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Launch HN: Savvy (YC W20) – Give employees tax-free cash for health insurance

news.ycombinator.com

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Re: Launch HN: Savvy (YC W20) – Give employees tax-free cash for health insurance

#51

Post by thehappypm »

RIMR wrote: post #5

Oh wonderful - more for-profit exploitation of people's need for healthcare. This business model is only possible because of deregulation by our current Federal Government. I hate to sound mean, but I really hope that this business fails. I know people worked hard on this with an expectation of a financial return, but 68,000 people die every year because of this illusion of choice being exploited here, and if we can…

This can lift a lot of employees in small companies from having no health insurance to having at least some level of coverage, and it seems to do so with minimal hassle for the employer. If you hope this fails, you're hoping those employees continue to have no real means of getting health care.

Re: Launch HN: Savvy (YC W20) – Give employees tax-free cash for health insurance

#52

Post by kevc »

tptacek wrote: post #45
thedance wrote: post #41

Earlier quoted context omitted.

There are plans that are exempt from ACA's "requirements" because of course there are, and the current administration has used its rules-making powers to expand such exemptions. These are not limited to backwater states with evil administrations. At this very moment there are plans on California's ACA market that are exempt and do not cover maternity.

It seems like all you have to say here is that there exist ACA-noncompliant plans. Yes, that was always the case. Why would you buy one of them? The major reason people end up in exempt plans is that they somehow miss enrollment (or have a payment snafu that gets them bounced from their compliant plan --- ask me how I know that). But this product appears to generate a new enrollment window; you can just buy ACA-compl…

You would be surprised how common missed payment issues are. Many carriers will only notify you via paper mail, so it's easy to miss. We manage the carrier payments for all enrolled employees to make sure that this doesn't happen.

Re: Launch HN: Savvy (YC W20) – Give employees tax-free cash for health insurance

#53

Post by IG_Semmelweiss »

danpalmer wrote: post #37
jkarneges wrote: post #9

Earlier quoted context omitted.

I don't know the details of the new law, but separating healthcare from employment is a positive step towards fixing the system.

Unless this can be used by employers to move from paying for an employee's healthcare, to giving them a smaller amount to buy their own.

People own Kias and Lamborghinis.

People eat at Popeye's and also at Whole Foods

No one bats an eye as long as both cars work as advertised and the food is edible.

When did it become mandatory for employers to pay for lmborghini-level service? ?

Re: Launch HN: Savvy (YC W20) – Give employees tax-free cash for health insurance

#54

Post by dang »

eganist wrote: post #23
dang wrote: post #18

Earlier quoted context omitted.

You guys keep saying you hate saying this and feel bad saying this, yet you've each posted repeatedly and your comments already make up a third of the thread as I write this. That's because reflexive comments on divisive topics (like healthcare) are the easiest to write and tend to fill up the threads early on. Let's not have yet another predictable flamewar about U.S. healthcare. It will just turn into the same flam…

An argument can be made that the model shouldn't exist in the first place, and part of our comments here are to see if we can steer the founding team towards an alternative that extracts value from a different target, in this case the insurance companies rather than individuals or SBs. In a perfect world, YC wouldn't be hedging in favor of a deteriorating healthcare system in the US by betting on this concept, but th…

If you mean the subthread at https://news.ycombinator.com/item?id=22527801, that's indeed much better.

Re: Launch HN: Savvy (YC W20) – Give employees tax-free cash for health insurance

#55

Post by dv_dt »

kevc wrote: post #44
unlinked_dll wrote: post #39

> For employees, we provide an in-app marketplace with access to every individual health plan, as well as vision and dental options. Employees can speak with licensed brokers every step of the way. I really want to like you for taking a stab at solving this problem because it's a serious one for startups and small businesses, but I can't as long as you keep this approach. Shopping for insurance (even through a broker…

What do you envision is the best way to do this? Our approach is to present employees with a few options upfront that, behind the scenes, have been recommended by a broker for them. They can speak with their broker if want help understanding and selecting one of the recommended plans, or look at the wider market if nothing suits them. We try to streamline the experience as much as possible, and put in a lot of work b…

Having been a small business owner who has had to shop, I would have loved the "CostCo" quality model applied. I know that would be really difficult for a startup with the state of our healthcare, but to me it would mean getting in the largest insurance pool possible with above average customer friendly choices making it easy to say yes. That also implies a very few options to chose from, and maybe ideally one (that gets you to the larger pool).

BTW costco quality also doesn't mean the absolute highest quality, just above average solid options plus using the volume to drive the affordability.

Re: Launch HN: Savvy (YC W20) – Give employees tax-free cash for health insurance

#56

Post by tptacek »

kevc wrote: post #52
tptacek wrote: post #45

Earlier quoted context omitted.

It seems like all you have to say here is that there exist ACA-noncompliant plans. Yes, that was always the case. Why would you buy one of them? The major reason people end up in exempt plans is that they somehow miss enrollment (or have a payment snafu that gets them bounced from their compliant plan --- ask me how I know that). But this product appears to generate a new enrollment window; you can just buy ACA-compl…

You would be surprised how common missed payment issues are. Many carriers will only notify you via paper mail, so it's easy to miss. We manage the carrier payments for all enrolled employees to make sure that this doesn't happen.

It happened to me. :)

I managed to avoid an exempt plan when BCBS screwed up my auto-pay. Ironically, I did that by leveraging a mistake I made when I first signed up for an ACA plan: I'd mis-entered my kids information, which screwed up the registration, and when I called for support to fix the problem the Marketplace team just created a new registration for me. After BCBS screwed up, we were able to use the original stale registration to enroll in a new plan. I got pretty lucky: the exempt plans retain the ability to DQ applicants for preexisting conditions, and while my family is healthy, my daughter had an unexplained seizure when she was 4 and is, for all intents and purposes, excluded from exempt plans.

The thing I think people don't know and really need to understand is that if you let your health insurance lapse, you can't simply pay up to reinstate it; you can only alter your insurance during qualifying events. That's because if you could lapse and then pay up later, lots of people would exploit that to avoid paying for insurance until they needed it, which defeats the purpose of insurance.

None of this has anything to do with your startup, of course.

Re: Launch HN: Savvy (YC W20) – Give employees tax-free cash for health insurance

#57

Post by HarryHirsch »

thehappypm wrote: post #49
eganist wrote: post #21

Earlier quoted context omitted.

I see your point, but to highlight a critical point of comparison: that's emblematic of the risk to healthcare. Pensions were an actual benefit to employees, largely subsidized by employers and taking into account various employment factors e.g. length of employment, salary, etc. With the advent of 401k, that expense was shifted almost entirely to the employee save for a remaining "match" benefit that the employer st…

Pensions are fantastically unsustainable. 401(k)s are much more responsible -- it's your money, you don't have to depend on a new crop of people funding your pension.

Pensions are fantastically unsustainable

How so? Annuities are the best-understood financial instrument of all. Of course financial projections fail if the participant pool is too small (vide Philadelphia with the rotten industries at the core and office parks at the periphery), but that is a political decision and could be fixed.

Re: Launch HN: Savvy (YC W20) – Give employees tax-free cash for health insurance

#58

Post by koolba »

danShumway wrote: post #48
unlinked_dll wrote: post #35

Earlier quoted context omitted.

As an employee whose has been on the receiving end of this, I won't work anyplace that does it. I'm sure I'm not the only one.

Honest question as someone who's never worked at a place that does this -- what left you feeling negative about it? Are the marketplace plans substantially worse than the employee plans, or are there extra caveats that come along with QSEHRA, or was it something else?

They’re substantially worse. ACA plans have worse networks, higher deductibles, and higher max out of pockets.

Imagine if they didn’t? No employer under 50 employees would bother getting group coverage as they could get better coverage for less via the QSEHRA route.

Re: Launch HN: Savvy (YC W20) – Give employees tax-free cash for health insurance

#59

Post by tptacek »

koolba wrote: post #58
danShumway wrote: post #48

Earlier quoted context omitted.

Honest question as someone who's never worked at a place that does this -- what left you feeling negative about it? Are the marketplace plans substantially worse than the employee plans, or are there extra caveats that come along with QSEHRA, or was it something else?

They’re substantially worse. ACA plans have worse networks, higher deductibles, and higher max out of pockets. Imagine if they didn’t? No employer under 50 employees would bother getting group coverage as they could get better coverage for less via the QSEHRA route.

I had ACA coverage before we offered group health insurance to our employees and did not find these things to be true: the network for my ACA silver plan was the same (fine) network as we get now, the deductible options are the same (but I was opting for higher deductibles to go with an HSA on the ACA plan, which is what I think most startup employees should do), and the out-of-pocket costs were the same.

I suspect that a lot of people alarmed by ACA costs are really just observing that their employers were subsidizing a lot of stuff for them. That's true! Employers who give you group coverage directly are usually giving you a shadow pay raise in the background to make the numbers look better!

But for startups, the difference between the individual market and the small group market probably aren't usually that big --- as you'd expect, since a small startup isn't really aggregating much risk.

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