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Employees Start to Feel the Squeeze of High-Deductible Health Plans

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Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#301

Post by WalterSear »

dsfyu404ed wrote: post #170
WalterSear wrote: post #142

Earlier quoted context omitted.

The incentive is gone, since preexisting conditions are no longer a disqualification.

The incentive is still very much there. You just can't use a preexisting condition as your excuse anymore.

I would argue that the incentive was implicit and fundamental to the nature of the business, because it provided agents with a method to pick and choose their clients.

By inducing lapses in insurance coverage, insurance companies were able to convert illnesses under active treatment into preexisting conditions.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#302

Post by jellicle »

pdonis wrote: post #230
CptFribble wrote: post #196

Every discussion on healthcare payment structures in this country is completely asinine. Healthcare is best managed as a risk pool. The bigger the pool, the cheaper to be in it. The biggest risk pool is everyone. Therefore, we should put everyone in a single pool. How we manage this is a separate discussion. Private, public, maybe a federally chartered non-profit like the Fed. But as long as we keep ourselves fractur…

> Healthcare is best managed as a risk pool. No, health insurance is best managed as a risk pool, which, as you say, should obviously be everyone. But much of health care is not health insurance because it doesn't deal with insurable risks. Your need to get an annual physical isn't an insurable risk. Neither is a one-time appointment with a doctor to see if your headache and runny nose is just a cold or an infection…

There's no reason to try to draw the distinction you're trying to draw. You're starting with ideology and proceeding to practice, which is a bad idea. There's a tremendous benefit to society in providing clean water, and also in providing medical care, for the same reasons.

Preventive medical care generally has a negative cost to society; treating diabetes from the beginning is cheaper than amputating limbs, transplanting kidneys, etc.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#303

Post by astura »

ericpauley wrote: post #239
pdonis wrote: post #230

Earlier quoted context omitted.

> Healthcare is best managed as a risk pool. No, health insurance is best managed as a risk pool, which, as you say, should obviously be everyone. But much of health care is not health insurance because it doesn't deal with insurable risks. Your need to get an annual physical isn't an insurable risk. Neither is a one-time appointment with a doctor to see if your headache and runny nose is just a cold or an infection…

While this may make sense from the perspective of why people get insurance (to mitigate a catastrophic loss), it doesn't consider the insurer's incentives. No insurance company will want to underwrite a plan that doesn't bundle routine services, since those clearly reduce risk of complications down the road. A yearly checkup is cheap compared to missing a disease and letting it get worse.

Sorry, but annual physical exams for asymptomatic adults do not reduce mortality or morbidity and certainly do not "clearly reduce risk of complications down the road"

https://sciencebasedmedicine.org/is-the-annual-physical-unne...

https://sciencebasedmedicine.org/re-thinking-the-annual-phys...

https://sciencebasedmedicine.org/questioning-the-annual-pelv...

http://www.clinlabnavigator.com/questioning-the-value-of-the...

https://www.ncbi.nlm.nih.gov/books/NBK82767/

The idea of the "annual physical" in general is a little odd because there's no standard on what an annual physical actually entails. I've been to doctors that order every blood test under the sun and don't touch me AT ALL to doctors who order zero blood tests but feel up all my organs in detail.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#304

Post by golover721 »

mikestew wrote: post #176
frenchman_in_ny wrote: post #160

Earlier quoted context omitted.

Though ( if both spouses were working & had access to employer sponsored insurance), wouldn't the husband being fired result in a qualifying change for the woman, allowing her to enroll on her employer's insurance plan, thus covering the pregnancy?

Or COBRA, unless you expect your pregnancy to last longer than 18 months.

COBRA these days ends up being way too expensive for most people to afford. Perhaps at one time it was a useful regulation. Now it is pretty unaffordable.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#305

Post by etchalon »

trynewideas wrote: post #103
etchalon wrote: post #95

At Mess (my agency), we were sort of forced into going with a HDCP, but we found a way for it to be a win for everyone. Our absolutely-perfect no-deductible no-coinsurance plan was retired, and every year, for five years, the cost of our reasonable-deductible no-coinsurance plan kept going up. Eventually, our broker convinced us that HDCP was the only way. But I absolutely hated it. We have quite a few employees with…

Taxes. HRAs can be a huge headache for employees (never employers). SEHRAs also have a bad reputation for being the worst of both HSA and more traditional insurance plans: underfunded, high overhead for employees, all for severely limited provider choice. ICHRAs (individual-coverage) are the real bridge between HSAs and traditional insurance—you can use them as an HRA-style account _or_ use the money to buy an insura…

I don't get how they'd be headaches for employees? HRA contributions are 100% tax-free and aren't treated as income. It's a pain for my co-founder and I, or would be, if we didn't have someone else doing our taxes.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#306

Post by golover721 »

lotsofpulp wrote: post #102
maxxxxx wrote: post #26

Earlier quoted context omitted.

Totally agree. All “innovations” like HSA and 401k are designed to make life easier for employers but are sold as benefit for employees.

401k are tied to employers, but I don’t see what HSA has to do with employers since they’re just as easy to have without an employer. It’s just a savings account with tax advantages for people with HDHP.

Yes however it is definitely a way for employers to save a bunch of money while convincing employees that they are better off too. The whole smokescreen of we will give you a bunch of money "for free!" that goes to your HSA and somehow that is better value for you than a traditional PPO. In much the same way that 401k contributions are better than a pension.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#307

Post by sDlEzAtyoNAz »

newsoul2019 wrote: post #158
JMTQp8lwXL wrote: post #87

Earlier quoted context omitted.

Pre ACA, pre-existing conditions could disqualify you from insurance. People with pre-existing conditions are the people that need health care coverage the most. We can't under-weigh the moral obligation we have to this previously marginalized group, when considering service may be slightly worse for people who have employer coverage. How I see it: if you were in the pre-ACA pre-existing condition pool, your perspect…

I don't like the entire concept of "pre-existing conditions". It goes against the entire concept of caring for sick people. We are all people. We all get sick sometimes. Sicknesses can last a long time, or a short time. Sick people need help. Help the sick people. Pay what you can (a reasonable amount) into a common pool and take what you need (only as much as you need)

OK, but why would I want to help sick people in need by paying a business which is going to skim profit off the top for shareholders and pay executives millions? Who other than the middleman thinks that's a good idea?

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#308

Post by SOLAR_FIELDS »

pintxo wrote: post #255
pdonis wrote: post #250

Earlier quoted context omitted.

Are people required by the insurance companies to get regular checkups?

No. But insurances are (to different degrees) heavily promoting checkups and health/fitness improvement programs. Some are even handing out coupons and benefits for those joining fitness studies or sports clubs etc.

It would also be pretty easy to incentivize. Have an annual physical and save $X a month on your premium. We do it for other things like smoking already. Plus many examples in the car insurance world.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#309

Post by loeg »

kasey_junk wrote: post #299
snowwrestler wrote: post #222

Earlier quoted context omitted.

Where do you have your individual HSA? I have an employer-provided one and I'm looking for a place to move it.

Fidelity has a pretty compelling offering: https://www.fidelity.com/go/hsa/why-hsa

Yeah, that looks competitive. It doesn't have the one highly specific fund I wanted at HSA authority but it's got everything you really need.

Re: Employees Start to Feel the Squeeze of High-Deductible Health Plans

#310

Post by sDlEzAtyoNAz »

munificent wrote: post #277
newsoul2019 wrote: post #158

Earlier quoted context omitted.

I don't like the entire concept of "pre-existing conditions". It goes against the entire concept of caring for sick people. We are all people. We all get sick sometimes. Sicknesses can last a long time, or a short time. Sick people need help. Help the sick people. Pay what you can (a reasonable amount) into a common pool and take what you need (only as much as you need)

> I don't like the entire concept of "pre-existing conditions". If you have an elective health insurance system where people choose whether or not and when to participate, it implies this restriction. Say you have private health insurance companies but don't allow them to prohibit members based on pre-existing conditions. Everyone will simply not get health insurance to avoid paying the premiums until the day they ne…

>This is another reason why healthcare should just be universal.

Or you could just not have a law forcing private health insurance companies to ignore pre-existing conditions, and have charity programs (public or private) to help people get medical care that they can't otherwise afford.

>It doesn't work at all like an actual efficient market product.

Certainly not when the government prevents it from working like one.

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