Employer-Sponsored Health Plans versus the Potential of a Government-sponsored plan – What’s the Answer?




As an HR practitioner with more than 35 years of experience in benefits design, I often wonder if there was an easier way to administer health care in our country.  I quickly talk myself out of that thinking, especially working in California.

Since the Affordable Care Act (ACA) repeal and replace efforts are off the table for the foreseeable future, there’s a new health care debate taking shape in the Halls of the Capitol in Washington, DC.  A plan that would mirror a Medicare-for-all is in the works in Congress and is gaining traction among lawmakers.

The U.S. has long since been the land of employer-sponsored plans.  California was at the fore-front of the HMO movement, and you can’t move anywhere in California without running into an HMO.  As traditional PPO plans dissolve for the new wave of High Deductible plans (or consumer driven plans), plus as states regulate insurance differently, would the U.S. ever be able to be united in one health care system?  Given that the country is still divided about the overtime provisions, something more complicated like health care would take years (or decades?) to debate, let alone implement.

As we think about employer sponsored plans, they are more expansive, have a wider range of coverage, and provide employers with flexibility.  Tailoring coverage to an employee population is one of the hallmarks of choice in employer sponsored health care.  In return employees have choice with regard to providers or primary care physicians and have access that can been seen as over-arching for services from hospital choice and durable medical equipment, i.e. crutches, walkers, and CPAP units.

My concern about a government-sponsored or a Medicare-type-plan-for-all stems from watching my own parents now navigate Medicare in their retirement years.  Medicare is not expansive and does not offer comprehensive benefits that is covered in a traditional (or more expansive) employer-sponsored-plan.  I’ve seen my parents and retired employees add Medi-gap coverage (to cover things like crutches) plus a supplemental policy to cover what they traditionally were accustomed to receiving in their employer-sponsored plans prior to retirement, such as low office co-pays.  Frequently, adding a pharmacy plan or increasing coverage in Medicare Part D is necessary as a person ages and require more medical services.  If a person had Medicare only, the number of hospitalization days is shorter, and health care becomes more cost prohibitive because the out of pocket costs can drive a person to not advocate for their own well-being.  Medicare can be bureaucratic where access is granted for some and denied for others.  Appeals can be costly and detrimental.  Ultimately, this will reduce access to health care and discourage Americans from seeking medical attention, until the situation is dire.

Finally, who would pay for government-sponsored-health-care, I can only imagine a new type of tax to do so.  What would you prefer?  Me?  I prefer to stay the course with current employer sponsored plans.



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