No, but they can increase the costs to your company.

“Not your Problem” is a fine response to that, but as an example I had a friend with a serious health condition who was afraid he’d jeopardize / bankrupt any small startup he joined (and he was probably right).

This was pre-Obamacare but I don’t think that aspect has changed in terms of the costs post-Obamacare?

Generally I have this in the bucket of one of many reasons why startups don’t make sense financially for lots of people (either directly per danluu.com or more indirectly because of stuff like this or inferior coverage for things like fertility treatment etc.).

>“Not your Problem” is a fine response to that, but as an example I had a friend with a serious health condition who was afraid he’d jeopardize / bankrupt any small startup he joined (and he was probably right).

I thought most startups were part of a larger group plan (ie: through their third party benefits provider) so the costs would be distributed across that group plan.

This I’m not as clear on and it for sure differs between companies. But most if not all small businesses are not self-insured. They use a larger insurance company like BCBS who pays out, and the company and employees split the cost of the premiums. Obviously if an employee has high costs that may figure into next year’s premiums but insurance companies are built for this type of thing and it’s not as crazy as you might think.

For larger companies (such as T-Mobile, google, or any other 5k+ employee company it starts to make sense to self insure and only have the insurance company administrate the plan, tho for Amazon scale it looks like they’ve started self administrating as well. Point is once you reach that scale everything looks different and you can absorb an expensive employee.

I think Obamacare/ACA put a cap on costs. It's high but before, it was basically infinity afaik.