6 surprising facts about healthcare reform

April 14 2015

I'm a bit of a healthcare reform nerd, largely due to my experience as an entrepreneur trying to keep myself, my family, and my employees insured while bouncing from company to company and state to state. At one point, due to seemingly imaginary "pre-existing conditions" I came very close to not being able to buy insurance for my family at any price, despite us all being healthy.

So I was glad that the Obama administration had the guts to push the Affordable Care Act through, even though it ended up being a Frankenstein's monster that's almost fatally compromised by the various concessions to industry that were necessary to ensure its passage. Nevertheless, it's built on a solid foundation of good ideas.

But here are some of the mostly-unintended, especially nutty aspects of the law. Some of them are pretty harmful, in large part because people don't know much about the ACA other than the spin that the talking heads are making, pro and con.

Did you know....

...that many companies are screwing over their employees while they think they're doing something good? Offering insurance to employees' families (especially if you don't offer a generous contribution toward family coverage) locks them out of eligibility for subsidies, and millions of workers would actually be better off today if their employers out-and-out dropped their health plan?

...that signing up for COBRA could be a very stupid thing to do (because what you should do if you lose your job is immediately sign up for an Obamacare plan, and staying on COBRA makes you ineligible for a money-saving subsidy), but your company is still required to send you information that tells you to sign up for COBRA?

...that by giving your employees a rich health benefit, you are in many cases actually doing them a big disservice, especially if they're young? (Because many employees would actually be better served by being signed up for "cheaper" health insurance if they're healthy and having the extra money redirected into their paycheck)

...that under the current norms of health benefits, many companies may have two people with the same job and same salary but one makes 50% less in total compensation? (because if you have a big family, it's not uncommon for one person's health benefit to be thousands of dollars higher than another's).

...that if your state hasn't expanded Medicaid, you could be locked out from Obamacare subsidies because you're too poor? (In this case, if you made just a little bit more, you could save thousands of dollars on health insurance) If you knew that, did you know that the IRS has said it's okay if you exaggerate your income in order to get the subsidy? (But nobody knows this)

You might know that you can now only sign up for health insurance during an open enrollment period. Did you know there's a loophole that would allow you to sign up for a new health plan any time, even if you wouldn't normally qualify for a special enrollment period? (Apply for Medicaid, even if you know you make too much. Being formally turned down for Medicaid triggers a special enrollment period).

So, dear Listservers, if you find any of these fact interesting and illuminating, let me know. In particular, if you're a business owner that would like to do right by your lower-wage employees and find out how you can find win-wins in Obamacare, let me know. That's what my company, Benefitter, does. If you're in the media and you'd like to do a healthcare reform story that will surprise and outrage people, also let me know, and I'll give you more details.

David Adams
[email protected]
San Francisco, CA

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