A recent study by Rogers et al appeared in Health Affairs, “Interruptions in Private Health Insurance and Outcomes in Adults with Type 1 Diabetes: A Longitudinal Study.” The findings indicated that for those with chronic diseases (Type 1 Diabetes in this case), the loss of insurance exacerbates their condition markers and lowers one’s perceived health and satisfaction with life. With the enactment in 1985 of the Consolidated Omnibus Budget Reconciliation Act (COBRA), and more recently, with the ACA Healthcare Marketplaces and Medicaid expansion there have been attempts to mitigate these observations. Though each has improved, there is much work to be done.
One dynamic is that the workforce is becoming more mobile, moving from job to job, or even career to career more often. Thus, as an employer, not only do I lose an employee in whom I have “invested” in their healthcare, I also gain employees that others have similarly “invested.” Businesses feel the impact of insurance gaps as the movement of workers from one job to another is constantly transpiring. Thus, there is value in guaranteeing coverage is continuous. Although viewing it this way, might be considered as a “pay forward” mentality; it is a much more a concept of “high tide raises all ships.”
So, what does this look like? As employer-based insurance is heavily funded by the company, COBRA which is purchased outright can be expensive for the purchaser; therefore, when one must carry the full costs, it can be cost-prohibitive. One possible solution, for a specified period, would be the creation of a tapering ex-employer payment that is cost subsidized for those with chronic illnesses. The offset of pricing for this coverage is through the avoidance of increased costs to the next employer. This approach assumes that the same situation occurs for those employees joining a company. Using this methodology requires contemplating the issue of insurance on a more global level, where all employers share in the common good.
Another consideration is to think about using governmental payment models such as Medicaid for short-term employee needs. Since the beneficiary would be the industry, there is a requirement for a pooled funding mechanism.
For us to move forward with a solution, we must study the results and design of the present structures in place. Instead of questioning whether they are working or not, we must think about how to adapt, revise and adjust to this ever-changing environment. After all, a healthy workforce benefits both the individual and society.