Agree or Disagree? New Study: Even Subsidized Job-Based Health Insurance Has Become Unaffordable

[Duaine]

High out-of-pocket health plans have become a debt trap for U.S. workers.

A new study from the Commonwealth Fund confirms a pain that millions of American workers already know: having employer-based health insurance (or job-based, as the study calls it) is no guarantee that workers are protected from financial ruin if they get sick or injured.

The study, How Affordable Is Job-Based Health Coverage for Workers?, distills the costs of employer-sponsored insurance (ESI) across all 50 states and D.C. It shows that even with growth in income outpacing rising deductibles, premiums and out-of-pocket costs are still consuming an outsized share of low- and middle-income workers' paychecks.
Folks are feeling the squeeze. Nearly a quarter of the U.S. families with employer-based coverage spent more than 10 percent of their household income just on premiums and deductibles in 2023. That doesn't even count copays or coinsurance. In Mississippi, single workers are shelling out more than 5 percent of their income just to pay their share of premiums. Add deductibles into the mix, and it's clear: Tens of millions of American workers are underinsured by any meaningful standard.
[EXTERNAL LINK] - New Study: Even Subsidized Job-Based Health Insurance Has Become Unaffordable

 

[somarco]

EGH is making coverage "affordable" with higher deductibles & OOP while simultaneously making it unaffordable to get sick or injured.

Obamacare does the same thing. Highly subsidized premiums make the fixed costs affordable but limited networks, higher deductibles & OOP scares folks from seeking care . . . or if they do get care, they are left with expensive, unpaid medical bills.

The same is true about MA plans.

 

[Duaine]

The maximum out-of-pocket limit for plan years beginning in 2026 is $10,150 for self-only coverage and $20,300 for family coverage.

The limits for 2026 represent a significant increase—approximately 10.3%—from the 2025 limits of $9,200 for self-only coverage and $18,400 for family coverage.

 

[LostDollar]

EGH is making coverage "affordable" with higher deductibles & OOP while simultaneously making it unaffordable to get sick or injured.

Obamacare does the same thing. Highly subsidized premiums make the fixed costs affordable but limited networks, higher deductibles & OOP scares folks from seeking care . . . or if they do get care, they are left with expensive, unpaid medical bills.

The same is true about MA plans.

Or if a carrier offers the same plans on and off exchange, the employer may offer its employees the carrier's off exchange versions as its EGH plans and underwrite a small portion of the chosen plan's cost.

 

[LostDollar]

The maximum out-of-pocket limit for plan years beginning in 2026 is $10,150 for self-only coverage and $20,300 for family coverage.

The limits for 2026 represent a significant increase—approximately 10.3%—from the 2025 limits of $9,200 for self-only coverage and $18,400 for family coverage.

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What's wrong with Medical Bankruptcy? If it makes you that happy, everybody should get it.

 

[Duaine]

Send them all to the Poorhouses:

 

[sman]

I agree, it's becoming unaffordable. Just had a conversation with a church yesterday (16 FTE). I used to handle their group insurance. They hired a guy to handle all the day to day business and he decided to move them to a PEO type situation. Evidently this past year they all went through the Marketplace and got individual policies and the church is now paying about $14k per month on those plans. I ran a traditional group plan and the lowest premium was about $35k per month. I then looked at self-insured plans and we can get it down to about $12-13k per month. I may end up with the business, but that's a chunk of change for any business, especially a church.

If I wanted a plan for me and my wife, with say a $5,000 deductible and a MOOP of $16k, it would only cost me a little over $25k per year. So in a worst case scenario I'd "only" have to spend $41k for the year. Asinine. Even the highest deductible plan would be over $17k per year. With an $18k MOOP. We go to the doctor maybe 4-6 times per year combined.

It has become unaffordable for many. ACA was the Cloward-Piven Strategy (as it relates to healthcare) and nobody can convince me otherwise. Overload the system, make it so terrible that government then has to come in and "save the day". It's the precursor to universal healthcare.

 

[Duaine]

Church's have their own rules for "employee" health plans:

What types of health insurance are available for church employees?

Churches seeking health benefits for their employees have several options, each with its advantages and considerations. Understanding these options can help church leaders make informed decisions that best suit their organization and staff. Here's an overview of the health insurance types available:

HRAs (Health Reimbursement Arrangements)

HRAs are employer-funded plans that reimburse employees for medical expenses and, in some cases, insurance premiums. This arrangement offers flexibility and can be a cost-effective solution for churches. It allows employees to choose plans that fit their needs, while churches control costs by setting reimbursement limits.

QSEHRA (Qualified Small Employer Health Reimbursement Arrangement)

Specifically designed for small employers, including churches with fewer than 50 employees, QSEHRAs allow for reimbursement of medical expenses and premiums up to a specific limit. This type of HRA is particularly appealing for small churches as it offers tax advantages without the need to manage a traditional group health insurance plan.

ICHRA (Individual Coverage Health Reimbursement Arrangement)

ICHRA is a more flexible version of the HRA that churches of any size can offer. It allows employers to reimburse employees for their health insurance premiums purchased in the individual market. This flexibility makes ICHRA an attractive option for churches that want to offer benefits tailored to the diverse needs of their employees.

 

[sman]

Church's have their own rules for "employee" health plans:

What types of health insurance are available for church employees?

Churches seeking health benefits for their employees have several options, each with its advantages and considerations. Understanding these options can help church leaders make informed decisions that best suit their organization and staff. Here's an overview of the health insurance types available:

HRAs (Health Reimbursement Arrangements)

HRAs are employer-funded plans that reimburse employees for medical expenses and, in some cases, insurance premiums. This arrangement offers flexibility and can be a cost-effective solution for churches. It allows employees to choose plans that fit their needs, while churches control costs by setting reimbursement limits.

QSEHRA (Qualified Small Employer Health Reimbursement Arrangement)

Specifically designed for small employers, including churches with fewer than 50 employees, QSEHRAs allow for reimbursement of medical expenses and premiums up to a specific limit. This type of HRA is particularly appealing for small churches as it offers tax advantages without the need to manage a traditional group health insurance plan.

ICHRA (Individual Coverage Health Reimbursement Arrangement)

ICHRA is a more flexible version of the HRA that churches of any size can offer. It allows employers to reimburse employees for their health insurance premiums purchased in the individual market. This flexibility makes ICHRA an attractive option for churches that want to offer benefits tailored to the diverse needs of their employees.

None of that changes the outrageous premiums for health insurance for them.

 

[Jim Wright]

None of that changes the outrageous premiums for health insurance for them.

What state is the church in?