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Excellent article from James Capretta on the huge growth in ACA subsidies for middle-income families.
It used to be that if you lost job-based insurance, you might be in serious trouble due to higher prices and pre-existing conditions.
The ACA has virtually turned that on its head. The ACA has virtually turned that on its head, though this is not widely known yet.
My only debate with Capretta is that he might be too loyal to the economist’s model about health insurance being just another form of income.
Let me explain. After age 65 I had two different jobs. In each instance, I went to the employer and told them that since I was not taking their health insurance, they should give me a higher salary. After all, the total compensation would be the same.
Both employers told me to forget about it and get back to work. They were looking on health insurance as a bonus, and if I did not need it, so much the better for them.
I will add another reason why I doubt the economist’s model about health insurance and total compensation.
Let’s say you are a skilled auto mechanic.
You work in the motor pool for the state’s vehicles in St Paul MN.
Your compensation is $50,000 plus health insurance that is worth another $8,000.
Now you go job-hunting. You are interested in a small family-owned garage that does not offer health insurance.
In the economist’s model, the small garage would offer you $58,000 and let you buy your own health insurance. (albeit with after tax dollars.)
But in the real world, the small garage would likely offer a salary of $45,000….and no health insurance.
I suppose there are some circumstances — say in computer consulting — where employers feel obliged to match the total package of the big generous firms.
But mostly they don’t do the match.
The problem is that $8000 is only a company-wide average. Any employee requesting cash in lieu of benefits has just identified himself as having low health expenses. The company could conceivably offer $2000 to the employee to opt out, but I imagine that would cause other problems. Easier to simply ban the practice and say it’s company policy.