Company insurance is deeply entrenched and poses a big challenge to Medicare-for-all — but costs for those plans are on the rise.
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Jessica Salfia knew the pay wasn’t going to be great when she became a teacher in Martinsburg, West Virginia, but she did have really good health coverage. She felt like she could go to see any doctor she wanted. The copay for an emergency room visit was just $15. She had three kids over the years, and health care was one thing Salfia didn’t feel like she had to worry about.
“The one thing about being a public schoolteacher was you knew that was taken care of,” Salfia, a teacher of 16 years, tells me. “But in the last four to six years, it’s been death by a thousand cuts.”
The state legislature kept cutting taxes, and copays for teachers kept going up — eventually costing Salfia and her family $100 just to show up at the emergency room or urgent care. On top of that, their health plan started to restrict which specialists they could see. Suddenly, some teachers had to travel as far as five or six hours to see a doctor.
Salfia’s daughter’s sore throat quickly spiraled into a $650 bill, as the rest of the family got sick. “My husband and I had to sit down and decide what bills we’re gonna pay or what bills we’re not gonna pay,” Salfia says.
The West Virginia teachers went on strike over rising health care costs, eventually securing a pay bump and a freeze on insurance premiums. But their plight reveals the cracks, increasingly difficult to ignore, in the bedrock of American health care: employer-sponsored insurance.
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Half of all Americans get health insurance through their jobs. That’s by design. Doctors and hospitals in the mid-20th century saw a rash of government-run systems being set up in Europe and they lobbied hard to avoid one of their own, vastly preferring private coverage. Employee benefits were exempted from wartime price controls during World War II, giving employers an incentive to offer them at a time when it was nearly impossible to offer raises. Labor unions got on board too, sensing an opportunity to expand the safety net for workers without needing to pass another massive piece of social reform so soon after the New Deal.
But employer-sponsored insurance did not deliver a health care utopia. More than 30 million people still lack health coverage. Premiums and out-of-pocket costs for employer-sponsored plans have been rising steadily.
“Right now if you look at a lot of the labor disputes that go on, very often they have to do with health care. They have to do with employers saying, hey, you know what, we’re raising deductibles, raise your copayments,” Medicare-for-all proponent Sen. Bernie Sanders (I-VT) told Vox in 2017. “What we can say to those workers is they will be better off financially and that their business that they work for will be better off financially.”
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