Employer Sponsored Health Coverage

The majority of non-elderly Americans get their health coverage through employer sponsored plans, but the ways those plans provide financial protection is changing. According to a new survey by the Kaiser Family Foundation, employers are increasingly relying on cost-shifting through high-deductible plans, higher premiums, and plans with larger co-pays. That means workers and their families have more to lose when healthcare costs spike.


Tools such as price transparency calculators and employee wellness programs are growing in popularity as consumers are pushed to treat healthcare purchasing decisions more like other household expenses. It may pay to shop around and avoid unnecessary office visits or procedures, but healthcare costs are not like other household purchases. Price tags don’t always communicate value, and high quality care is not one-size-fits-all. For some consumers paying more to get the care that suits their needs is the only viable option. The rise of narrow networks, which offer few choices of providers and hospitals in an effort to curb costs to insurers, exacerbates the problems these consumers face.


With wages increasing slowly, consumer advocates are on the alert for healthcare costs that prevent workers from seeking necessary, high-quality care. Nobody should forgo a trip to the doctor when they’re ill because they can’t meet their deductible or afford the copay. The American narrative of employer sponsor health insurance only works if employees aren’t impoverished the moment they need services.

birth_control_supreme_courtGuest post by Lois Uttley, Director, Raising Women’s Voices – NY

The Supreme Court’s decision this week in the Hobby Lobby case is a blow to the hard-fought campaign to ensure that women have affordable health insurance coverage for contraception. The court, in a 5-4 ruling, said that family-run corporations like the crafts chain store Hobby Lobby can refuse to provide contraceptive coverage to their employees if the owners say contraception violates their religious beliefs.

Women’s health advocates are concerned that the decision could begin to undermine valuable gains for women’s health and economic well-being that we’ve started to see as a result of the Affordable Care Act’s Women’s Preventive Services provisions. Last year, the share of women with no out-of-pocket costs for the types of contraception covered by the law increased to 56 percent from 14 percent only one year earlier. The contraceptive coverage mandate saved women an estimated $483 million in out-of-pocket spending last year, according to the IMS Institute for Healthcare Informatics.

Prior to the Hobby Lobby decision, the Obama administration already had exempted purely-religious organizations, such as churches and seminaries, from complying with the contraceptive mandate. In addition, the administration had fashioned an accommodation for religiously-affiliated non-profits, such as Catholic hospitals and nursing homes, that allows them to shift the burden of providing contraceptive coverage to their insurance companies or third-party health plan administrators.

The court’s ruling carves out an exception to the contraceptive coverage mandate for another type of employer (so-called “closely-held corporations” in which more than half the stock is held by five or fewer people), when the owners of the company (such as the conservative Christians who own Hobby Lobby) have religious objections to contraception. By some estimates, as many as 90 percent of all corporations are closely-held entities, and they employ about half of American workers. Hobby Lobby runs more than 600 stores across the country, with 13,000 employees.

Justice Samuel Alito, who authored the majority opinion by five male judges in the Hobby Lobby case, suggested that the employees of corporations like Hobby Lobby could still get contraceptive coverage if the government granted those companies the kind of accommodation already in place for religiously-affiliated employers, or if the government simply paid for their contraception. However, the accommodation is being challenged in separate lawsuits by religious entities. Moreover, Justice Ruth Bader Ginsburg, who authored the dissent that was joined by the other two female justices, wondered:  “Where is the stopping point to the “let the government pay” alternative?  Suppose an employer’s sincerely held religious belief is offended by health coverage of vaccines or paying the minimum wage […] or according women equal pay for substantially similar work […]?”

The Hobby Lobby decision was the first time that corporations were granted legal protections under the federal Religious Freedom Restoration Act for the religious beliefs of their owners, a step that was very troubling to Ginsburg and the dissenters. “The exemption for these employers from the requirement to provide contraceptive coverage would deny legions of women who do not hold their employers’ beliefs access to contraceptive coverage that the ACA would otherwise secure,” Ginsburg wrote.

Fortunately for women in New York State, the decision and the federal RFRA does not apply to state contraceptive coverage laws, such as the Women’s Health and Wellness Act in New York. The Women’s Health and Wellness Act requires employers to cover contraception, as well as other important women’s health services. This state law was upheld by the state’s highest court, the Court of Appeals, which rejected a challenge by religious groups in our state.

No grandpa for you!

There is an article out in the Associated Press that seems to be raising a lot of eyebrows across the internet this morning.  Titled, “Like your insurance? You may be losing it,” it explains how a lot of folks who currently have limited benefit health coverage may have to upgrade this coming fall.

This information may seem to fly in the face of what many folks have been told about Obamacare: “If you like your coverage, you can keep it.”  While this may still hold true for a lot of folks, the devil – as always – is in the details.

Most health plans that existed before the ACA was signed in March of 2010 were eligible for grandfathered status.  This means that they are exempt from having to provide most (but not all) of the comprehensive benefits and consumer protections that the ACA requires.  But, if in the past three years or so, the insurer or the employer have made significant changes to a plan’s benefits or how much members have to pay, then the plan would have lost its grandfathered status.

So, there you go.

This should not be cause for panic. Chances are, if your current health plan is a good one, then it probably meets the requirements set forth in the ACA (or has already changed to do so), in which case you are fine. Those who may have to get a new health plan are the folks with non-grandfathered plans that have not changed to meet the new requirements.

This is not a bad thing. Yes, folks might be confused about it at first. Yes, some folks will end up having to pay more. But the new benefits and consumer protections will mean better health insurance and greater financial protections for you when you get sick.  And you will get sick.*

The important thing to keep in mind here is that people need to be vigilant of their health insurance. Talk to your HR department and find out if your plan is changing (which may or may not be due to Obamacare). If you buy coverage on your own, just keep an eye out in the mailbox for a notice from your insurer or the Department of Financial Services. If your insurance is being discontinued, and you need help figuring out your options, you can always get free help from Community Health Advocates by calling (888) 614-5400.


*I use the term “sick” catch-all term for any illness or injury (even good ones like childbirth) – physical, mental or dental – or even just plain growing old. 

Coverage choices

Thanks to the Affordable Care Act (ACA), more than 1 million uninsured  New Yorkers will newly have access to affordable health insurance options starting this fall.  That’s a lot of folks who will need to wade through a lot of new information in the coming months.

HCFANY will be holding a briefing in New York City on Thursday, March 7th at the Interchurch Center from 9:00 am – 11:30 am to go over the necessary public outreach and enrollment efforts that will need to happen in order to ensure that the greatest number of New Yorkers benefit from the ACA.  Specifically, we will be going over the following questions:

  • How will New Yorkers learn about new health coverage options?
  • How is New York State going to reach out to and sign up the uninsured?
  • What will individuals, families, and small employers in New York l need to know?
  • What’s to be gained if we do it all right  (…and at risk if we don’t)?
  • What can our elected officials do to help make it go smoothly?
  • How can groups across New York contribute and participate?

This meeting is open to all New York members, allies, colleagues and new friends in the NYC area.

For more information, or to RSVP, click here!