0To prepare for this Discussion: Review the materials on critical reading strategies and on the MEAL plan for paragraphs.Read the provided article in the Learning Resources, taking note of where the a

Before the enactment of the Affordable Care Act of 2010 (ACA), businesses such as the mid-sized construction company and their employees were part of the uninsured population. During this time, around 28 percent of non-elderly adults were uninsured (Chase & Arensmeyer, 2018). Employer based insurance provides coverage for over 160 million Americans (Galvin, 2016). Access to ACA marketplaces and Medicaid in numerous states, has become somewhat critical to small business employers and their employees who may be low-income. To benefit the employees working at the mid-sized construction company, the employee benefits manager is obligated to mitigate any potential risk by providing insurance. Working at a construction company presents several risks that employees would like the security of insurance to share the financial burden should an event arise. Should insurance not be available at the company and an employee has low-income or becomes disabled, the government can provide insurance through Medicaid (Getzen, 2015).

The company is comprised of 60% healthy employees who may or may not participate in the health insurance option. Adverse selection is probable due to the knowledge of twenty employees with chronic diabetes, requiring a more comprehensive plan. The benefits manger should offer benefits such as wellness, which would appease the healthier population to pay regular premiums (Getzen, 2015). If all the employees pay into the company insurance, there is a possibility of moral hazard which will impact insurance provisions. For those who are insured, if anything should happen at work or a sickness occur, the likelihood to visit the doctor is greater. Less pooling of risk will happen, which creates economic waste (Getzen, 2015).

The type of insurance policy the benefits manager designs, should accommodate both the healthy employees and employees who need to suffer from chronic diabetes. A preferred provider organization plan would be suitable for the company in which the employee services are covered by selected physicians and hospitals. Since majority of the employees are healthy, the option is still available to pay extra for outside services while still maintaining a low premiums. A specialized cost sharing tool can also be included for the employees with chronic diabetes to visit the most appropriate treatment facilities to maintain their health. As suggested by Baicker and Levy (2015), if little to no cost sharing were an option for the employees who need more medical attention, it is possible for them to receive higher value care, improve their health overtime, and be able to keep their job.

References

Baicker, K., & Levy, H. (2015). Cost sharing as a tool to drive higher-value care. JAMA Internal Medicine,

175(2), 399–400.

Chase, D., & Arensmeyer, J. (2018). The Affordable Care Act’s Impact on Small Business. Issue Brief

(Commonwealth Fund), 2018, 1–9. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=mnh&AN=30280862&site=eds-live&scope=site

Galvin, R. (2016). How employers are responding to the ACA. The New England Journal of Medicine,

374(7), 604-606. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1056/NEJMp1514649

Getzen, T. (2015). Health economics for the healthcare administrator (Laureate custom edition). New

York: Wiley.