If The ACA Was Meant To Give People More Career Flexibility, Will the AHCA Take That Away?

May 22, 2017

Katie Horowitz is making dinner at her home in Morningside. On this night, it’s sautéed spinach with chicken breasts boiled in broth.

“One of the hardest parts of this diet is that you have to cook everything,” Horowitz said. “I have a really busy job, and it’s really challenging to find time.”

Horowitz was diagnosed last year with Crohn’s disease, a chronic inflammatory bowel condition, and is now on a very restrictive diet. She’s been hospitalized several times, and her doctor said she’ll likely need surgery someday.

“I’ve racked up $65,000 worth of bills,” she said. “Not for me, but that’s what it would cost.”

Katie Horowitz, 32, of Morningside prepares a meal that won't aggravate her Crohn's disease on Wednesday, May 10, 2017.
Credit Liz Reid / 90.5 WESA

As vice president for education at Planned Parenthood of Western Pennsylvania, Horowitz said she’s lucky to have a job that offers health insurance. But she worries that she might never be able to start her own business or take time off to travel. Or if she gets really sick and can’t work, what happens to her coverage?

Thirteen Senate Republicans have been meeting in secret to craft a health care bill to replace the Affordable Care Act. They’ve given little indication of what it might look like or how much they’ll borrow from the house’s bill, the American Health Care Act.

The AHCA doesn’t change the Obamacare mandate that health insurance companies have to provide coverage to anyone who wants to buy it. But it does give states the ability to opt out of a provision that says insurance companies can’t charge people extra if they have pre-existing conditions.

“So in effect, the people with preexisting conditions could find coverage so unaffordable that they don't have access to the market even though the guaranteed issue rule is still in place,” said Julie Donahue, professor of health policy and management at the University of Pittsburgh.

Donahue said that could lead to a phenomenon called job lock, where people stay in jobs simply for the health insurance. She said the ACA was designed, in part, to combat that trend.

“In a rapidly changing economy that’s experiencing rapid technological changes, … people have to be flexible and adaptable and look for other opportunities, including self-employment and starting their own business,” Donahue said. “Tying health insurance to an employment-based system didn’t give people adequate flexibility.”

Lowell Taylor, who teaches economics at Carnegie Mellon University, said that flexibility supports a more dynamic economy.

“People should be working for firms where they think they have the highest value added,” he said. “Firms should be able to hire the workers who they think will provide the highest value added.”

Researchers disagree about whether job lock is even a real thing.

A 2008 literature review of relevant research showed that people with employer-sponsored health insurance stayed at jobs about 16 percent longer than people without such benefits. They were also 60 percent less likely to leave their jobs.

A 2002 study found that chronic illnesses limited job mobility by about 40 percent. But other studies dating back to 1994 found that health insurance benefits had little or no effect on people’s career decisions.

Taylor said, assuming job lock does exist, it’s hard to tell if Obamacare has helped. That’s, in part, because not enough time has passed since the health care exchanges went live in 2013.

He said it’s also because the economy is strengthening overall, so more people feel comfortable starting businesses or making career moves.

The real solution isn’t mandating coverage or putting caps on premiums, he said. It’s disentangling health insurance from the world of work so that everyone can access it and fulfill their career potential.

But given the current political climate, Taylor said that’s not likely to happen. And as long as there’s uncertainty about where health care policy in the U.S. is headed, he said the country will never know the extent to which insurance causes job lock.

“Why would I ever leave a job that has decent health insurance, if I think there's even a prospect that the law will be changed down the road?” he said.

Horowitz said she remembers those days from before the ACA.

The need for health insurance dictated the job she took after college, even before her Crohn’s diagnosis. And depending what happens in Washington, her chronic condition might dictate how long she stays in her current job as well.