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Last week, Americans learned about the GOP playbook laying out the strategies, tactics and talking points the Republican faithful should use to demagogue the Affordable Care Act. A quick glance at Monday's headlines from the Chicago Tribune ("Employers could drop health care"), the Wall Street Journal ("Companies Prepare to Pass More Health Costs to Workers") and The Hill ("O-Care mandate could pass costs to workers") shows the GOP's latest sound bite du jour.

Of course, reading those dire predictions, you'd never know that those exact trends in employer-provided health insurance have been underway for years and have resulted in the number of uninsured Americans jumping from 37 million in 2000 to over 50 million today.

Including Medicare, roughly 263 million Americans--about 85 percent of the population--already have health insurance. As the nonpartisan Congressional Budget Office (CBO) estimated in May, 156 million are workers and their family members who received insurance from their employers. But as the chart above from the National Institute for Health Care Reform (NIHCR) shows, the percentage of Americans getting coverage through their workplace has been dropping for years, and nose-dived during the recession.

But that's not the only indicator of an employer health insurance system "coming apart at the seams." For years, businesses have been shifting the costs for health care onto their workers by hiking employee contributions, raising deductibles, dropping spousal coverage and more. In its 2009 Employer Health Benefits Survey released six months before Obamacare became law, the Kaiser Family Foundation found the pace of cost-shifting was accelerating. As the Washington Post reported the findings from KFF:

Forty percent of employers surveyed said they are likely to increase the amount their workers pay out of pocket for doctor visits. Almost as many said they are likely to raise annual deductibles and the amount workers pay for prescription drugs.

Nine percent said they plan to tighten eligibility for health benefits; 8 percent said they plan to drop coverage entirely. Forty-one percent of employers said they are "somewhat" or "very" likely to increase the amount employees pay in premiums.

Just days before President Obama signed the Affordable Care Act into law the following March, a study by the National Business Group on Health of 507 companies with over 1,000 employees found that:

Many say they may charge more to cover spouses, tighten eligibility standards for their health plans and dispense financial rewards or penalties based on the results of certain lab tests. At some companies, overweight employees could be excluded from the most desirable plans.

Meanwhile, employees at many companies can expect significantly higher premiums, deductibles and co-payments.

Again, this was prior to the passage of Obamacare and specifically its employer mandate whose implementation has been pushed back to 2015. As Kaiser's latest employer survey showed, between 2006 and 2013, the percentage of workers who employer-based plans required a deductible jumped by half from 52 to 78 percent. During that same time frame, the share of workers whose deductible topped $1,000 a year almost quadrupled from 10 to 38 percent.

Nevertheless, CNN Money recently asked, "Are employers dumping health benefits because of Obamacare?"  CNN cited anecdotal examples of organizations like Trader Joe's and Romney-aligned Home Depot shifting part-time workers to the ACA exchanges and others like the University of Virginia and UPS which announced plans to end benefits for spouses with coverage options elsewhere. But as the Wall Street Journal and others have documented, part-time employment is falling as businesses add more full-time positions. And as the CNN article also noted, "Obamacare is not the only reason behind the benefits adjustments."

"An increase in costs of a few percent isn't enough to cause widespread changes in benefits," said Larry Levitt, senior vice president at the Kaiser Family Foundation.

Other factors, such as the improving economy, are contributing to rising costs since people use more medical care when the economy is healthier.

Also, companies have been shifting costs to employees for years. While UPS will limit its spousal coverage, it is not the first company to do so.

That, to put it mildly, is an understatement.

It also happens to be the same understatement U.S. media outlets reproduced on Monday. While The Hill briefly mentioned that "the share of people receiving employer-based health insurance has been on the decline since the 1980s," the Journal noted only, "Employers have been pushing more of the cost of providing health insurance on to their workers for years."

Originally posted to Jon Perr on Mon Nov 25, 2013 at 06:23 PM PST.

Also republished by Daily Kos.

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Comment Preferences

  •  Thank you Jon Perr. I was hoping someone would (4+ / 0-)

    highlight these trends.  Trends that I have personally witnessed (in various forms) over the past 20 years regardless of the type or size of employer.

    I've also personally been affected by employer switching health insurance providers-resulting in the loss of our family physician & other healthcare providers because they were not part of "the network" of the new insurance carrier.  This happened in the late 80s.  So, this is yet another thing that is not "new" despite that particular ACA meme.

    Granted, these factoids may be "new" to younger folks that have no history or knowledge base concerning what happened decades ago but the MSM could or should be informed enough to address these facts.

    Thanks again for this informative diary.

  •  This diary from 2009 should be remembered (9+ / 0-)

    How I Lost My Health Insurance at the Hairstylist's

    Skip ahead then.  On your first day in large teaching institution, you are visited by a social worker, who surprises you by demanding to know not the details of your home life, or about your state of mind on being diagnosed with a more-lethal-than-not form of cancer, but simply: "Who is carrying your insurance, you or your husband?"

    You think this is rather cold for a social worker and inform her somewhat frostily that you are sure the bill will be taken care of – it’s pre-approved.

    Social worker looks at you with what you interpret as pity and says it’s really, really important.  So you say, spouse, as you work for small non-profit that offers no benefits, but also admit to her that you think marriage is for sure doomed now.

    "Good, good!" she says.

    And you wonder why, why, on top of extra-lethal form of cancer, must you also get unbalanced social worker?

    She must be able to tell from your expression that you think she’s nuts, because she explains, like so:

    If you worked for a company that offered insurance, if you carried your family’s insurance, next year your insurer would slap a million dollar surcharge on the company policy for carrying a leukemia patient.  The company would get the bill and someone in accounting would question "what is this extra million dollars we are being billed?"

    The insurance company would explain to them that the million is for you, and it is yearly, but is, ahem, "fixable."  They will say "as long as she is on your insurance (wink, wink) this charge will be there.  So what you have to ask yourself (more wink, wink) is whether this employee is worth a million dollar a year salary on top of what you are already paying her."

    Social worker said she had seen small business owners go almost broke trying to cover this charge, and had even heard of one who defiantly did go broke, throwing all of the employees out of work.  But more usually, she said, they just fire you.

    "Wait, wait!" say you, "Isn’t it illegal to fire someone for their health history?  Suppose I’m all well and working?"

    She looks at you with more pity, says yes, so of course they will have to find "cause" to fire you, which any employer can always do.

    "But I am a very, very good employee!" you protest.

    "Yes," she says, "but they can always find some cause."  The real problem she goes on to explain, is that you will find a new job, that company’s insurer will slap them with the surcharge, they will take their turn at firing you, until you’ve been through six or seven jobs in a year, fired "for cause" from all of them, which of course looks very, very bad to a prospective employer.

    "So in a year or so of this, you will not just be uninsurable, you will also be unemployable."

    She asks who your husband works for, since they’d probably try to do this to him too.  You say he is a cop working for a municipality, which pleases her.  "They have all sorts of layers of officials, elected and otherwise, to work their way through to get to the decision, then once they do they have to get past his union, so it will take much longer to get him fired."  She also, though, offered sympathy for the fact that what with the police union and the municipality fighting out whatever "cause" they got him on in such a public profession, it was sure to end up in the local papers and disrupt all our lives – including the children’s – when they did get that far.

    You remind her you seem headed for divorce, and she says, well, okay then, just carry the COBRA to the limit and keep on working for small not-for-profits that don’t offer insurance.

    You ask her what you are supposed to do for health care and she says sooner or later the insurance companies would force you onto Medicaid – either by means of making you unemployable and broke, or by means of you being uninsured and going through any and all assets you have paying medical bills until you are broke and sick enough that you can’t work, and end up on Medicaid.

    Click through and read the rest.

    Fry, don't be a hero! It's not covered by our health plan!

    by elfling on Mon Nov 25, 2013 at 08:30:26 PM PST

  •  Absolutely - but even more important is this!! (9+ / 0-)

    For many years I was on the team that did health care insurance renewal for our company.  Did we as a company make the decision to change co-pays, deductibles, prescription drug co-pays, etc. ? As your diary notes, yes, in some years we did, but if we did we always tried to balance premium increase, co-pay and deductible increases, etc. to be at most 5% and we always tried to introduce improvements or options (vision, orthodontia, etc.) with any increase to keep the benefits a good value.

    But I can also tell you this - the insurance company changed the terms of our plans almost every year as well! Not by our choice, but the overall plans themselves changed, be it in co-insurance terms, deductibles, procedures/drugs covered, adding tiers to prescription drug coverage, and on and on.  I know the 7 years I worked on this, our plans' terms were changed by the insurance company in 5 of those 7 years.

    I have also been on an individual plan, and my brother is an actuary for Blue Cross.  He will tell you the same thing for that market - the insurance companies change the plans all the time.

    So the fact is - you NEVER have been able to keep the exact same insurance plan if you liked it.  NEVER.  The insurance companies change terms all the time.

    The key difference is:  the changes made by the insurance companies were to your detriment - higher costs, less coverage.   The ACA changes give you more and better coverage, even if in some cases it does result in a higher cost.

    This is a key argument that I wish Obama had made.

    Liberalism is trust of the people tempered by prudence. Conservatism is distrust of the people tempered by fear. ~William E. Gladstone, 1866

    by absdoggy on Mon Nov 25, 2013 at 08:36:24 PM PST

    •  I'm sure somewhere I have stuffed away all the (5+ / 0-)
      Recommended by:
      a2nite, ahumbleopinion, glb3, worldlotus, gmats

      various plan / provider changes over the many years I had a "real" job -- a time during which full-timers' (typically between 25-45 employees) coverage went from comprehensive medical / dental / vision / prescription plans paid almost entirely by the company, to useless crap barely qualifying as insurance with premiums -- which had huge increases each renewal period -- split about 50/50 between employer / employee (it may have been a 33/66 split by the time I left).

      No catastrophic health events within the group, pretty average risk pool (on the low-risk side in fact), yet even with weeks of negotiations with multiple carriers each renewal period, the best the company could usually manage was a not-insignificant rate hike for significantly less coverage with much higher deductible / co-pay / etc.  I'd be willing to bet that in the last couple years I was there the "insurance" company paid out exactly zero dollars for claims simply because they'd been allowed to jack the "kick-in" figure so high.  And by "allowed" I mean basically forced the company to accept just to keep the rate hike barely manageable.

      Not "affordable", not "acceptable", but "barely manageable".

      I can't think of any other industry that has been able to consistently get away with that type of coercive, monopolized price gouging. Hell, drug dealers have more scruples than health insurers.

      But hey - at least we have our Freedumbs, right?

      This is bowling. There are rules.

      by here4tehbeer on Mon Nov 25, 2013 at 09:38:37 PM PST

      [ Parent ]

    •  I was on an individual plan. (2+ / 0-)
      Recommended by:
      absdoggy, worldlotus

      What happened to my policy over the years is exactly what you have described.
      I'm now signed up with the ACA.

      A mirror is facial recognition hardware. Your narcissism is the software.

      by glb3 on Tue Nov 26, 2013 at 07:26:18 PM PST

      [ Parent ]

  •  Wasn't employer-based health insurance a kludge (1+ / 0-)
    Recommended by:

    Proposed in order avoid Euro-style single payer?

    •  Originally it was a WWII dodge of wage and price (7+ / 0-)

      controls. Loophole for healthcare insurance.  Kaiser gave his workers accident insurance, then pre-paid hospitalization which became Kaiser Permanente.  During the Depression there were some communes and "socialized" formats for teachers in Texas and some areas of New York, but the real bigge was WWII dodge for healthcare to get the best workers - the defense industry really went for it.

      Displaying a picture of House Majority Leader Eric Cantor (R-VA) and seven GOP colleagues sitting opposite empty chairs in a conference room, Maddow cracked, “Nobody learned anything from the Republican National Convention last year.”

      by sailmaker on Tue Nov 26, 2013 at 07:15:51 PM PST

      [ Parent ]

  •  Yep, pretty much the case with all (3+ / 0-)
    Recommended by:
    worldlotus, a2nite, Lencialoo

    employers I've had. The trend doesn't lie.

    Thump! Bang. Whack-boing. It's dub!

    by dadadata on Tue Nov 26, 2013 at 07:13:15 PM PST

  •  You've doing a great job on the ACA, Jon. (2+ / 0-)
    Recommended by:
    worldlotus, Lencialoo

    I'm really impressed with your coverage and analysis. Thank you!

  •  Employers really shouldn't be expected to pay (3+ / 0-)
    Recommended by:
    jbsoul, Lencialoo, Cordyc

    for employees health insurance and that's why Medicare for all makes so much sense. The extra tax on corporations would be more than offset by the savings in health insurance premiums.

    •  Agreed. (1+ / 0-)
      Recommended by:

      I totally agree that employers should not be on the hook for their employees' health insurance.  That should be the burden of a single payer entity.

      I would think most corporations and nationalists, who champion US industries, would agree with this statement.

      Why would a US corporation want to price products with its labor cost to include health care costs relative to foreign competitors that largely do not?


  •  So True (3+ / 0-)
    Recommended by:
    worldlotus, gmats, Lencialoo

    In 2003 I paid $60/month for me and my kids for medical and dental, with no deductible and a $10 co-pay for services.  This past year it was $118 /month for just me, $25 co-pay, $15 generic drugs / $30 or more for brand drugs, a $1500 deductible.  If I'd still had the kids it would have been almost $400 / month premium.  

    By current standards it was very good insurance, but it did creep up every year.  I paid for my mamograms, blood work and annual physicals out of pocket most years.

  •  There is a relevant issue here (1+ / 0-)
    Recommended by:
    Jon Says

    I couldn't care less about comparisons to alternate issues because none of that means anything compared with the fact that my employer is cutting my inadequate coverage back to $9,500 in 2018 and to prepare me for it my deductibles are increasing each year.

    $45 for a specialist right now and even though I need a specialist, after adding that up with several follow ups, I can't afford it. I'm not going for treatment. By 2018 in my well regulated Blue State that increases insurance cost it will probably be $90 for a specialist.

    At some point saving lives should trump saving face for Democrats. That $9,500 cut off that will only increase by normal inflation and will ignore medical cost inflation might just work in Texas but here is a state that has been controlled Democratic and the many laws have been passed to prevent the medical industrial complex from becoming a self will run riot, it dosen't work here. It dosen't work at all and with each passing year we are more and more screwed.  

    What Repugs and the media are saying is not what matters. What matters is that state workers and union workers in blue states are getting screwed out of affordable care by the affordable care act. The fact is that we are all being told by every employer "Never going to pay any tax on healthcare and it's not negotiable."

    •  Those stories linked in this are fact based (0+ / 0-)

      Employers have slashed benefits has no relation to the facts behind that $9,500 cut off.

      Don't ever looks at the facts unless it makes Obama look good. The fact that people are losing good coverage, no problem. Just point to previous act by employers and pretend blue collar blue state workers are not getting the shaft.  

      I've written about it many time. I gave up when I realized that it could never matter here. The (none/0) effect of lack of loyal support. But you keep explaining it to the media. I'm sure they are impressed.

  •  spot on (4+ / 0-)
    Recommended by:
    worldlotus, gmats, a2nite, Lencialoo

    This article is correct. I keep wondering who all these Americans are who claim they love their health insurance plan. The plan I have through my husbands work is a PPO with an HSA account, $5,000 deductible. It is really a catastrophic policy. There is a rediculous limit on how much we can have inthe account. It is 10,000 I think. Hardly enough if real care is neede. The system is bad and no one wants to fix it. Why do Doctors and hospitals stay so silent?

  •  My own history with health insurance (2+ / 0-)
    Recommended by:
    Lencialoo, bfbenn

    is instructive. I left the military in 1984 after nearly 11 years to fly for a major international air carrier. The union negotiated benefit had no premium, 80/20% co-insurance, low ~$250 individual/$500 family deductibles and an out of pocket limit that I do not recall. Our first time sharing premium costs came in our 1989 contract and have increased every contract since despite the percentage of sharing only changing tow or three times. That is after two mergers and an explosion of medical costs that doubled about every ten years since. My retiree cost sharing is 51% of the premium for very good health insurance that is not a financial burden to my family. I have no real complaint except that my share is more than double what it was prior to the merger.

    My company would love nothing more than to eliminate that expense for everyone and is a leader in whining about how much the benefit affects their bottom line. They have been leaders on the anti-PPACA propaganda front with several doomsday letters sent to employee and retirees this year. I'd love to know how the ACA has impacted their very successful campaign to keep most employees in HSA and HRA insurance. I do not know if they are ACA compliant but I'm sure they'd be screaming bloody murder if not.

    The past thirty years have been a boon to disaster capitalism. The corporate bastards never miss out on an opportunity to take advantage of a crisis, manufacture a crisis, or use a convenient situation to put the squeeze on middle Americans while they increase profits and their own bonuses.

    Time makes more converts than reason. Thomas Paine, Common Sense

    by VTCC73 on Tue Nov 26, 2013 at 09:02:28 PM PST

  •  Of course, this is nothing new (1+ / 0-)
    Recommended by:

    It is so frustrating to hear and read the histrionics, accompanied by deceitful examples as applied to the ACA.  There was and is a very important reason Obamacare is vital to the not only the welfare of our people, but the very economy we are desperately trying to improve.

    The old way could never be sustained. After 2008, when the financial and housing bubble broke and this country was facing a depression, our country was faced with many reforms that had to be set in place.

    Of course, the Republicans fought every step of the way, still fighting.  However, there have been reforms however modest because the work to strengthen the financial reforms and housing rerforms is just too hard for the Republicans in Congress to tackle.  They'd rather vote on repealing Obamacare over 44 times then roll up their sleeves and legislate change to protect our banking system and housing markets.  "Change," is what Obama pledged to do, so stifling and  obstructing any "change" keeps the Obama proposals from happening.

    President Obama was able to get reform and regulations in our health insurance delivery.  It requires the reform of this industry to finally give the policyholder what they are paying for; decent coverage for all unforseen human conditions.  No longer can your insurance company screw you.

    Once the ACA has a few years under its belt, we will see a leveling off of large increases in premiums, we will see less of our GDP (now we spend more than any nation in the world 17.7%) spent on health costs, and a dip in our debt.

    You must ask yourselves, why is the GOP, their media outlets, so bent on bad mouthing this monumental achievement?  I think the answer is pretty obvious.  

    Their whole election campaign rhetoric for 2014 and 2016 will be on the phantom Obama failures, failures which actually are not, but if they say they are enough, people will believe they haven't worked.  

    The regulation of our health insurance industry and those mandated requirements are just too good, most people will find that they actually are better off with Obamacare than they were before.  Success for Obama is something that just can't happen.

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