I really don't want my at-will employment status to be the arbiter of whether an unforeseen health issue will bankrupt me. Tying either private insurance or public insurance eligibility to your employer seems like a bad pattern we should be trying to get away from.
It's a bad pattern for the employee, but a good pattern for employers and the healthcare industrial complex. The possibility that you could be bankrupt if you let your insurance lapse is an enormous concern for employees that may want to leave but can't; much more powerful, and cheaper, than golden handcuffs.
COBRA is a joke, as if most could afford multi-thousand dollar a month bill when unemployed.
What that communicates to me is that those in power, both of the gov and of businesses, are primarily concerned with forcing productivity to make line go up than they are with incentivizing treating people humanely. But really I don't think that's so surprising considering the timeline we find ourselves in.
IME, COBRA is almost always a better deal than the marketplace offerings typically, unless you qualify for marketplace-only subsidies. COBRA premiums for whatever reason are hundreds of dollars (or more) cheaper than marketplace plans.
I've also had the opposite experience. My workplace plan through COBRA was around $500/mo, while only the highest-end marketplace plans were around that range. I took a middle-end plan at ~$300/mo.
To be fair I hadn't looked closely at what all my workplace plan covered, but I was doing physical therapy when I switched that wasn't covered (had to reach high deductible) on my workplace plan and was covered on my marketplace plan!
It depends heavily on location. When I last ended up on Cobra in California it was a touch more expensive than the marketplace plan but my work plan was much better than the best available on the marketplace so it was worth it to go Cobra.
And it’s great how your employer can change which insurance provider they offer every year and along with it your coverage, provider network, prescription costs, etc.
Sometimes even more frequently than once per year if an acquisition takes place.
It's a frustrating situation for employees (and their dependents) but the ability for self-funded employers to shop around and switch health plans is one of the only things that is preventing healthcare prices from rising even faster than they already are. Most of those "insurers" no longer really do insurance, they largely construct provider networks and administer claims on behalf of self-insured group buyers. Some payers drive harder bargains with providers and you can see significant price differences in the price transparency files.
Sure, the employer is doing what is best for them in the current system. Everyone is. But the results can be rough for real people to actually live with.
One of the big scary talking points when politicians start talking about changing our insurance system is that people like their current plans and doctors and are scared to change things.
I just think this is silly since my plan has changed roughly annually since I've been in the workforce due to a combination of employers shopping plans, employers changing ownership and moving to the new company's plans, and switching jobs.
An in-between step to single payer would be to let me pick a marketplace plan and then let my employer reimburse it directly, provider a voucher, or something like that. At least that way I have the freedom to switch jobs without entering a whole new health insurance world, and which health plan I pick is none of my employer's business.
Nice, I hadn't heard of that but yeah I think that's a much better system than employer group plans. If more of the market went that way, insurers would have to actually compete at a consumer level and not just offer "go away" pricing when you try to get insurance outside of a group plan.
