You can’t compare what isn’t getting measured
| AFSCME's 2026-2027 contract barely passed and obviously does not keep up with increasing costs of living. Multi-unit collective bargaining somehow thankfully did retain (against inflating costs that all the while were hidden in plain sight behind Obamacare's ACA subsidies) health plan premiums that seem very little-changed from the previous contract. 1 In Gallup's recent poll of 18,400 workers, in many kinds of employment, only 40% said they have jobs that "provide financial well being, safe and respectful workplaces, some control over their work, a voice in decisions that affect their job, and opportunities to build skills and advance." Those five criteria for defining a 'quality' job become four when apathy, distraction, cynicism or burnout throw away the most basic affirmation an individual worker can make: a contract vote that 'says' for each member separately on an individual level whether or not the proposed contract will uphold acceptable workplace quality in fair pay, predictable hours and access to advancement. | |
| Embedded Plan Structure | In auto insurance jargon, policy coverage limits or deductibles can be "stacked". What comes to mind is Russian dolls..... When health insurance embeds an individual deductible within a concurrent family plan, the single deductible precedes on top of the family deductible, which applies to the total combined expenses of all members. Any one or combination of covered members' cost can serve to meet the family deductible so that everyone benefits once that number is met. Got that? Embedding of deductibles is an actuarial magic trick best pulled off with large groups, not individuals, the State Minnesota has over a hundred thousand public employees. Keeping that many employees in jobs under one contract? Yeah, that's magic. Why even bother mentioning a separate family plan, when there's for sure more buck but maybe less or the same bang? The Affordable Care Act required 'family' OOP max coding nominally appear in open enrollment materials but statistically this coding offers little value for ‘families’ of less than three members: single parents, childless couples or any kind of fertility-limited family that comes up short on enough actuarial 'critical mass'. 2 The full effect of the 2025 U.S. Congress ending $1 trillion ACA subsidies to states, timed exactly coincident with peak years of baby-boomer retirements, is not clear. Increasingly longer clinic wait times, for appointment scheduling and at ER triage, look likely if not already evident. |
| Employer pros | Once the individual hits their limit everything is free for that individual but if the other family members continue with medical needs, they can still have bills up to their own individual limits or until the total family limit is reached. Embedded plans have significant cost savings for employers that are blessed with a healthy workforce. |
| Employer cons 3 | More complex to administer than traditional plans, an embedded plan risks dissatisfaction among employees who already face, or believe are likely, unavoidable medical expenses. Traditional plans cost more than embedded plans, it becomes guessology squared trying to anticipate in juggling uncertain effects when there are two deductible thresholds in play instead of one. A workplace benefit less easy to explain makes it harder to attract and retain top-tier talent. Nuanced and involved plans require more time and more expensive expertise to finesse communication with employees, potentially putting more confidential health information in play, even if that is not intended. |
| Employee pros | Offers more flexibility for staffing by attracting younger workers undergoing the risks and extra expenses unavoidable in starting and growing a family. Minnesota's new Earned Sick-Safe Time law helps parenting in the private sector and is about to take full effect, name one working parent who has never had to struggle finding affordable daycare or decent health care insurance. 4 |
| Employee cons | Embedded plans are the most complex health insurance structure, with both family and individual deductibles to consider. In a workforce with less healthy worker demographics, families with high medical expenses can experience more stress from unplanned higher upfront costs. |
Health Care Homes, Chapter 358, Article 2 (SF 3780) added Minn. Stat. §§ 256B.0751; 256B.0752; and 256B.0753, becoming effective August 1, 2008 to start a large sweep of many health care reforms. Health-care delivery and related costs steadily keep inflating, surging, until finally at some point on 'non-profit' balance sheets, such as the cliff-drop that is the lapse of ACA medicare subsidies, systems with large sunk costs in bricks and mortar expansion, and it seems many over-worked, under-paid staff, blew the whistle and dropped the flag. Out the window went a few medicare miracles and any credible way for comparison with other clinic systems under criteria such as State of MN “Health Care Homes”.
Were statewide health measures a virtue signal, care quality studies a grandstand that government cares? And now have unprofitable, un-elected non-profits, in disconnecting fixes legislated by the elected, cured their shortfalls by exposing there isn't enough charity in the world to cover an even worse wound?
Ending educational liaisons with university medical schools happens exactly as everyone, young, old, working, looking for work, has never been more aware AI is never going to be better than an educated, skilled, trained, effective, compassionate and caring human healer.
References
1 https://www.reddit.com/r/HealthInsurance/comments/1m40l3a/i_dont_understand_the_point_of_family_deductibles/
2 https://www.cbo.gov/publication/59899
The Demographic Outlook: 2024 to 2054 | Congressional Budget Office
3 https://www.google.com/search?q=embedded+deductible+fertility+profitability+analysis
4 https://jamanetwork.com/journals/jama-health-forum/fullarticle/2838753
Improving Implementation of Fertility Preservation Benefit Mandates