It means the employer has to offer a sufficiently generous benefit so that enough of the company’s lower income employees sign up for it, such that it passes non discrimination testing rules. Which means the health insurance benefit must be good enough that even the lower paid employees find it makes sense to sign up for it.
No, exactly the opposite. ERISA is a Federal law that strictly regulates how plan fiduciaries can operate employer-sponsored health plans. A key element of ERISA is that an employer cannot offer more generous benefits to some employers over other; everyone in the company must be offered the same plans, and within each plan, every beneficiary must be treated the same.
prior to the No Surprises Act just signed (and maybe after too?) ERISA allowed for balance billing. Which means not even California laws against balance billing would apply.
For anyone not living in the permanently-fucked US, an explanation: your health insurance covers you for "in network" doctors at an "in network" hospital. If you go to an "in network" hospital you would assume (wrongly) that you are fully covered. But no. Some random anesthesiologist can come into your room, provide their service for 20 minutes, and stick you with a $5,000 bill because they are "out of network". And you have ERISA insurance and you are just plain fucked.
Anyone getting health services in the US must hang a sign on their door saying "In Network Only". I'm 100% serious. Every person that walks in your room must be vetted. And good luck if they can't find an "in network" surgeon for that emergency service or whatever.
Full disclosure: I work in this industry and am a claims adjuster on fiduciary plans that fall under ERISA
Everything you're saying is partially correct, but it heavily depends on the specifics of the plan. FAANG companies, in particular, typically have extremely generous PPO plans that offer 0 co-insurance and broad networks. You're correct that, out-of-network, balance billing may occur, but Amazon's plans have networks so broad that this is unlikely to happen.
In addition, if you look at Amazon's plan documentation, they also offer a Kaiser HMO for which none of this applies.
There's a lot that can be improved around price transparency, but Amazon is one of the few companies that offers Cadillac gold-standard insurance, and because ERISA requires that all employees receive the same benefits, this extends to their full-time warehouse workers too.
> but it heavily depends on the specifics of the plan
> Amazon's plans have networks so broad that this is unlikely to happen
I mean, this doesn't sound reassuring you know. "unlikely" and "depends on the specifics". That's kind of the problem. No one knows what is covered and what is not. Billing in the US is this labyrinthine thing where hospitals, doctors, and insurance all seem to be making it up as they go along in conjunction with whatever they feel are the laws and whatever they feel like they can get away with. Leaving it up to the patient to appeal after appeal after appeal on a flood of bills they will receive, depending on their operation or service.
You can't even get a detailed bill out of some of these places. The doctors vanish and you're literally stuck talking to one of those robocalling bill collector agencies, which probably has a PO Box in fucking Alaska. It's shady as hell. All of it.
Believe me, you're preaching to the choir. I personally adjudicate claims, and some of the stuff I see is downright asinine.
All that being said...
> I mean, this doesn't sound reassuring you know. "unlikely" and "depends on the specifics". That's kind of the problem. No one knows what is covered and what is not.
"American healthcare in short:
~60% (in good employer plans, generous state Medicaid, or M.Adv/Medigap) have the best healthcare in the world.
~30% have insurance with gaps/risk of big bills.
~10% uninsured must rely on uncompensated care, go without treatment, or risk bankruptcy
The strength of M4A proposals is that they begin with an understanding that the 40% exist and need things fixed.
Their weakness is that they pretend that the 60% don't, and threaten to take away what they have."
Amazon is, pretty reliably, part of that 60%; it offers some of the best employer health coverage out there. Like, it doesn't even compare to public health plans in a lot of the world.
All of the problems you brought up (labyrinthine systems, appeal processes, bill collector agencies in Alaska) are real problems that you and I agree need to be solved, but they're also problems that don't afflict beneficiaries of generous plans paid for by rich companies, and that's what we're talking about in the context of Amazon Warehouse workers.
Most FAANG companies cover all of the premium amount. The only difference is in the deductible. Some engineers might choose a higher deductible plan so that they can take advantage of an HSA and enjoy the triple tax advantage. Warehouse workers are probably better off choosing the $0 deductible HMO plan that Amazon offers.
