The nation's large self-insured employers are beginning to abandon their health benefit programs

Comment by Don McCanne of PNHP: Many larger employers have said that they do not want to be the first to initiate major structural reforms in their employee health benefit programs - reforms that would bring the employers relief but at a cost to their employees - but that they would quickly follow others out the door. It looks like the door has opened.

This is a very fundamental change in employee health benefit coverage. The Affordable Care Act relies heavily on self-insured large employers maintaining their coverage of a large percentage on America's workforce, so that the Act can concentrate on lower-income and uninsured individuals. Under the radical change described in this WSJ article, employers will discontinue their self-insured programs and switch to a defined contribution - a specific dollar amount that employees will use to shop for health plans in these employer insurance exchanges.

There has been considerable discussion recently over converting Medicare to a defined contribution - premium support or voucher program - in which the costs to the government would be fixed to some index of inflation, whereas the greater increases in health care costs would be borne by the Medicare beneficiary. Thus health care would become less and less affordable, especially for those with greater health care needs.

With this move by employers, they are putting in place the same perverse defined contribution approach which we have determined would be so destructive to our Medicare program. And, oh yes, the benefits consultants and health insurers are jumping in to draw off even more health care funds in administrative costs - already one of the greatest burdens in our health care system. The executive vice president of WellPoint says, "Within the next two or three years, it's going to be mainstream."

Further, as was reported in yesterday's Quote of the Day, over 90 percent of individuals do not select the Medicare Part D drug plan that would be best in their individual circumstances. It shows that health insurance shoppers really do not know how to shop for health insurance. Obviously comprehensive health plans are much more complex, and it would be virtually impossible for individuals to select the best plan, even with the language of simplified plan descriptions called for in the Affordable Care Act.

In fact, several studies have shown that most individuals select plans based primarily on the lowest net premium, with very little attention paid to plan benefits and cost sharing. The most common strategy for insurers to keep premiums low is to use large deductibles and coinsurance, though they also manipulate benefits and provider networks to reduce costs. Besides the increasing deductibles, coinsurance is particularly a problem since it is a percentage of the charges rather than a dollar copayment which is usually much smaller. Low premium plans tend to set coinsurance rates at very high percentages. As this article states, the savings will be dependent upon "workers' voluntary choice of skinnier coverage." It's all the workers'fault!

It is likely that the initial defined contributions will be fairly close to the amounts that employers are currently paying for the health benefit programs, so the immediate impact will not be transparent. Only after many employees face bankrupting medical debt - a phenomenon that will increase as the employer contribution buys ever less insurance - will the implications be clear. It is tragic that so many will have to experience financial hardship before we are ready to get serious about fixing our system by enacting an improved Medicare for everyone.

Haven't we had enough policy discussions to understand what is happening? Why aren't we doing anything?

By the way, just in case you didn't get the gist of today's message, OUR NATION'S LARGE SELF-INSURED EMPLOYERS - THE MAINSTAY OF HEALTH CARE COVERAGE IN AMERICA - ARE BEGINNING TO ABANDON THEIR HEALTH BENEFIT PROGRAMS AND SHIFT THE RISKS TO THEIR EMPLOYEES.