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

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

#131

Post by apinstein »

apinstein wrote: post #130

This is great! As a founder, I have long felt employee-sponsored health care is awful. A company should not be required to be intertwined in the medical concerns of their employees. It is a very weird conflict of interest. I am solidly behind the complete unwinding of employer-sponsored health care plans. Also insurers are very predatory towards small groups. There shouldn’t be small Or large groups! It’s a bogus way…

I should add that at my last company we switched to a PEO mainly due to the advantages in health insurance prices and administration. JustWorks has been amazing. You might look at how they do the onboarding and maintenance of plans as a low-friction way to handle this. If you could partner w payroll companies you could integrate your solution completely into the hr onboarding process and get access to a huge distribution channel.

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

#132

Post by midnightmonster »

exabrial wrote: post #42

If we could see the return of individual HSA plans to the marketplace, this would be truly incredible!

In Florida individual HSA plans (with a large network) are still available, and they actually make sense for families with chronic health conditions. It's still a jaw-dropping amount to pay, but you pay even more any other way without a larger employer sponsored plan.

Source: I spend >$30k each year on my family's HSA plan premiums and deductible, and I run the numbers on every option that has the network we need every year, and this really is as good as it gets.

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

#133

Post by snarf21 »

jbkiv wrote: post #62

Congrats! How do you handle discrimination in your case? I'll give you an example: 50% of your employees are young and healthy and they opt out of the health plan offered and go with Savvy. How do you handle the remaining 50%, assuming that some of them are older, have cancer, or have kids with disabilities, diabetics or whatever. Would ANY health plan accept to cover only the sick and old? This is based a concept ca…

You really can't stop it without more regulation. It is also why Obamacare didn't work for a lot of people, payors simply pulled out of states or raised rates on existing customers.

Although ICHRA is a baby step forward, it is optional. Employers can offer this but they aren't forced, it isn't illegal. We need healthcare to be completely detached from employment. Employers should still be able to contribute to the HSA (no need for separate HRA) just like they do to a SIMPLE/401K and employees can spend it on any medical expenses they want. The HSA is portable and gives people choice.

We also need to move to reference based pricing (1.2 * Medicare) instead of the payors negotiating with each health system. This also gets rid of "out-of-network" as that just doesn't matter. This also removes all the brokers and other rent seekers from the system.

The last thing we need is to stop treating healthcare like insurance. Insurance products are for unlikely catastrophic events. You are going to need a checkup each year and a flu shot and you'll get a sinus infection. These are known and expected events. Being able to pay for these out of HSA gives good savings and insurance can be used to treat things like cancer and hospitalization and knee replacements. Medicare could also be expanded slightly to automatically cover an annual physical and age based cancer screenings. Then health insurance is mostly a risk management construct and since you are likely to stay with your carrier, they are incentivized to get you healthy and lose weight. Today, payors don't want to push on wellness since your employer will switch carriers each year looking for savings and the new payor benefits.

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

#135

Post by kevc »

apinstein wrote: post #131
apinstein wrote: post #130

This is great! As a founder, I have long felt employee-sponsored health care is awful. A company should not be required to be intertwined in the medical concerns of their employees. It is a very weird conflict of interest. I am solidly behind the complete unwinding of employer-sponsored health care plans. Also insurers are very predatory towards small groups. There shouldn’t be small Or large groups! It’s a bogus way…

I should add that at my last company we switched to a PEO mainly due to the advantages in health insurance prices and administration. JustWorks has been amazing. You might look at how they do the onboarding and maintenance of plans as a low-friction way to handle this. If you could partner w payroll companies you could integrate your solution completely into the hr onboarding process and get access to a huge distribu…

Appreciate the tip! Will definitely check out the Justworks onboard flow. I think partnering with payroll vendors would be a great idea.

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

#136

Post by AnthonyMouse »

snarf21 wrote: post #133
jbkiv wrote: post #62

Congrats! How do you handle discrimination in your case? I'll give you an example: 50% of your employees are young and healthy and they opt out of the health plan offered and go with Savvy. How do you handle the remaining 50%, assuming that some of them are older, have cancer, or have kids with disabilities, diabetics or whatever. Would ANY health plan accept to cover only the sick and old? This is based a concept ca…

You really can't stop it without more regulation. It is also why Obamacare didn't work for a lot of people, payors simply pulled out of states or raised rates on existing customers. Although ICHRA is a baby step forward, it is optional. Employers can offer this but they aren't forced, it isn't illegal. We need healthcare to be completely detached from employment. Employers should still be able to contribute to the HS…

> Medicare could also be expanded slightly to automatically cover an annual physical and age based cancer screenings.

It doesn't even have to be Medicare. Just give everyone a $100 voucher for a physical every year and let them take it to any licensed physician. Then there will be some who do it for the $100, others who charge $120 but maybe it's worth the extra $20 from your HSA because it's 3 miles out of your way instead of 30 (and has to charge more because real estate costs more there).

The way Medicare "negotiates" prices involves a lot of wrangling and distortion and politics. Vouchers solve the same problem while still allowing people to choose to pay a little more for something they find to be worth a little more.

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

#137

Post by Jommi »

sn wrote: post #89
Jommi wrote: post #84

How does this compare in cost to startups using justworks that has better negotiating power for cost savings in the insurance even with low amount of employees?

justworks is a PEO and their PEO certification is currently suspended. https://www.irs.gov/tax-professionals/cpeo-public-listings https://www.irs.gov/pub/irs-utl/suspended-cpeos.pdf

AFAIK this sentence is a bit dishonest. Justworks is still a PEO, they are just not a CPEO. CPEO is a PEO that is certified by IRS to be in excellent standing, it's not a requirement.

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

#138

Post by [deleted] »

AnthonyMouse wrote: post #136
snarf21 wrote: post #133

Earlier quoted context omitted.

You really can't stop it without more regulation. It is also why Obamacare didn't work for a lot of people, payors simply pulled out of states or raised rates on existing customers. Although ICHRA is a baby step forward, it is optional. Employers can offer this but they aren't forced, it isn't illegal. We need healthcare to be completely detached from employment. Employers should still be able to contribute to the HS…

> Medicare could also be expanded slightly to automatically cover an annual physical and age based cancer screenings. It doesn't even have to be Medicare. Just give everyone a $100 voucher for a physical every year and let them take it to any licensed physician. Then there will be some who do it for the $100, others who charge $120 but maybe it's worth the extra $20 from your HSA because it's 3 miles out of your way…

[deleted]

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

#140

Post by skrtskrt »

AnthonyMouse wrote: post #136
snarf21 wrote: post #133

Earlier quoted context omitted.

You really can't stop it without more regulation. It is also why Obamacare didn't work for a lot of people, payors simply pulled out of states or raised rates on existing customers. Although ICHRA is a baby step forward, it is optional. Employers can offer this but they aren't forced, it isn't illegal. We need healthcare to be completely detached from employment. Employers should still be able to contribute to the HS…

> Medicare could also be expanded slightly to automatically cover an annual physical and age based cancer screenings. It doesn't even have to be Medicare. Just give everyone a $100 voucher for a physical every year and let them take it to any licensed physician. Then there will be some who do it for the $100, others who charge $120 but maybe it's worth the extra $20 from your HSA because it's 3 miles out of your way…

How about we add everyone to Medicare, adjust what it covers to be more relevant to the average person, and use the massively diversified risk pool plus minuscule administrative costs (compared to private insurance) plus price negotiation power to save trillions of dollars and keep everyone healthy, for the larger benefit of society?
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