familiar with them:
Families USA, a leading national, non-partisan voice for health care consumers, is dedicated to achieving high-quality, affordable health care and improved health for all. Our work is driven by and centered around four pillars: value, equity, coverage, and consumer experience. We view these focus areas — and the various issues unique to each area — as the cornerstones of America’s health care system.
Public policy analysis that is rooted in Hill and administration experience, movement-building advocacy, and collaboration with partners are deep-rooted hallmarks of our work. In turn, our work promotes a health system that protects consumers’ financial security as much as it does their health care security.
As we advance our mission by combining policy expertise and partnerships with community, state, and national leaders, we forge transformational solutions that improve the health and health care of our nation’s families and speak to the values we all have in common.
A huge part of the controversy about "pure" Medicare for All is tied to the fact that nearly 50% of the population (roughly ~160 million Americans, give or take) currently receives healthcare coverage via their employer. Some of this Employer-Sponsord Insurance (ESI) is pretty damned good, while some of it kind of sucks, but that's how our absurd system currently works for good or bad.
Anyway, most employers cover the bulk of the premiums for their enrollees...but a lot of people (my guess is the vast majority) either have no clue that they do so or at best have no idea how much of their monthly premiums are covered for them by the employer.
About 90% of my focus here at ACASignups.net is on the two biggest sections of the ACA: The Individual Market (3-legged stool, exchanges, subsidies, etc.) and Medicaid expansion. I tend not to write much about Medicare, "traditional" Medicaid or the Employer-Sponsored Insurance (ESI) market, which mainly consists of the Large Group Market (companies with 50 employees or more) and the Small Group Market (companies with fewer than 50 employees). As it happens, the ESI market covers nearly half the U.S. population (roughly 155 million Americans, give or take).
Under the ACA, individual market policies have to include the following "Blue Leg" provisions to be considered ACA-compliant:
Here is our call to action for employers: Guide employees of any eligibility status to health coverage, whether employer-sponsored or government-supported, because it will benefit both employees and your company.
The main thrust of the article is that while most employers offer some sort of healthcare coverage option to their employees (in fact, most did so before the ACA mandated it), most of them don't appear to make a whole lot of effort to actually get the employees to enroll in that coverage...and even fewer make any sort of effort to encourage their staff to enroll in other types of healthcare coverage outside of the employer plan.
They include several charts and graphs, but this is the key one to me:
Although nearly half of the country is covered by it, and the Affordable Care Act does impact it, I don't write much about Employer-Sponsored Insurance (ESI); there's a lot of facets to the ACA, and my main focus has obviously been primarily on the Individual Market (both on and off-exchange) as well as Medicaid (both expansion and "woodworkers").
Today, however, there are two big developments which relate directly to ESI:
When it comes to the Cadillac Tax, I know that it's supposed to help curb overall healthcare costs. I know that it's extremely unpopular with unions (which are obviously one of Clinton's core target constituencies). I know that it's supposed to be one of the main revenue sources for funding the rest of the ACA. Beyond that, I don't know much about it.
Economists love the idea of limiting the tax exclusion for employer-sponsored coverage. For one thing, subsidizing employer-based care is regressive — it's a tax subsidy paid, in effect, by people who don't have good jobs that give them health care. But perhaps more important, it encourages employers to spend more and more money on lavish health insurance, which in turn pushes up health-care costs across the system.
...But voters? They hate it. And employers really hate it. Coalitions have sprung up in Washington, DC, for the sole purpose of killing it. Hundreds of legislators on both sides of the aisle have backed a bill to repeal it. It's become one of Obamacare's central weaknesses — and thus one of the GOP's main targets.
That, however, is not the main point of this entry. This is:
