While it seems there is little on which politicians can agree when it comes to health care, one thing they seem to agree on is that our current system leaves many Americans without affordable access to healthcare. It is time for a major change in how Americans acquire health insurance. It is time that we separate health insurance from employment.

The marriage between employment and health insurance started in the 1920’s—a time when medical practice was advancing rapidly and so was the cost of health care. Baylor hospital in Dallas, Texas noticed that most working class people could not pay for the cost of a hospitalization but they could afford luxury items like cosmetics when they were purchased a little at a time. Baylor started a program with the local public school teachers where, for 50 cents per month, Baylor would cover the cost of their hospital visits. This idea grew in popularity and developed into Blue Cross insurance.

The link between employment and health insurance became stronger during World War II when, in an effort to attract more workers during a time of wage controls, factories started offering benefits such as health insurance. This link was further strengthened when the IRS passed a law making employer contributions to health insurance exempt from taxes.

According to the Kaiser Family Foundation, as of 2015, 49% of Americans were covered by employer-sponsored health insurance plans¹. For the remaining population, 36% were covered by public insurance such as Medicare, Medicaid, or the Veterans Administration, 7% purchased plans in the non-group market, and 9% of the population remained uninsured.

One of the provisions of the Affordable Care Act, ACA, requires employers with over 50 fulltime employees to offer employer sponsored health insurance to their fulltime employees or be subject to fines. The employer mandate might make sense in the current system where most working Americans receive health insurance through their employer, but the current system leaves those without employer-sponsored health insurance to fend for themselves in the individual market. This arbitrary partnership between employment and health insurance puts a significant burden on small businesses and self-employed individuals.

One of the major criticisms of the ACA is that it is very expensive for businesses with just over 50 employees to offer their employees health insurance. Many of these businesses were faced with the choice of cutting the number of employees or employees’ hours to avoid having to provide health insurance or risk going out of business. But a employer going out of business, moving operations overseas, or cutting hours, benefits neither the employee nor the employer, so why are we putting this pressure on employers?

Additionally, health care is a very personal matter and employers should not have any say in from whom or for what their employees seek healthcare. There have been instances where employers have refused to offer plans that cover certain healthcare services. For example, Hobby Lobby argued that it should not be required to pay for insurance that offered certain types of birth control for their employees because it violated the company’s owners’ religious beliefs. The 10^th Circuit Court of Appeals, including recently confirmed Supreme Court Justice Neil Gorsuch, and later the US Supreme Court upheld the rights of closely held for-profit companies to refuse to offer insurance plans that cover services that are in conflict with the owner’s religious beliefs in the 2014 ruling of Burwell v. Hobby Lobby Stores, Inc.².

But what is the alternative? Historically, people who were self employed or who worked for small businesses that didn’t offer health insurance could purchase their own coverage directly from insurance companies. This process was made easier by the creation of state-run health insurance exchanges under the ACA. Now individuals can purchase health insurance for themselves or their families on the exchanges. Additionally, the ACA provides income-based subsidies for people with lower incomes to make purchasing an insurance plan on the exchanges more affordable.

Some argue that by buying health insurance through their employer, people have greater bargaining power. They argue that entering the health insurance marketplace as an individual gives you less bargaining power, but people enter into individual markets for most other things they buy, including car and homeowners insurance. Having more people purchasing insurance through the individual marketplace would create more competition in the individual market and incentivize insurance companies to create more affordable plans with coverage that meets consumers’ needs. Insurance companies would no longer be negotiating large deals with employers, instead they must appeal directly to consumers and offer plans that meet consumers’ needs.

It is a bizarre relationship for your employer to pick your health insurance provider and by extension, who provides your healthcare. Your employer does not choose where you buy your food, your car, your cell phone, or your home, so why do they choose your health insurance? In a time when people are more mobile in their employment and many small businesses struggle to remain profitable, it is time that we remove employers from the health insurance market and allow all individuals, regardless of their employment status, to purchase their own insurance in the individual market. This is one tiny step that will help make health insurance more accessible to more Americans.

1. Kaiser Family Foundation. (2017). Health Insurance Coverage of the Total Population. Retrieved from http://kff.org/other/state-indicator/total-population/.
2.  Alito, S. (2014). Burwell v. Hobby Lobby Stores, Inc.