Excellent information and analysis, Dana. Interesting point about the label "Obamacare" and how it implies a national health care system, when it is not. Also, it's not a common point of discussion (but should be) that we pay for health insurance and only sometimes receive the medical care we need.
Yes, of course, Joan, thank you for your piece! That's a great point; we pay for health insurance year-round and can be denied care at any time. And we *have* to pay for the insurance every month whether we receive care or not, because we have this weird limited window to enroll in a new plan, so there's no proper competition.
One other aspect that's becoming even more of a problem with the increase in remote work: insurance is organized at the state level.
When I first set up Wanderwell's group plan years ago, I spent months trying to find someone that would help me figure out how to support remote employees in other states. The standard answer was "you don't have to provide insurance to your employees, and you can't insure out of state employees anyway"... and that was it. Because I didn't have to, I shouldn't (and they were wrong about the out of state thing).
I finally found a broker who could think creatively, and figured it out...but since I moved the business to a new state, we've lost the group plan-- so I'm back to figuring out options all over again, and VT is waaaay more expensive than PA for the same exact plans through the same insurer. What's more, out of state employees need to obtain PPO plans and mostly see out of network providers, all of which is more expensive.
I haven't seen this issue talked about much anywhere, but it seems like something that's going to become a bigger problem as certain workforces are more distributed.
This is an important point! State-based everything is the U.S. causes so many problems.
And I find this frustrating as a small business owner, too: Every expert wants to tell me how to legally cut corners, compensate people less, pay less in taxes, cut costs — no one seems to be able to fathom the idea that I'm willing to pay wages, taxes and fees if it makes life better for workers, customers and the community.
My very-not-secret workaround is to find "experts" that work within the solidarity economy...that's how I finally figured out the health insurance thing: found a broker that works with cooperatives.
We were able to get around this by going through our "PEO" at JustWorks. Basically, because they are the Professional Employer Organization, and they work with many companies across all the states, they can often get better deals on insurance.
That being said, it's not cheap (we pay both JustWorks and the insurance fees) and it only works when you have enough employee enrolled, otherwise you're not allowed to enroll at all.
Definitely, yes, PEO's can be a workaround...I actually met our broker because I was working on a healthcare cooperative idea a few years back, and he ended up taking the idea and running with it. Has a PEO that he runs now, because of the cooperative influence, it's more friendly, affordable, and set up to avoid the restrictions on employees numbers that JustWorks and similar companies have.
That said, I do think it's a weird structure to have your employees employed outside of your company, and yes, expensive! I also have some thoughts on what that does to finances and thinking about employment relations... for another time ;)
Nice clarifications. It’s always been my opinion that the biggest winner in the ACA were the insurance companies. It is great that we can all purchase coverage, yes, and have you seen those prices?
I love that you're tackling the terms we use when we describe "health care".
This is such an important big picture look at the US health insurance landscape.
Thank you! And I so appreciate you sharing your insight :)
Excellent information and analysis, Dana. Interesting point about the label "Obamacare" and how it implies a national health care system, when it is not. Also, it's not a common point of discussion (but should be) that we pay for health insurance and only sometimes receive the medical care we need.
And thanks very much for the newsletter mention!
Yes, of course, Joan, thank you for your piece! That's a great point; we pay for health insurance year-round and can be denied care at any time. And we *have* to pay for the insurance every month whether we receive care or not, because we have this weird limited window to enroll in a new plan, so there's no proper competition.
One other aspect that's becoming even more of a problem with the increase in remote work: insurance is organized at the state level.
When I first set up Wanderwell's group plan years ago, I spent months trying to find someone that would help me figure out how to support remote employees in other states. The standard answer was "you don't have to provide insurance to your employees, and you can't insure out of state employees anyway"... and that was it. Because I didn't have to, I shouldn't (and they were wrong about the out of state thing).
I finally found a broker who could think creatively, and figured it out...but since I moved the business to a new state, we've lost the group plan-- so I'm back to figuring out options all over again, and VT is waaaay more expensive than PA for the same exact plans through the same insurer. What's more, out of state employees need to obtain PPO plans and mostly see out of network providers, all of which is more expensive.
I haven't seen this issue talked about much anywhere, but it seems like something that's going to become a bigger problem as certain workforces are more distributed.
This is an important point! State-based everything is the U.S. causes so many problems.
And I find this frustrating as a small business owner, too: Every expert wants to tell me how to legally cut corners, compensate people less, pay less in taxes, cut costs — no one seems to be able to fathom the idea that I'm willing to pay wages, taxes and fees if it makes life better for workers, customers and the community.
My very-not-secret workaround is to find "experts" that work within the solidarity economy...that's how I finally figured out the health insurance thing: found a broker that works with cooperatives.
We were able to get around this by going through our "PEO" at JustWorks. Basically, because they are the Professional Employer Organization, and they work with many companies across all the states, they can often get better deals on insurance.
That being said, it's not cheap (we pay both JustWorks and the insurance fees) and it only works when you have enough employee enrolled, otherwise you're not allowed to enroll at all.
Definitely, yes, PEO's can be a workaround...I actually met our broker because I was working on a healthcare cooperative idea a few years back, and he ended up taking the idea and running with it. Has a PEO that he runs now, because of the cooperative influence, it's more friendly, affordable, and set up to avoid the restrictions on employees numbers that JustWorks and similar companies have.
That said, I do think it's a weird structure to have your employees employed outside of your company, and yes, expensive! I also have some thoughts on what that does to finances and thinking about employment relations... for another time ;)
Nice clarifications. It’s always been my opinion that the biggest winner in the ACA were the insurance companies. It is great that we can all purchase coverage, yes, and have you seen those prices?
Yes! That's a really great point.