Personalized Care Act (ICHSA) Could and Should End Employer-Based Health Insurance

In 2016 I predicted that an individual health policy would be an eligible pre-tax expense by 2020. On January 2020, the Individual Coverage Health Reimbursement Account (ICHRA) was enacted, and employees for the first time in 75+ years could buy an individual policy with pre-tax dollars if their employer adopted an ICHRA.

In 2022 and again when interviewed in 2023 by the Freedom Hub Working Group ICHRA: The Key to Consumer Healthcare Empowerment (rumble.com) I said the ICHRA did not go far enough. An ICHRA still leaves the employer in control of adopting the ICHRA. We need to adopt ICHSA’s, making the premium of an individual health insurance policy an eligible expense under a Health Savings Account. An ICHSA would take control from the employer and give it to the employee.

I am not saying I am Nostradamus here or care to take credit for predicting change. I do believe it is important to look at the market and do a business risk assessment if you are in the benefits business. I wrote about this with my article, “A Zombie Movie and the Relationship to Trump’s HRA Changes“.

My belief, which I also believe is shared by the majority in Washington, is that it is our employer health insurance financing system that is driving up the costs of the underlying markets. Much like college education, the financing system drives the price of the product, not the other way around. If you give an 18-year-old who has no job and no assets $50,000 per year to purchase college, colleges will become country clubs. In health insurance, our financing system denies employee choice and therefore we do not have a true consumer market driven system. Our employer-based financing system is the root cause of health care cost inflation because it denies consumer choice that we have for almost every other product we buy in the U.S.

The ICHSA is now on the horizon. The Personalized Care Act, proposed by a group of Republicans (See article here: https://www.washingtonexaminer.com/news/senate/ted-cruz-seeks-expand-accessibility-healthcare-savings-accounts ) would make the premium for the purchase of an individual health insurance policy an eligible expense under an HSA, thus making the purchase a pre-tax expense.

If this happens employer-based insurance is over. Younger people working for many companies would be able to buy insurance on the individual markets often at prices lower than what their employee contribution is today for a group plan. Those under 30 could buy Catastrophic coverage at even lower costs. Young people leaving the employer risk pools would cause a death spiral driving up the costs for those who remain on an employer plan. Other employees would simply ask employers to give them the contribution they would have given them for health insurance in their pay, so they could buy a plan. Employers who don’t provide contributions for dependent coverage would result in almost all dependents, particularly younger ones, going to the individual markets.

I would add that I think most employers and employees would want this. Very few employers want to be in the middle of health insurance. I have written in the past that this is a misplaced responsibility.

This is a much-needed change and will begin the process of reconstructing our health care financing and underlying health care pricing system. Consumer choice should drive down costs, requiring the system to operate more efficiently to maintain profitability. This system is much like the Bismarck System used in other countries. The U.S. is not blazing a new path here.

Mike Pires and I started Enrichly (www.getenrichlyhr.com) anticipating this market shift. It is our belief that current benefits programs aren’t very beneficial for most. Employers want to help their employees, not impose high health insurance costs on them from ever growing employee contributions. Our Enrichly program is designed to enrich employee’s lives. By allocating existing benefit dollars in a different and more efficient way, we think employers can create more value for all their employees, not just those who are high health care utilizers.

Changing Health Care in America – Video

How to attack the root cause of a broken healthcare system

The following article was published in Employee Benefit News

More than half of Americans have reported medical debt of some kind, lamenting that it affects other financial goals. As a result, many are delaying care. So it’s not surprising that employers, with the guidance and support of their benefit brokers, have been trying virtually every trick in the book to control costs — with little to no avail. 

Some will claim that they have slayed this high-cost dragon, but I would argue that they have not, because most cost-savings solutions are only treating symptoms and not the disease. Individual short-term wins at controlling costs do not have any impact on the system as a whole, leaving the majority of Americans struggling.

Click Here to Read the Rest https://www.benefitnews.com/advisers/opinion/how-to-attack-the-root-cause-of-a-broken-healthcare-system

Employee benefits are inequitable — and it’s getting worse

Read my recent article as published in Employee Benefit News. See the link below.

As long as employers control employees’ healthcare, life-saving technologies will go underutilized

A familiar mantra about why health insurance is so expensive is that the cost of healthcare is expensive. I have always disagreed with this statement. It is the third-party financing through employers that drives the underlying costs — not vice versa.

Our current financing system provides inferior healthcare for many and inhibits adoption of new and emerging technologies. This often results in poorer health outcomes and, at times, even death. It also creates false vendor markets created by misplaced incentives.

But there’s an easy fix. By changing incentives, we can develop more efficient healthcare markets, better care and lower costs.

To read the rest of the article as it was published in Employee Benefits News click HERE .

TO START FIXING HEALTH CARE LET’S START WITH SOME TRUTHS (My Ideas)

This was my first post on my other blog titled, New Health Care for America. I am republishing this here because this is a different audience. It is intended to start discussion.

To start my blog about fixing health care I thought I would start with just making some comments that in my heart of hearts I believe to be true. These are random thoughts but my thoughts. Anyone who wants to add to them feel free to jump in.

Most Americans want everyone to have access to health care.

Providers of care, generally care. They want to do good.

Our chaotic pricing of health care is caused by our financing model. Everyone has a deal, and everyone is trying to push the cost onto someone else.

Our health care financing system is the cause of escalating health care cost. Fix health care financing and you will reduce health care costs. The insurance industry thinks it is the other way around. I disagree.

We will never fix the system until the incentives are properly aligned. Providers of care need to be rewarded for keeping people healthy and being efficient.

Employers don’t want to be in the health insurance business. Most would get out if they could.

Employers are blocking access to higher quality and more affordable health care. I will write about this one. 

I can lower my own costs easier than my employer.

Health insurance should not be tied to a job.

I want all my health care information in one spot.

Artificial Intelligence can possibly save my life. However, it can’t work if my data is scattered all around. 

I want my doctor to have all my health care information so he/she can properly advise me.

I don’t want my employer to be involved in my health care. 

I want my doctor to be incented to keep me healthy.

I am never going to understand how the whole system works so it better be easy or I need someone to guide me through.

On second thought, it should be so easy nobody would need a guide. 

When people have health issues, they don’t want to be worrying about how to navigate the system.

Low cost care, like office visits and tests, should not be insurance. Insurance is designed to protect oneself from an unanticipated event that could cause long term financial harm.

Health Spending Accounts are a good idea.

If the government wants everyone to buy insurance, then it should be with pre-tax dollars for all.

Everyone in the system thinks the other guy is ripping them off. Health insurers blame the providers and the providers blame the insurers. The brokers blame everyone. People should look in the mirror. 

The whole country can run on 10 health insurance options.

Revision – after talking to some people, I think we only need 5

Fee for service needs to go away.

Price transparency is a feel good, bad idea. It won’t fix anything. Which is why fee for service needs to go away.

Health insurance should not be a 1-year term policy. You insurance people know what I mean.

Health insurance should be a whole-life policy.

As long as we have rules that let people game the system, they will.

Employers are dumping their bad risks into the individual market if they can. This is one of the games.

The government is the biggest driver of escalating costs through tax policies.

Most health care dollars pay Americans. If we reduce costs 20%, who is losing?
I think we can reduce administrative costs to around 5%-7% but not under the current system.

Everyone should watch Mark Bertolini’s presentation to the Mayo Clinic. He presents the future of health care. https://youtu.be/7LVSj0JcD2A

Webinar Invite – Introducing a New and Transformative Employee Benefits Model

April 7 – 12:00 – 1:00 EDT

Register Now

We would like to invite you to be a part of something new that will transform the employee benefits business. Between new technologies, new laws, a changing workforce, and what we call the “new math” of employee benefits, the opportunity to help millions of Americans improve their financial health and access better health care is here. However, getting the message out and challenging the status quo takes an army. We want you to consider being a part of this movement, our army, to pave the way to a much better benefits and health care future.

In this webinar we will cover the following:

• Our Why – The Vision Overview
• New Technologies that enable this change
• The Old Math vs. the New Math of Employee Benefits
• The Solution Overview
• Improving Heath Care
• Benefits to Employers and Employees
• Target Market Opportunities
• Why and how you should be paid

We think this will be invigorating, exciting, and thought provoking. It will create a “spring in your step” because after you hear about what we are doing the creative mind will start working.

To register for this webinar, click on the Register Now link. Please note that this webinar is for select Benefits Brokers, Payroll Companies, HR Consultants, Retirement Advisors, and Accountants. N4one reserves the right to not accept someone into the meeting who may Register. If you have any questions and/or review your participation, please call 508-498-7591.

Webinar Invite – Deliver the Advanced ICHRA – Moving Beyond the Obvious

January 28th and February 2nd  – 12:00 – 12:30  EST

Register Now

You have probably gotten invited to many ICHRA Webinars. This webinar will be different. We think every broker will be able to deliver an ICHRA. We have the Advanced ICHRA. In this webinar we get into the weeds. We identify the gotcha’s. We bring ideas that most have never thought of. We will identify sales tips that can make a difference. Then we will introduce the Advanced ICHRA.

In this webinar we will cover the following:

• Review the Consulting Process
• Steps to Execute an ICHRA
• 5 Gotcha’s that Cause Problems
• Review of the Vendors
• Delivering the Advanced ICHRA
• How to Win with ICHRA’s in 2021

Don’t ignore the ICHRA. This will be bigger than most think. We get into the weeds identifying things few have considered. To register just click on the Register Now Button.

Webinar Invite – Bring a Unique New Benefits Solution to the Market

January 14th and 19th from 12:00 – 12:30 EST

Register Now

Do you want to challenge the status quo of benefits and bring a new idea to market that can grow your business? In this webinar we will introduce a new idea and demonstrate a new product we are bringing to market. We think the current benefits market is very broken and we will show you some data that supports this that will astound most brokers. Working with some MIT Technologists we have developed a new model that benefits consultants can deliver that can improve an employer benefits program and bring more value to employees.

The Agenda is as follows:

• Why the Current System is Broken
• The Data That Supports It
• A New Benefits Model
• The New Formula for a Modern Benefits Program
• The Marketing Campaign to Grow Your Business

If you would like to attend just click on the Register Now button. If you have any questions, please feel free to reach out to us at 508-498-7591.

N4one Launching New Employee Benefits Platform

We are happy to announce that our new employee benefits platform, “Employeaze” is launching on February 1^st. We do not want to share all the secrets publicly here yet, but this system fills some gaps in the market that we have recognized for some time. For brokers and others such as payroll companies or HR Consultants wanting to bring something new to the market, it is an opportunity.  For those who know me I have been consulting in the HR/Benefits/Payroll technology business since 2001. I have worked with hundreds of employers, implemented systems from over 30 vendors, and have tracked hundreds of vendors along the way. Our new solution delivers a whole new employee benefits model in a streamlined way to the small to mid-sized employer market. And no, we are not another benefits enrollment system. I think we fit in our own box right now.

For those interested in learning more, feel free to reach out to me and we can schedule a call. Send me an email @ joemarkland@n4onehr.com .