Summary: Seemingly obscure regulatory battles can make a huge difference. Here’s one case, about stop-loss insurance regulations and self-insured employers, from an opinion piece in The New York Post. “Before switching to self-insurance two years ago, Pharos faced double-digit premium hikes for conventional insurance coverage every year,” writes Kevin Pickhardt, CEO of Rochester-based Pharos Systems International. “Since we started self-insuring and building our wellness initiatives, our health costs have dropped significantly and stabilized from year to year. We haven’t had to raise our employees’ health-care contributions for three years. That will change unless the Legislature fixes the legal definition of ‘small employer,’ which dictates whether a firm like ours can self-insure. A 25-year-old state law prohibits ‘small employers’ from purchasing ‘stop-loss’ insurance (a form of coverage that reimburses self-insured plans for medical claims exceeding a certain, relatively high threshold). Without stop-loss, a single catastrophic event — like a cancer diagnosis — could threaten our business. In 2012, the state changed the definition of ‘small employer’ from one with fewer than 50 workers to one with fewer than 100 employees. Conventional health insurers, seeking more customers, lobbied for the change. Together with their allies in the Legislature, they argue that the conventional insurance market is faltering and needs premiums from mid-sized firms with healthy workforces to stabilize.” Kevin Pickhardt, “Why is New York killing health insurance for my employees?” The New York Post.
Jeanne Pinder is the founder and CEO of ClearHealthCosts. She worked at The New York Times for almost 25 years as a reporter, editor and human resources executive, then volunteered for a buyout and founded... More by Jeanne Pinder