Several state legislatures are considering taking action in an attempt to force larger employers to offer health insurance to their employees. While there is considerable variation among the states, most appear to require large employers to dedicate around 10% of payroll dollars to health benefits.
I’m not sure this is Constitutional, legal or advisable, but it is clear that the level of frustration experienced by the middle class (read – voter) is growing. And their legislators are acting upon that frustration. According to the New York Times, the effort “underscores state lawmakers’ growing frustration with the progress of federal health care reform and the success of a union effort to turn Wal-Mart into a symbol of everything that is wrong with the system.”
It is remarkably easy to throw stones at Wal-Mart – while I won’t fault their desire to succeed in a capitalist economy, I do have problems with the company’s lobbying for state financial incentives, tax subsidies and abatements while thousands of their employees, who can’t afford or are not eligible for Wal-Mart-sponsored health coverage, receive their health insurance through Medicaid. This well-documented “double-dipping” at the taxpayers’ expense is highly unethical and inappropriate.
What does this mean for you?
While the effort to force employers to provide health insurance is doomed to failure, the larger message is clear – voters want health care reform. Expect this issue to finally rise to the top in elections this fall.

Matthew Holt has bravely published his predictions for 2006, with some surprising, some incendiary, and some intriguing perspectives. His observations on efforts to electronicize (my word not his) many of the patient – provider – payer interactions are worth reflecting upon.
One of the more intriguing is Matthew’s observation that payers are beginning to integrate clinical and billing data. Here’s the quote:
“2005 saw some of the first steps by major insurers to integrate what they know about patients’ clinical information with their administrative activity. Using technology from WebMD on an ASP basis, Empire BCBS has led the way here putting its members’ patient records online. It looks like the rest of the Wellpoint organization (which bought Empire last year) will adopt the technology this year. That will force competitors like United to follow suit.”
As an ex-United person, and one who still can’t understand how United could be viewed as the best managed care company in the country, I welcome the observation – if nothing else it validates my skepticism re UHG.
Matthew and I are both pretty skeptical about Consumer Directed Health Plans; while I believe they will grow substantially, I (and he) don’t see them as anything other than cost-shifting to individuals from employers and payers. That is not a value statement, but a definition. My bet is CDHPs will enjoy a brief but rapid growth in popularity, and may well represent the last gasp of the private sector before they implode. And when the middle class enrollees in CDHPs and their plan sponsors see that they do not resolve the underlying problem in health care (cost will continue to increase dramatically), the pressure on politicians to get this fixed will force change.
The rest is well worth a read and some reflection.
Here’s hoping I’m wrong and CDHPs work very well, health care costs come down, and access is dramatically increased. After all, the White Sox won the Series, so miracles do happen.