Dicey Solutions to ACA Costs

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Most employers that currently provide good benefits to their employees are starting to relax as the realization sets in that ACA is not going to bankrupt them. But employers with large uncovered workforces are starting to panic. And desperate times lead to. . .

I recently received a white paper on dumping sick employees. This paper represents that a self-insured employer (not subject to most state laws due to the ERISA exemption) could implement a health plan that covers preventive care and routine care of individuals participating in clinical trials—and nothing else. Further, this paper represents that a self-insured plan can use a disability-based coverage definition to exclude coverage for conditions such as diabetes, AIDS or hemophilia.

The paper supports a product called PanaBridge Advantage, offered by Pan American Life. The product combines three plans: 1. Essential, a limited-benefit medical plan offering the essential benefits mentioned above; 2. Essential, an ACA minimum-value plan; and 3. Plus, a comprehensive high-deductible plan.

Another product, OptiMed, offered by Fidelity Security Life, looks a little less radical. The brochure illustrates an Essential Bronze Plan that is ACA compliant. This plan is combined with a Gap plan to offset high out-of-pocket costs and a limited-benefit medical plan, which looks like a classic minimed. The theory is that an “affordable,” ACA-compliant plan is offered that avoids penalties, but it really won’t be affordable. Low-wage employees might find the low-cost, first-dollar minimed more appealing, since the upfront costs of a 60% plan render the minimum value plan useless to these workers. Of course, they would then face the individual mandate penalty.

With the redesign of healthcare, actuaries and product designers are working furiously to find creative solutions. CMS is going to be busy protecting consumers. Employers facing new ACA costs may be willing to roll the dice.

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