I’m talking about the small business where an employee is on their spouse’s insurance or a Marketplace plan and the company just reimburses them for all or part of the premium like a regular business expense. You're not supposed to do that.

The One Big Beautiful Bill Act (OBBBA) increased your health insurance premiums in two meaningful ways: It cut pandemic-era premium tax credits (which help the working poor get healthcare) and it cut funding for Medicaid (which pays for healthcare for the very poor).

The game begins. You have one calendar year to spend the money. The company has a year to collect it back from you. If you both follow the plan, you’ll both walk away scot-free, with the taxes you didn’t spend still in your pocket.

What if, instead of inflating wages with cash, the company offered to pay for something even more valuable than cash? The health of workers and their families. 

Did you know that if your company has more than 50 employees (100 in CA, CO, NY, and VT), the employer sees all the prescriptions people take?  They don’t know who, but if there are fewer than 100 people it’s pretty easy to guess who needed a prescription to control their excessive underarm sweating. Or who's on Lithium.

But why would someone take a 40+% pay cut by choice? That time must be more valuable than money. There are plenty of reasons besides laziness why this might be true. 

Insurance premiums have been increasing at more than double the rate of inflation for the past 3 years. In 2026, employer group plans are expected to increase nearly 8%. 

Everywhere I went, I saw the same thing: Employees didn’t understand what they signed up for. Brokers didn’t really understand either. HR didn’t want to touch it. Claims were denied. People thought their plans sucked.

Given the significant cost of many COBRA premiums, PeopleOps teams should be prepared to answer departing employees’ questions about COBRA i