You can’t compare what isn’t getting measured
| AFSCME's 2026-2027 contract passed, but barely, as only a couple hundred more voted to accept the tentative proposal than voted to reject until continued efforts were made to negotiate something more acceptable. Apparently what passed was an un-raise that will barely touch rising inflation. Let's assume hundreds of hours of confidential multi-unit collective bargaining negotiations did result in something of value, for every employee: continued medical insurance plan stability. See 2026 Schedule of Benefits On the schedule, fine print at the very bottom includes the term "embedded deductibles" but that is not some con or trick, it was negotiated to remain in the 2026-2027 contract and appears as a benefit chart for services incurred on pages 605-606. 1 Circumstances, choices and incentives that allow paying less for insurance are not a substitute for real hard cash payroll raises. What are the circumstances? For a while, the trend to off-load state road maintenance was to increase lane miles handled by counties. In some areas, co-siting of large systems has upped the presence, enlarged the share of investment, physical footprint and operating responsibilities of counties or private operators and services. But something now is different about what work there is, where it is and who will work at the wages offered. After the COVID pandemic, A.I. and remote work reduced road traffic, bringing changes to the job market that had economic effects and now counties have started looking for the state to handle on-boarding unemployment means testing, screening for work-ability or other evidence of eligibility for social programs. During this open enrollment, the longer one stares at a hospital system, the more it resembles a health plan. Many health care coverage things aren't the same. Acting on cut-offs, closings and what could be the start of rationing requires doing more than nothing. Changing to a clinic or plan that is now on a better tier, with lower deductibles and out-of-pocket maximums, can 'feel like' getting up to a 12% net pay increase. Some individuals report cost of their plan coverage for 2026 will rise over 50%, what size raises could cover that? In a recent Gallup poll of 18,400 workers in many kinds of employment, only 40% said their jobs "provide financial well being, safe and respectful workplaces, some control over their work, a voice in decisions that affect their job, and opportunities to build skills and advance." Those five criteria for defining a 'quality' job become four if union membership denies, tunes out, abstains and neglects to claim the most basic affirmative right any individual worker can ever make: a contract vote on an individual level that 'says' whether or not a proposed contract upholds acceptable workplace quality in fair pay, predictable hours and access to advancement. | |
| Embedded Plan Structure Unpacked | In auto insurance jargon, policy coverage limits or deductibles can "stack". When health insurance embeds an individual deductible 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. 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. Embedding of deductibles is actuarial magic best pulled off with large, mostly healthy groups, and the State Minnesota has over a hundred thousand public employees. And it is magic keeping that many employees working under one contract. Why bother mentioning a separate family plan, if for many choosing that costs more buck but returns less or the same bang? The Affordable Care Act required 'family' OOP max coding nominally appear in open enrollment materials but statistically, this coding offers little value for ‘families’ of less than three members: single parents, childless couples or any kind of family short of minimum actuarial reproductive critical mass. 2 The full effect of the 2025 U.S. Congress ending $1 trillion ACA subsidies to states, timed exactly coincident with peak years of baby-boomer retirements, is not clear. |
| Employer pros and cons 3 | Embedded plans have significant cost savings for employers that are blessed with a mostly healthy workforce. More complex to administer than traditional plans, offering an embedded plan risks dissatisfaction among employees who already face, or believe might be coming, unavoidable medical expenses. Traditional plans cost more than embedded plans, require juggling two deductible thresholds instead of one. A workplace benefit less easy to explain, makes it harder to attract and retain experienced top-tier talent if doing so puts off younger workers who face risks and extra expenses in starting a family. 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 and cons | Minnesota's new Earned Sick-Safe Time law helps child-rearing parents in the private sector, name one working parent who has never had to struggle finding affordable daycare or decent health care insurance. 4 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. But when open enrollment occurs in a time of health care and insurance market unpredictability, the savings by re-shuffling the provider or plan deck can amount to hundreds of dollars a month. |
Health Care Homes, Chapter 358, Article 2 (SF 3780) added Minn. Stat. §§ 256B.0751; 256B.0752; and 256B.0753, become effective August 1, 2008, the start of many sweeping health care reforms. Nothing seems to stop health-care delivery and related costs steadily inflating. At some point on 'non-profit' balance sheets, there came a cliff-drop for enormous health system entities. Large sunk costs in bricks and mortar expansion, perennially unresolved troubles with over-worked, under-paid staff that has to include doctors legally bound by non-compete agreements. Things get desperate when the busiest office at a hospital is its legal department. Finally a whistle blew and that dreaded rationing flag had to be dropped. Out the window went performing medical miracles for low wages and any widely recognized, evidence-based and credible way for comparing clinic systems under criteria such as State of MN “Health Care Homes”.
Were statewide health measures a virtue signal, and care quality studies grandstanding that government cares? Have unprofitable, un-elected non-profits, in disconnecting fixes by the elected, cured shortfalls of being too big to fail, with the side effect doing this exposing there isn't enough charity or tax revenue in the world to cover the worst sacred-versus-secular wound ever.
Ending educational liaisons with university medical schools happened exactly as workers who are young, old, working or looking for work have never been more aware AI is likely to increasingly displace educated, skilled, trained, effective, compassionate and caring human 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