Restrictions to the right to choose health care insurance are once again being applied to the detriment of workers

Lawyer. Employment advisor of companies and chambers of business. Academic Counselor for Libertad y Progreso.

This is a setback in the evolution of the system because workers are no longer free to choose the health insurance provider that suits them best.

The Executive branch has brought back the original restriction to the system, whereby workers who start a new job in a given industry shall keep the union’s health care insurance for one (1) year, and then are allowed to choose a different health insurance company provided it is managed by a Union.  

Undoubtedly, this is a setback in the evolution of the system, because workers are no longer allowed to choose the best option for them among health insurance providers at their own convenience. What’s more, when analyzing the map of health insurance providers managed by unions, marked differences are found in terms of service quality and infrastructure. There are also unions that do not provide any health care services in certain provinces or cities, thus leaving workers and their dependents totally unprotected.

In the 1990s, the so-called deregulation process begun for health insurance managed by Unions. In 1993, workers were given the right to choose their health insurance provider from a national health insurance system. This right is enshrined in Acts No. 23660 and 23661 and was implemented by Executive Order No. 9/93 and EO 130/97, both under Carlos S. Menem’s administration. In 1998, some restrictions were introduced. In 2001 it was stated that workers had the right to choose their health insurance company from the very first day of their employment.

The right to choose was somehow compromised when the subsystem was restructured because there were health care insurance providers that did not provide any services but collected funds, and control was virtually impossible.

Other alternatives were considered in which workers could get private health insurance plans by paying an extra cost, which was usually covered by leading companies that wished to provide quality health care services to their staff and family members. These plans protected the workforce against any work-related disease or accident but also covered maternity assistance, which in this scenario was a key factor.

According to Executive Order No. 438/2021, “… the right to choose may be exercised just ONCE during the whole calendar year, and workers may effectively exercise their right as from the first day of the following month after the request is formalized.”

This order also stated that the right to choose a health care insurance company had to be exercised individually and personally by taking the steps determined and/or to be determined in the future by the Health Care Service Supervising Authority (SSS), ensuring workers transparency, integrity, expediency, and information. It is particularly important to set the dates on which workers may cancel and switch to a new health insurance provider to avoid any unnecessary gray areas where mutual claims may arise, speculating with the lack of clarity by any of the parties involved at the time of transition.  

As a matter of fact, in practice, switching to a different health insurance provider usually becomes highly bureaucratic, with many hurdles along the way. The use of digital platforms and other methods shall ensure that the workers are informed about the options that are available and that this information is easily accessible at any time.  

According to the law, in cases of difficulty, inadequate information or lack of access, Health Insurance Companies shall ensure that beneficiaries receive full, detailed, and adequate information about their health plan and benefits. Beneficiaries should be given access to a full list of providers at any time with a detailed description of their health plans and programs on the respective institutional web page and other channels of communication that the Health Insurance Company may provide.

The Supervising Authority is expected to ensure a smooth automatic transition when workers exercise this option, mitigating any unnecessary bureaucratic hurdles, in an attempt to improve the system. It would be advisable to do away with those Health Care Insurance Companies that are still unviable due to their critical mass or poor management and merge them with those that run reasonably well in order to keep the health services they provide and add others, such as training or tourism, as an integral part of the health plans of member workers represented by the most representative unions.   

Considering that this newly-passed provision is actually detrimental to workers, it is clear that the lack of services may pose a greater cost to companies that will have look for this services elsewhere when health insurance companies are inoperative or inviable, and in many cases end up turning to public health services.

Again this untimely setback, based on a rather vague argument, benefits unions that are not providing minimum indispensable services. The right to choose freely used to encourage competition between unions, in particular about the services offered, immediate medical assistance in case of emergency, out-patient care, hospitalization, surgery, treatment and rehab. It has become evident that there are those who collect funds without rendering accounts and without offering any services, which has led to the merger or liquidation of unviable providers. In other words, this is such an untimely step back that adds more fragility to an already fragile national, provincial and municipal health care system, badly hit by the public health crisis as a result of the Covid-19 pandemic. 

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