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by aksss 1974 days ago
We should not ignore the attempt to relax restrictions on Association Health Plans in 2019, which would have made it easier for small businesses to band together to negotiate insurance terms using combined group numbers on par with that of larger corporations. This was struck down by a federal court[0], but would have moderately improved one of the biggest barriers to small business ownership/employment - unobtanium health insurance. This was a huge loss of something almost great.

[0]https://www.shrm.org/resourcesandtools/hr-topics/benefits/pa...
1 comments
lotsofpulp 1974 days ago
The better, and simpler option is to remove employers from the equation entirely. Either go with taxpayer funded healthcare, or force everyone to buy from healthcare.gov where they can choose whichever insurance company they want.
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aksss 1974 days ago
In terms of moderate tweaks to an enormous problem, AHP reform for small businesses is comparatively low-hanging fruit that could help businesses today meet the minimum requirements for attracting talent - health insurance. Your proposal may be better in the long term, but the journey there is not simple by any means.
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lotsofpulp 1974 days ago
My proposal could be done immediately. All the infrastructure already exists. Remove the tax deduction for employers, give it to individuals on healthcare.gov, job done. Or ban employer sponsored health insurance and don’t offer anyone a tax deduction.

Either way, it’s all just a matter of changing regulation. The real problem is big business will lobby against it because it gives them an advantage over small business, and a leash on employees.

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aksss 1974 days ago
> immediately

Theoretically only, perhaps. I feel like you're overestimating the ability of our regulatory bureaucracy to implement change, or assuming that if you (or I) were dictator the proposal could be done immediately. But imagine flushing out that proposal nationally, getting it through the Legislature (with all the conflicting interests of the medical field, employers, etc), President and then implementation. Comp structures nationally would radically change, so such an overhaul would have to be phased in even if you did get through the gauntlet of bill approval.

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lotsofpulp 1974 days ago
Getting it through legislation is the only problem is what I mean. People can already purchase insurance on healthcare.gov. The infrastructure, the sellers, the pricing is all ready to go with no work. The insurance companies already do the same work so it’s not even like they need to hire people. It’s just cutting out a middleman.

Only politics is in the way, and current entrenched interests not wanting to lose their advantages.

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