Why Is Health Insurance Tied to Employers in the First Place?

This week has been reason #972 why health insurance should not be tied to employment. This whole year has proved this, in spades—that millions of workers could lose their health insurance because they were laid back in the middle of a global pandemic alone should be reason for changing the system—but the Supreme Court’s approval of Trump’s wide exemptions to birth control coverage has emphasized again the problems inherent to this system.

Does it make sense that your employer should decide what your health insurance covers? No. No, it does not. It really, really does not. This should not even be a debate. Your employer should not have that level of control over your life. Period. Does it matter that this is about birth control? Sure. But you know what? I also wouldn’t want my employer deciding not to cover my children’s vaccines, because they’re an anti-vaxxer.

It’s not incidental that this is about birth control. If this were about Viagra, the discussion would likely look very different. We live in a country that is still governed largely by men. We live in a country home to numerous religious groups that do not believe women should play an equal role in our society to men. This should not be ignored.

But.

I also think we need to ask a slightly different question—why is health insurance tied to employers in the first place? It should be clear and obvious that this connection would bring with it inherent problems.

I already noted that an anti-vaxxer might try procuring plans for their employees that exempt vaccine coverage. The law requires health insurance to cover vaccines, yes—but it also initially required health insurance to cover birth control. I don’t see any reason why things should be so very different for employers with a strongly held anti-vaxxer position—particularly when many anti-vaxxers work to portray their position as moral or religious.

And then there are Jehovah’s Witnesses, who oppose blood transfusions. Should Jehovah’s Witnesses get to decide whether or not their employees have blood transfusions covered? What about people who are anti-trans? Should they be able to choose not to cover their employees’ hormones? (Oh wait, they already are.)

This isn’t complicated: anyone who values freedom should be able to see that letting employers decide what healthcare their employees have access to is a problem. 

Company towns, anyone?

And it’s not just all of the above reasons that are a problem. My husband’s employer just switched insurance companies, which forced us to once again double check that all of our healthcare providers are in network. Fortunately, they were. But what if they hadn’t been? Our employer’s choice to change plans could have forced us to leave a trusted family doctor, and there would be absolutely nothing we could do about that.

And then there was the time my husband got a new job, sometime back, and there was an inexplicable month-long gap between the coverage provided by his old company and his new employer, even though he went straight from the one to the next. We could have purchased COBRA during that time, but that would have cost a ridiculously large sum of money. Instead, we crossed our fingers and made sure not to travel during that period.

Oh—and we once again had to check whether our doctors were in network and update our insurance with all of our healthcare providers. Simply because we changed employers.

Why we gifted employers this level of control over their employees’ lives, I do not know. Actually, I do know. Our current system is a relic of WWII, when the government set limits on wages to protect the war effort and private employers responded by offering extra perks to woo employees, such as employer-purchased health insurance. Rather than treating that as an anomaly and phasing it out after the war, we made it the cornerstone of what is now a badly cobbled together system. No one planned any of this—and it shows.

It’s time to take employers out of the health insurance system.

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