Updated Jun 6, 2018

Why some employers are turning to progressive health benefits

Illustration: Sarah Grillo/Axios

It’s a practice that has not received much attention, but some employers have moved to "progressive," or wage-related, health benefits in recent years. That's where their lower wage employees pay a smaller share of insurance premiums, deductibles or health account contributions than higher-wage employees do.

Why it matters: Unlike consumers in the Affordable Care Act marketplaces, lower wage workers in the far larger group market don’t get any help with premiums or cost sharing. With premiums and deductibles rising and wage growth stubbornly flat, progressive benefits are one way for employers to help their low wage employees with their health care costs.

The back story: We don’t have great data on how many employers are cushioning the costs of health care for their lower wage workers, but we have some:

  • We asked about this in our 2014 Kaiser-HRET Employer Health Benefits Survey, and found that 25% of very large firms (more than 5,000 workers) asked lower wage employees to pay less for premiums, compared with just 1% for firms with less than 200 workers. Preliminary data from this year’s survey suggests these numbers have not changed much.
  • In a 2016 survey of large firms, The National Business Group on Health found that 27% of large firms adjust premiums contributions for lower wage workers, 13% reduce contributions required for health accounts, and 2% reduce deductibles.
  • It’s understandable why workers might need help. The average cost of a family premium in the group market was $18,764 in 2017, with workers paying $5,714 of that. Lower wage workers pay somewhat more — $6,001 — in companies with large numbers of low wage employees.

More large non-profits seem interested in progressive benefits than corporations do. I wrote about Harvard University doing this in the Wall Street Journal in 2015. The University of Miami has a similar program.

The big picture: Premiums, deductibles and other out of pocket costs have been rising at a time when wages have been relatively flat, increasing the pain from out-of-pocket costs for employees and especially for lower wage workers. That's why progressive health benefits may get a closer look — but they're not a panacea.

Economists take it as an article of faith that any break on benefits comes from wages. As an employer, I know that it's always a dilemma for employers to decide between wages and benefits, and employers balance the tradeoff in different ways depending on a myriad of factors (it’s not a straight economic calculation).

There are other complexities:

  • What wage level is fair?
  • Will employees just above the level feel aggrieved or seek a salary cut to reduce their health costs?
  • How complicated is the policy to administer?
  • How will this play out in unionized work forces?

What to watch: Despite the challenges, at a time when the 155 million Americans who get their insurance at work are getting no relief from health costs, don't be surprised if more employers give lower wage workers some help by linking premiums or other out-of-pocket costs to wage levels.

Go deeper

Facebook spending $100 million to help news outlets in coronavirus crisis

Photo Illustration by Budrul Chukrut/SOPA Images/LightRocket via Getty Images

Facebook says it is spending $100 million to support news outlets around the world that have been impacted by the coronavirus, the company said Monday.

Why it matters: Whatever Facebook's motivation, this is a much-needed cash infusion at a critical time for the local news industry.

The next American struggle: Waiting out the coronavirus

Illustration: Aïda Amer/Axios

There are now a lot of known knowns about the coronavirus: It's here, it's spreading, it's stressing hospitals, it's crippling the economy, it's slowed only by distance and isolation — and it's sure to get much worse before it gets much better. 

Why it matters: Similarly, there is a sameness to the patterns and known unknowns. So now we hit the maddening stage of waiting.

Go deeperArrow31 mins ago - Health

Coronavirus pushes traditional businesses into the digital age

Illustration: Aïda Amer/Axios

A slew of old-line industries that once hesitated to embrace digital technologies are now being forced to do so for the sake of survival.

Why it matters: Once consumers get used to accessing services digitally — from older restaurants finally embracing online ordering, or newspapers finally going all-digital — these industries may find it hard to go back to traditional operations.