New rules encourage affordable worker health insurance

Stethoscope and chart

by Gregory Warner

The new health care rules are designed to encourage employers to continue offering health insurance to workers at a reasonable price. In return, employer benefit plans will be exempted from some of the expensive requirements of health care law. One facet of the new rules says that all new plans cover "essential health benefits" like lab work, prescription drugs and free preventive care. A business that kept within the White House rules would not have to do that.

A few other rules
One rule says that a plan cannot increase deductibles or co-payments by more than the rate of medical inflation plus 15 percentage points. So if medical inflation is 8 percent, an employer would not be allowed to jack up your emergency-room copay from $50 to $75, a 50 percent increase.

Another rule says employees can't shoulder a higher percentage of their medical costs than they were before. So if you were paying 20 percent of your bill for a heart bypass, you can't be charged 25 percent now.

Who is this aimed at, and will it work?

Business groups have been clamoring for an exemption like this. They don't want to have to rejigger their benefit plans to accommodate all the health care reform laws; they say that could cause a lot of disruption and expense.

Critics will say these don't provide businesses with enough incentive to keep their plans. When the government-run exchanges come online in 2014, some number of employers will drop their plans or give employees a check and tell them to go shop for themselves. Small and mid-size businesses would be more likely to take that step.

About the author

Gregory Warner is a senior reporter covering the economics and business of healthcare for the entire Marketplace portfolio.

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