By Robbie Cape
It’s a pivotal time in modern history, and humanity is facing a crossroads. Our American lawmakers are in the spotlight, working hard to develop public policy responses to the greatest healthcare and economic disruption in the history of our country. Forging the right path forward will involve countless variables. But of these, how the U.S. reframes its view of health insurance laws and overall healthcare access, quality and affordability will be among the most critical.
In less than three months, lives have been turned upside down. Happy hour has become a Zoom, physical distancing is now part of our vocabulary and telehealth is the latest buzzword in healthcare—and becoming the new norm. Unfortunately though, a large number of critical essential workers who don’t have employer-sponsored health insurance or receive insurance on their local Exchange are unable to take advantage of virtual care because of bureaucratic red tape involving the Employee Retirement Income Security Act (ERISA).
The definition of “essential” has shed new light on the vital yet often undervalued role workers in shipping, grocery, agriculture, food service, elder care and other crucial industries play in meeting society’s fundamental needs. Many of these essential workers fill some of the lowest-paying jobs in our country. In part, they represent the 27 million people classified as part-time, working fewer than 35 hours per week, and the nearly 28 million individuals who remain uninsured.
Hourly workers who have been deemed essential had no intention of being at the center of this global pandemic. They continue to go to work, helping others and doing their jobs so the rest of us can remain safely at home. We must do more to support them and ensure they can afford to see a doctor. Millions of Americans with fragile financial security are paying out-of-pocket for their healthcare expenses—or else going without the medical attention they need.
We have a responsibility and opportunity to fix this problem, and can do so through a revision of existing law. When ERISA was amended by the Health Insurance Portability and Accountability Act, and complexity added by the Affordable Care Act, several unintended consequences were the result. These include limitations that make it burdensome for employers to provide certain benefits to part-time or other non-benefits-eligible employees (because they work less than full-time), which in turn have borne additional, albeit inadvertent, healthcare barriers for some high-need populations.
Under the current ERISA framework, employers cannot provide their part-time workers with certain low-cost benefits—like telehealth and virtual care services—without exposure to legal risk and penalties. Because of this, the framework fails to align with the broader healthcare, health insurance and employer landscape. Simply put, if an employer wanted to offer a non-insured employee telehealth, they would have to offer an entire healthcare package or nothing at all. This binary choice limits the employer and increases risk for the employee. Especially during our fight against this pandemic, all parties need to come together and agree that access to virtual care is critical and far better than not having access to any care at all.
Telehealth and virtual care options provide inexpensive access to basic, quality primary care. These services improve patient outcomes, help keep people healthy and shift the healthcare paradigm for the uninsured, underinsured and rural populations with limited access to physicians. Virtual care has also emerged as a viable solution for providing safe primary and non-emergent care during this pandemic. Moreover, it saves money—upwards of $6 billion by some estimates—to the overall healthcare system.
Businesses of all sizes are ready to provide this benefit to its employees. While many employers can’t afford comprehensive health insurance for everyone on their payroll, they are ready to invest in the virtual care option for those who don’t otherwise qualify for full benefits. Employers currently ready to offer this benefit represent more than 3 million workers. Countless others have expressed interest. Revising the statute with an express inclusion of virtual care in the definition of “excepted benefits” will resolve this issue and open the door for millions of Americans to obtain primary care benefits.
We are all in this crisis together. Lawmakers are problem-solving to ensure people are taken care of now and in the pandemic’s aftermath. With perspective on the humanity of this issue, and a strong collective response to revising ERISA, our country will come out the other side with an improved healthcare ecosystem for all.
Robbie Cape is CEO and co-founder of 98point6.