The Affordable Care Act defined "full-time" as anyone working 30 hours per week or 130 hours per month.

https://www.irs.gov/affordable-care-act/employers/identifyin...

Ime, this threw a whole bunch of entry level laborers under the bus. When I entered the workforce, you could work up to 29 hours (typically flex scheduling) at an entry level position in my region. If you wanted any more, you either worked multiple jobs - both of which likely changed your schedule week-week, or worked for an employer who knew they could do whatever they wanted with you, because what they were offering was a rarity in the environment.

This is sort of a damned if you do damned if you don't type situation for legislators, because other people are getting screwed over if they are kept right under what counts as full time employment so they don't get benefits. In some cases this is the only reason people need to work multiple jobs in the first place.

The only way to really fix it is to make health care not connected to employers in the first place so your hours/number of employers don't matter.

I can assure you no employer that before ACA had employees working 34-36hrs a week magically started giving them health insurance and made them 40 hour workers.

no the ONLY thing that happened is those workers had 15% of their hours cut, i.e they took a 15% pay cut.

Indeed, this is a solved problem. Everyone gets healthcare, it comes out of their taxes.

40% of Americans are already covered by socialized medicine, between Medicare, Medicaid and the VA. We're really only looking to expand that from 40% to 100%. It's not nearly the jump into the chasm of socialism the right is painting it as.

If we can't bring the Manchins of the world onboard, at the very least require all employees, regardless of hours worked, to receive healthcare and if you work for multiple employers, then they can sort out amongst themselves.

> this threw a whole bunch of entry level laborers under the bus

Was it the law, or the shitty companies taking advantage of a "loophole" in an unethical manner? You're attributing the fault incorrectly, IMO.

Blaming a company for using a loophole is like blaming a shark for eating fish. Organizations tend to optimize for their target metrics irrespective of morality. It's only when they act beyond that mandate that they then become morally culpable, imo.

Perverse incentives are hard not to introduce in a complex legislative push. But whoever wrote that specific provision either never worked for a company that saw them as expendable, or might as well have forgotten that the sun can rise.

I like a lot of what the ACA did. But the instability and financial strain I've seen that came from the economic restructuring the provision caused single-handedly butchered my faith in the government's competence to help its citizens for years.

That doesn't mean people weren't struggling before. But I've never met anybody at the low-end of the employment spectrum who the provision actually helped.

The state is supposed to keep these large organizations under control, and the sin is its failure to execute on that portion of its mandate.

> The state is supposed to keep these large organizations under control, and the sin is its failure to execute on that portion of its mandate.

I'm not sure what part of US history gave you the impression that this is how our `state`s are defined. But this has very much not been what this country considers it's responsibility, and it probably never will without a massive, multi-decade overhaul or a revolution.

That's not part of our cultural mythology, no.

Though the US government isn't nearly as overbearing as a European state, it's still active in the domain of regulation and the public is generally fine with that.

Thr US government has long-since taken up the mantle of corporate regulation. Its presence is felt in nearly every aspect of our economy. That presence is seemingly just as often the product of corruption as it is altruism, and it's only occasionally competent. But it's there, and no serious political force seems interested in completely removing it. At most the republicans want to reduce it in some capacity, and principled libertarians are a sideshow.

Everybody I know who works in the service industry works more than this, yet is not offered any sort of employer health care option. Is there something I'm missing, or do these employers rely on employees not knowing this?

Some of them maybe comes down to "people are technically only scheduled for 29.5 hours but are pressured into working overtime or coming in when they're not scheduled, which doesn't count towards full-time healthcare accrual"?

IRS requires employers to look at no less than 3 and no more than 12 calender months (chosen by the employer) to set average hours. "Scheduled" is not a factor in the law, it is how many hours the employee works on average over the "lookback" period

Do they work for large (>50 full-time employees) employers?

I wish that the Affordable Care Act banned employer-sponsored group policies. The health insurance remains bifurcated between the individual exchanges and people covered under their employer's plan.

That was the goal (if a taxpayer funded healthcare model was not possible), but even just getting rid of employers and dumping everyone on healthcare.gov was not politically possible.

Big and well funded employers love the competitive advantage of having lower per employee administrative costs over smaller employers.

This was sort of fixed at the end of 2016 by allowing all employers to reimburse employees for employee purchased health insurance with pre tax income.

Employers also love obfuscating labor prices so it makes it more difficult for employees to compare wages from employer to employer (although paystubs and box 12 code dd of w-2 does show you the price of the health insurance you are getting, but you usually do not have access to this information when deciding on a job offer).

This always runs into strong resistance by the section of labor force who do get good health insurance coverage by their employers as theyre afraid to lose it.

Which sort of doesn't make sense. The companies that provide insurance would likely continue to provide supplemental policies on top of whatever the government sponsored healthcare would be. The only way that there'd be a difference between companies that provided health insurance vs companies that provide supplemental policies:

- The cost of government provided healthcare does not match dollar for dollar or below private health insurance

- There is no value add from a supplemental policy

This definitely isn't me.

While I want to be able to choose my own insurance because I think I could select a better one, my HSA with my company costs me either $0 or like $2 a month. The PPO is like $100 / month. If I got my own, personal insurance, it would easily be $600/mo.

Now, I can afford this; but people who make less than a software engineer absolutely could not; and, they're not going to be getting an 8k / year raise (taxes) to compensate for that. It'd be nice (edit: if) they were; but, they won't.

It goes without saying that severing the employer insurance relationship should come with premiums being pushed back into salaries. What exactly that should look like is a pretty open-ended question, though.

Correct. You'll have a employer and employee deduction per period to Blue Cross or your insurer of choice. Same for dental, workers comp, etc.

OP has an interesting point, but at the societal level it's not fair to do comparisons with an unpriced externality in one of the alternatives.

More and more companies are direct insurance, meaning even if they use an "insurance company" to manage the group, that is just for the administration of the group. The companies are paying the medical costs of the employee directly.

Or why not tackle the bigger problem at the same time and move towards a more nationalized system.

Fully nationalized systems (e.g. UK) experience significant political exposure which is mostly avoided in subsidized markets (e.g. Japan). This can lead to occasional shortages, and it makes life a lot worse if you work in healthcare.

The solution to that is to ensure that there are no private options, forcing those in power into the same system as everyone else.

Are there government run medical systems today that have no supplemental policies available?

Anecdotally, I was required to use the VA and only the VA for a period of time. Private healthcare options drastically improved my quality of life during this time.

What is it with Americans and extremism? We're moving (slowly) out of the situation where we had the most unequal healthcare system in the developed world, now we have calls (echoed by actual Presidential candidates) to create what would be the most restricted healthcare system in the developed world.

Can't we just be normal for a few years and see how that goes?

You’d have to outlaw going to another country to get healthcare

Because not everyone agree's that a nationalized system is the best solution to the bigger problem, hell we probably do not even agree what the bigger problem is

i.e I am sure you believe the market is the problem, where I believe government is the problem, so since I believe government is the problem i certainly do not believe giving more control to the same government that created the problem is the solution to the problem

A role of a politician is not to ensure there is a complete public consensus before enacting a policy. It is to gather what makes a policy good, persuade the public that it is indeed a good policy, and then finally push through the legislative assembly with a general support from the public.

A politician that never acts unless there is a complete consensus is a pretty lousy politician and should probably be voted out of office.

Pretty sure none of that is relevant to my comment, Politicians have been trying to persuade the public to allow the government to take over health care since the 1990's, and have enacted a number of policies to worsen the health market making it harder and harder to operate, to extort the public in to accepting the government as the solution to the problem they have been slowly creating for the last 40+ years. (or really since WWII if you want to count creating the link between employment and insurance by enacting wage controls during the war)

So, the solution is to live with employer-controlled and -connected healthcare and watch them as they cut the coverage and hike the costs year after year. This might be fine when your a SWE in your 20's and not on any meds but for those on BP or diabetic medications, this isn't much of a solution.

Government didn't create this problem because it didn't mandate that employee healthcare be a benefit from employers. That was simply "laissez-faire capitalism", i.e., the belief that the market is all-knowing and will eventually guide us to an efficient and effective equilibrium. Except that really only happens in perfect markets and they don't exist outside of textbooks.

>Government didn't create this problem because it didn't mandate that employee healthcare be a benefit from employers. That was simply "laissez-faire capitalism",

No it absolutely was not. Employer provided benefits like health care became a part of the compensation package as a direct result of Government imposed Wage Controls during WWII, companies then had to get creative to attract talent because they could not simply offer more income like laissez-faire capitalism would have normally resulted.

It is increasingly frustrating that people do not understand American history enough to see all the time the government has causes a problem, then rides in with a novel solution to the problem they caused. Employers have zero desire to linked to health insurance, and laissez-faire capitalism most certainly did not create this link.

>the belief that the market is all-knowing and will eventually guide us to an efficient and effective equilibrium.

Almost no one that supports free markets believe this, it is a trope used by people to straw-man. free markets are not perfect, not by a long shot, they are however infinitely preferable to government, why? Market for the most part give you choice, when choice is taken out of the market one can often find government regulation behind that removal. Government is the removal individual choice, I like choice, I like freedom, I have no desire to have my healthcare controlled by the 535 morons in the US Congress, I know that makes me "crazy"

And funnelled back into taxes which would pay for that $600 cost directly.

There is no reason your employer can't offer you the insurance, or put the same amount of money in a tax excempt account for your to purchase your own insurance from. The only reason why is employers love you to be 'tied' to them for the benefits.

Outstanding.

Now, given the way the world is, at this second, how do you see this evolution actually going?

Same here. The insurance through my Fortune 500 company is incredibly good and cheap. It would be so expensive if I tried to buy a similar level of insurance at market rates.

The insurance from my Fortune 500 company is very cheap, and if you like the insurance options they have then it is very good. But if you'd prefer something else, there is no option at all.

I would like to be able to keep my preferred doctor when I switch jobs.

Don't companies get to deduct their contributions to health care plans from their payroll taxes, which means the government is effectively subsidizing employer coverage (as opposed to individual coverage)?

Right, so legislate that companies with health insurance plans release the amount of money per employee they're paying to subsidize the plan, and force them to increase wages by no less than that amount.

Yet another reason to separate employment from insurance.