"5% of patients account for half of health care spending," by Kelly
Kennedy, USA Today, January 20, 2012 ---
http://www.usatoday.com/news/washington/story/2012-01-11/health-care-costs-11/52505562/1
"Will Employers Undermine Health Care Reform by Dumping Sick Employees?"
by Amy Monahan and Daniel Schwarcz, Virginia Law Review 125 (2011) ---
http://www.virginialawreview.org/articles.php?article=321
Thank you Paul Caron for the heads up.
This Article argues that federal health care reform may induce employers to redesign their health plans to encourage high-risk employees to opt out of employer-provided coverage and instead acquire coverage on the individual market. It shows that such a strategy can reduce employer health care expenditures without substantially harming either high-risk or low-risk employees. Although largely overlooked in public policy debates, employer dumping of high-risk employees may threaten the sustainability of health care reform. In particular, it potentially exposes individual insurance markets and insurance exchanges to adverse selection caused by the entrance of a disproportionately high-risk segment of the population. This risk, in turn, threatens to indirectly increase the cost to the federal government of subsidizing coverage for qualified individuals and to exempt more individuals from complying with the so-called individual mandate. The Article concludes by offering several potential solutions to the threat of employer dumping of high-risk employees.
Jensen Comment
Since it's illegal to dump sick employees without justifiable reasons, the
impact of Health Care Reform may be to both increase the number of law suits and
increase the number of hurdles that employees must surmount to obtain and keep
jobs. For example, factory employees and store clerks must be able to stand
without a break for x minutes, diabetic and epileptic bus and taxi drivers may
be dropped at the first episode of unconsciousness, drug testing may become more
common, Mental health patients may be particularly vulnerable to dismissal.
Then there is an even bigger risk that employers will drop health coverage of all employees
"No, You Can't Keep Your Health Insurance: A new study by McKinsey
suggests that as many as 78 million Americans could lose employer health
coverage," by Grace-Marie Turner, The Wall Street Journal, June 7,
2011 ---
http://online.wsj.com/article/SB10001424052702304432304576371252181401600.html?mod=djemEditorialPage_
"'The Flight to the Exchanges': The Wall Street Journal
writes that ObamaCare may cause small businesses to drop insurance coverage,"
The Wall Street Journal, July 25, 2011 ---
http://online.wsj.com/article/SB10001424053111903554904576462010405702984.html#mod=djemEditorialPage_t
McKinsey & Co. made itself the White House's public enemy number—well, we've lost count—after releasing a survey last month showing that nearly one in three businesses may drop insurance coverage as a result of the new health-care law. The real offense of the management consultants seems to be accurately portraying reality.
Consider a suggestive new survey to be released today by the National Federation of Independent Business, the trade group for small businesses. William Dennis, a senior research fellow who has conducted the study for 35 years, reports that 57% of a cross-section of companies that employ 50 or fewer workers and offer coverage may stop doing so. Look out below.
About two of five small companies sponsor insurance—a share that, according to NFIB, has on net held mostly stable or declined very slightly since the passage of the Affordable Care Act. Yet 12% of these companies—one of eight—have either had their plans cancelled or have been told that they will be in the future. This churn in the private small-group market is a direct result of ObamaCare's new rules and mandates—but a far larger destabilization could be in the offing, what Mr. Dennis calls "the flight to the exchanges."
Those would be the dispensaries of heavily subsidized insurance, and the NFIB finds that 26% of small businesses today sponsoring insurance are "very likely" to drop it should their employees start to flood government coverage. Another 31% of the 750 firms surveyed report they are "somewhat likely."
Small-business workers are eligible for exchange subsidies even if they can get job-based coverage. The incentive is for them to take it—given that the new government payments will be so generous, small-group coverage is generally costly and the insurance tax break for employers usually doesn't go very far when the employer is small.
If enough workers split, in other words, private coverage will soon erode and cease to exist as an option. Meanwhile, start-ups are constantly entering and exiting the market, and the ones with fewer benefits and liabilities will gain a competitive advantage. Businesses with fewer than 50 employees also aren't subject to any "play or pay" penalties. As Mr. Dennis put it in an interview, "Once you pull the string, everything may unravel."
ObamaCare's partisans claim none of this will happen because of the social norm theories of behavioral economics. Businesses offer insurance to attract workers, the thinking goes, and it's the right thing to do. But that assumes utter irrationality—that workers won't take a cheaper deal when they see it and businesses won't try to compete against their rivals.
Continued in article
Bob Jensen's threads on health care are at
http://www.trinity.edu/rjensen/Health.htm