You can’t compare what isn’t getting measured
| AFSCME's 2026-2027 statewide multi-unit contract health insurance benefit continues administering "embedded deductibles" to set OOPM 1 | |
| Plan Structure | In auto insurance jargon, policy coverage deductibles "stack". When health insurance embeds individuals within a concurrent family plan, the single deductible precedes on top of the family deductible, which applies to the total combined expenses of all members. Any one or combination of covered members' cost can serve to meet the family deductible so that everyone benefits once that number is met. The Affordable Care Act required 'family' OOP max coding nominally appear even when in actual practice it does not yield any bearing or value for ‘families’ of less than three members: single parents and childless couples 2 The full effect of ending $1 trillion ACA subsidies to states in the next couple of years, exactly coincident with peak years of baby-boomer retirements, is not clear. Increasingly longer clinic wait times, for appointment scheduling and at ER triage, look likely. |
| Employer pros | Once the individual hits their limit everything is free for that individual but if the other family members continue with medical needs, they can still have bills up to their own individual limits or until the total family limit is reached. Significant cost savings for employers with a healthy workforce. |
| Employer cons 3 | More complex to administer than traditional plans, an embedded plan risks dissatisfaction among employees who have high medical expenses and must juggle uncertain effects between two deductible tiers. A benefit less easy to predict, harder to explain, makes it harder to attract and retain top-tier talent. Nuanced and involved plans require more time and more expensive expertise to finesse communication with employees, potentially putting more confidential health information in play, even if that is not intended. |
| Employee pros | Offers more flexibility for staffing by attracting younger workers undergoing the risks and extra expenses unavoidable in starting and growing a family. Minnesota has a new Earned Sick-Safe Time law that helps parenting in the private sector about to take effect, many parents struggle with juggling both affordable daycare and decent health care insurance. 4 |
| Employee cons | Embedded plans are the most complex health insurance structure, with both family and individual deductibles to consider. In a workforce with less healthy worker demographics, families with high medical expenses can experience more stress from unplanned higher upfront costs. |
In 2022, the MN legislature passed an act tasking the Dept of Health doing three levels in measuring outcome studies called “Health Care Homes” at certified, participating clinics. Since then, health-care related costs have steadily continued inflating, up to 17%, and some large systems that over-expanded, such as Essentia, no longer want comparisons with any other clinic system, for example State of MN “Health Care Homes” criteria, and have reached the point of totally dropping participation in any evidence-based, controlled, long-running or large scaled academic health care outcome studies, in this case disconnecting important connections with university medical school students just as they are learning how to focus their purpose in life to become compassionate, caring healers.
References
1 https://www.reddit.com/r/HealthInsurance/comments/1m40l3a/i_dont_understand_the_point_of_family_deductibles/
2 https://www.cbo.gov/publication/59899
The Demographic Outlook: 2024 to 2054 | Congressional Budget Office
3 https://www.google.com/search?q=embedded+deductible+fertility+profitability+analysis
4 https://jamanetwork.com/journals/jama-health-forum/fullarticle/2838753
Improving Implementation of Fertility Preservation Benefit Mandates