The Insider has tracked the impact of Walmart, the nation’s largest retailer, with considerable interest. We have no idea what happens to employees who file workers compensation claims, but we would guess that the company is ferociously aggressive in applying claims management/denial techniques. As with many employers, the company’s workers comp problems are compounded by the fact that more than half of their employees lack health insurance. That is about to change.
The Good News
We read in today’s New York Times (registration required) that Walmart is significantly expanding the health insurance options for its workers. The good news concerning the company’s new health insurance plan is its cost. This is a relatively inexpensive plan — as low as $11 month for individual coverage, $37 for a single parent and $67 for families. Individuals could visit a doctor three times before paying a deductible, an arrangement aimed at encouraging workers to seek preventive care. In the past, workers have had to pay a deductible before their insurance kicked in.
The Squeeze
That’s the good news. This being Walmart, we better look at the details. When Walmart says that monthly premiums would cost between 40 percent and 60 percent less than those for any existing Wal-Mart insurance policy, we need to find out why. The plan carries a $1000 deductible — a big number for most people and one which represents over 5% of the annual income for many Walmart workers. In the first year, total payments under the plan are capped at $25,000, so workers had best plan their catastrophic illnesses only after they are beyond their one year anniversary. In addition, out-of-pocket payments range from $300 for prescriptions to $1,000 for hospital stays.
As with many types of insurance, this plan works best for people who don’t need it. It’s a good fit for workers who are young and healthy, as opposed to those who are older and more vulnerable to illness. It’s one thing to have an annual check up with no follow up visits. It’s quite another for an older Wal-Mart employee, who might visit a doctor three times in a one month and then need to pay $1,000 before the company would share the cost of care. The last time I wandered through a Walmart, I saw more people likely to run up against the deductible than those who would not.
Bottom Lines and Health Care
Perhaps Walmart has taken the recent spate of bad publicity to heart. Sure, their prices are low, but consumers may have begun to balk when a company hires illegal immigrants to clean their facilities and then locks them in to prevent theft, or when many company employees end up on public assistance because they lack health insurance.
The Walmart model will be closely watched from all sides. Wall Street and Wal-Mart investors will scrutinize the bottom line, tracking the impact of the new benefits on Walmart’s profitability. There are a number of analysts hoping that the Walmart plan will prove a useful model to others in controlling spiralling health costs. On the other hand, consumer and worker advocates will focus on the impact of the premiums and the deductibles on the quality of health care available to workers. We are a long way from resolving this problem, but it is encouraging to see Walmart step into the health care arena. Whether it’s a step in the right direction remains to be seen.
Tags: health insurance, retail, Walmart
