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The Real Reason
Why would cancer survivors be seen as a liability to their employers? The obvious answer is fear of a recurrence, where the employee would again have to take more time off and be re-accommodated on the job. But the real answer is less obvious.
Although illegal cancer discrimination still occurs among patients who are yet under treatment, we suggest it is far more likely to happen to a survivor for whom treatment is over and has returned to work.
Although there are many stories of cancer as a life and career-changing event, most survivors resume their work when they can. In one study, researchers found that although similar numbers of men and women (41 percent of men and 39 percent of women) stopped working during cancer treatment, most of those who returned to work did so during the first year following treatment. Eighty-four percent of cancer survivors surveyed returned to work within four years of their diagnosis.
We suspect that a cancer survivor is most likely to be perceived as a liability to his or her employer in a small business, i.e., fifty or under employees. At a larger employer, a survivor probably finds it easier to keep his or her condition in confidence, and is in general more anonymous to the upper management and owners of the business. In a small firm, however, confidentiality is harder to keep and visibility is much higher.
But though these are all valid possibilities, we believe the real reason that small businesses see the cancer survivor as a liability is more insidious, and presently at the forefront of a national debate…
Group Health Insurance: BIG vs SMALL
Small employers offer group health insurance to their employees just like their larger counterparts do. But there are some substantial differences. Small firms (like a doctor’s office comprised of 15 workers), are more susceptible to the medical risks presented by their members than large ones (for example, the regional operation of a Fortune 500 firm with 1,200 employees). Because of economies of scale and a larger dollar amount of premiums paid, large company insurers can more easily “absorb” the health care claims cost of any single employee illness in a given policy year. By contrast, small groups generate a much small premium dollar, and are more vulnerable to the claims expense of a single sick worker. In the language of insurance, the difference is in the loss ratios. This is the ratio of an employer group’s claims paid in any given policy year to the total premium collected from that group for the same period. If the result is less than 80%, the carrier considers that a financial loss.
In Adrian’s case, her small employer’s group averaged about 21 employees
during the year she had her cancer treatment (2005). The average monthly
premium paid by those who chose the employer’s health plan, perhaps 2/3,
or 14 individuals, was about $250 per person. The total collected for the year
then was around $42,000. But Adrian’s claims were in the neighborhood
of at least $ 250,000 (EST.). The resulting loss ratio of 16.8% was far below the 80%
the insurer would book as a financial loss.
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