The Obamacare marketplace has a big problem—too many sick people and not enough healthy people. The problem is so bad that health insurance companies claim they lost billions of dollars and some are leaving the exchanges. Unless the federal marketplace can enroll more young and healthy people these insurers may never return. Another proposition outlined in a New York Times article by Margaret Sanger-Katz, is for the remaining states to expand Medicaid, which will bring down health insurance premiums for everyone.

In her article, Sanger-Katz refers to a study by the Dept. of Health and Human Services that concluded that marketplace premiums were lower (in the high single digits) in states that expanded Medicaid compared to those that did not. That is great news but it’s not enough to offset premium rate increases in the high double digits. For that we need exactly what the health insurance companies claim they want—a healthier risk pool. Moving employer-sponsored health insurance to the exchanges give us a healthier risk pool that will lower premiums, but there is strong opposition to this.

Employers want to hold onto their health insurance programs because they want to control how much they contribute to them. Health insurers want to maintain these plans because they can better predict their risk and set their rates to ensure they always make a profit. Employees want to keep their employer-sponsored coverage because they don’t want to assume the responsibility of choosing and paying for their own coverage. They also want to keep their employer and government subsidies.

Anyone who thinks that these strong powerful advocates for employer group health insurance are going to suddenly decide it is in the public interest to have one health insurance risk pool is mistaken. Individuals covered by employer health plans make up about half of the insured population. They are over 150 million individuals strong and it will take the other 150 million plus individuals to force change in our health insurance and health care system. And the first thing we other 150 million plus have to do is stop acting like workplace health insurance is more virtuous than other types of health insurance.

How minimum wage workers that are uninsured or underinsured rail against Obamacare because it extends free or low-cost health insurance coverage to the unemployed is perverse. They have bought into the notion that health insurance is for the employed or those who can afford to pay for it themselves. Like it is some exclusive club whose members are better than other health insurance club members and even better than those who belong to no club at all—the uninsured.

And if you think I am going a little overboard with the exclusive club thing, I promise you that I’m not. As Ron Shinkman reported in FierceHealthcare, an attorney for Parkview Hospital, which is being sued for charging an uninsured patient nearly three times what they would charge an insured patient for the same services, provided this gem to explain their billing practices:

"We don't think a person who is not a member of the club should get the benefits of the club," Parkview attorney Ted Storer said, according to the Journal-Gazette.

How Do We Break Up The Workplace Health Insurance Club?

• Increase regulatory compliance and disclosure requirements. We need to make maintaining a workplace health plan a very unpleasant job that employers are willing to give up
• Eliminate the favorable tax treatment of group health plans. We all know it is unfair that regardless of wealth, individuals enrolled in workplace health plans receive a government subsidy that reduces their health insurance cost
• Start a revolution. Bernie Sanders needs a second act and this could be it. Universal health care and employer-sponsored health insurance cannot coexist. We need to advocate for one health insurance risk pool and no one but Bernie has the support and courage to make it happen

Tags: obamacare, workplace health insurance, Subsidies