Unlike nearly every other country in the industrialized world, 155 million Americans access healthcare through employer provided health insurance and every year the Kaiser Family Fund publishes its Employer Health Benefits Survey.
This year, they report that the average annual premiums for employer-sponsored health insurance are $7,739 for single coverage and $22,221 for family coverage. For PPO plans—the kind of plan most likely to be part of a union-negotiated package—the rates are $8,092 and $23,312 respectively. On average, workers are contributing $5,969 per year for family coverage and the employer pays the remainder of the premium.
Here are some key takeaways from the 2021 health benefit survey:
· It’s unsustainable. The average premium for family coverage has increased 22% over the last 5 years and 47% over the last ten years. This is a major driver of wage stagnation and employer attempts to shift the costs of healthcare onto the backs of workers.
· The deductibles and copays are killing us. On top of the upfront contribution out of the paycheck, the average plan now has a single coverage deductible of $1,669 (and 29% of all plans have deductibles of more than $2,000) with additional average copays of $25 for primary care, $42 for specialty care and 20% coinsurance for most hospital stays. Out of pocket maximums go as high as $6,000.
· The more you need it, the less you get. Low wage workers face much higher average contribution rates for family coverage than higher-paid workers (35% vs. 27%). Workers with families pay much more ($5,969) than single employees ($1,299). The system generates and magnifies inequality.
· Too many workers are left out. Only 56% of employed workers are currently covered by employer sponsored insurance plans. The remaining 44% either work for employers who don’t offer any health benefits (9%) or they don’t qualify for the offered coverage (17%) or they decline coverage (18%) because they are covered by another plan or can’t afford the premiums for the offered plan. This puts companies with decent coverage and high levels of employee participation at a huge competitive disadvantage and creates powerful incentives for them to join the race to the bottom.
· You’re going to pay sooner or later. Many union workers have fought long and hard to continue to pay little or nothing for their health insurance, often deferring wage increases or other benefit improvements to sustain them. They are justifiably proud of their achievements. But their position has become untenable. Only 4% of employers still offer fully paid family health insurance coverage.
Do workers really love their health insurance?
Opponents of Medicare for All—including both President Biden and House Speaker Pelosi-- often claim that “people love their health insurance” and would be unwilling to trade it in for a system of guaranteed cradle to grave comprehensive coverage with no co-pays and deductibles and freedom to choose providers.
But when politicians say that workers love their health insurance, what they really mean is that they fear the prospects of being without coverage or of having their coverage radically reduced. As the results of the Health Benefits Survey illustrate, this fear is not unfounded as millions of workers go without health insurance or are subjected to massive and unpredictable out of pocket costs.
This insecurity is magnified by the fact that workers lose their health insurance coverage all the time whenever they change their jobs or their employer decides to change the insurance carrier or “redesign” the plan.
Healthcare profiteers exploit these insecurities by manipulating people’s "loss aversion"—a pattern observed by social scientists (and union organizers in just about every organizing campaign) that people tend to be more motivated by the fear of losing something they have than by the hope of gaining what they need. This ad from a 2018 Congressional campaign in New Mexico shows exactly how they do it:
See how loss aversion is used in this anti-M4A attack ad.
Unions Must Step Up!
Unions are absolutely right to fight for the best employer-provided healthcare that they can negotiate for their members and the Labor Campaign for Single Payer stands in solidarity with every worker everywhere struggling to secure decent healthcare for themselves and their families.
But union leaders also need to be honest with their members and confront loss aversion head on. As the Health Benefits Survey shows, our irrational system of employment-based healthcare is unsustainable. It generates inequality and drives wage stagnation. It would be madness to expect it to ever deliver real healthcare security to the 155 million Americans who rely on it.
Unions need to be at the center of the campaign to take healthcare off the bargaining table by making healthcare a right for everyone in America. Expanded and improved Medicare for All would treat healthcare as a public good and increase workers individual and collective bargaining power.
The Labor Campaign for Single Payer is calling for the Senate to pass the Build Back Better Act before the end of the year and then for Congress to pivot to working towards the long term solution to the healthcare crisis through the passage of the Medicare for All Act of 2021. To do anything else would be sheer madness!