Well, the jig is up on this one. On Tuesday of this week, HHS posted notice that insurance options that don't cover both inpatient services and physician services will be considered noncompliant with the ACA. So-called "skinny plans" have apparently been a subject of interest among self-insured employers exempt from the essential health benefits requirements. Instead, self-insured (sometimes called non-ERISA qualified plans) only have to cover 60% of potential health costs, the equivalent of an exchange-sold bronze plan.
It was interesting while it was an option. Now, it is no more except to linger on as an oddity in grandfathered-in programs for some brief period of time. But, still, I want to ask what the attraction might be for employees (since they are manifestly obvious for large employers with many low wage workers moving into insured status).
First, there is always the "it is better than nothing" argument. Second, such a plan might appeal to those who are young and robust but who acknowledge they might want some value for their premiums (beyond preventive care and catastrophic insurance). A fair number of low wage workers lack commercial disability insurance, leaving it possible that they contemplate Medicaid will provide the backstop catastrophic insurance. Call it the anti-high deductible plan that gambles on Medicaid catastrophic coverage or Medicaid's relatively expansive coverage of pregnancy and childbirth.
Now, I have no idea who has been offering these plans. Everyone seems to deny it is them. And I am not endorsing their continued operation in the wide open frontier of non-ERISA qualified plans. I'm just saying, I'd like to know if any consumers with choice chose this option. Putting aside path dependence, if you are gong to have thin insurance, might it not make sense for some demographic groups to prefer front loaded insurance benefits?