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Comment by coffeeblack | Hacker News Reader

I am sure that companies would love that. Being tied to the company for your healthcare (in the U.S.) and also being tied by having so your friends in the company. Great “lock in”.

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You are not tied to the company for healthcare. You are tied to a company. This means that healthcare is not much of a leverage to keep you tied to any particular company.

Similarly, I am not required to go through the company in order to socialize with friends I made in that company. Indeed, I maintain friendships I made in companies I no longer work for.

Lastly, making friends through your job is how it always has been. Talk to your parents.

The removal of the pre existing condition exception does make heath insurance more portable. On the other hand, getting a new job while you have a major health issue is much harder while keeping an existing job is not because companies can’t discriminate based on employee health, but it’s much harder to prove discrimination during highering.

So in theory it’s not a limitation, but in practice it often is.

> On the other hand, getting a new job while you have a major health issue is much harder while keeping an existing job is not because companies can’t discriminate based on employee health

As far as I know, employers are free to terminate anyone having health issues that render them unable to perform their duties:

https://work.chron.com/termination-employment-due-ill-health...

FMLA (if employer has more than 50 employees) or a state disability law might protect employment for up to 12 weeks or so, but other than that, there is no reason a business has to keep a sick employee who cannot fulfill duties on payroll.

People who are unable to function long term, qualify for SS disability. It’s the middle ground where people have significant issues but are still capable of working that’s at issue.

> You are not tied to the company for healthcare. You are tied to a company. This means that healthcare is not much of a leverage to keep you tied to any particular company.

Switching insurance is a hassle. Maybe in some areas plans are more fungible, but where I live there are two main insurance companies with two highly disjoint networks. Switching jobs has a 50% chance of forcing us to also switch pediatricians, which is a huge hassle when the kids have finally become comfortable with our current one.

Interesting, I have used BCBS affiliated insurance on both costs in 3 states with 3 different companies, and every doctor I have looked up has been in network.

You are not even tied to a company for healthcare. You just get to purchase insurance with pre tax money rather than post tax money. But if you are self employed, you can also purchase with pre tax money.

The people that get screwed are employees of employers that do not offer health insurance. They have to buy with post tax money.

Remember that your situation is not universal. The moment I change jobs, either I have to pay several arms and my remaining leg through COBRA to keep my insurance for a few months or I have to eat whatever I've already paid towards the deductible and annual out-of-pocket max with my old insurance, plus start spending towards the deductible and annual out-of-pocket max with my new insurance. For my family, it depends on the insurance company, but it's typically between $15 and $20k.

My wife and I have chronic conditions- we frequently hit our annual max within the first three months of the year. If I don't switch to a new job before that fills up, I've wasted $15,000. For me, switching jobs is essentially a $15,000 fine.

So yeah, insurance being tied to a specific company is very much an incentive to stay with that company.

The health care exchange plans usually aren't as good as employer plans, but they do exist and should remove a lot of the tie to employers.

It's not like the before times where you'd need to visit a bunch of brokers and hope someone could find a plan you might qualify for, if you're lucky.

What you usually miss out on is non-emergency coverage outside your home area, whether that's limited to the state or county you live in depends, and sometimes it's pretty bad if you live in an area where it's common to cross county or state boundaries but the exchange plans don't allow that.

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