In the US, medical insurance is tied to the employer in the vast majority of cases. Paying for an employee health plan is beyond the means of many startups. Founders are often willing to take the chance or make the sacrifice to forgo medical insurance for themselves. But when hiring employees, you can run up against competition from larger employers who can afford to offer medical insurance. Some great potential employees have pre-existing conditions or children and need health insurance - you'd like to hire them, but they need this one particular benefit.
Startups need to run lean, and most fringe benefits aren't something you should expect in a lean startup. But medical insurance in the US seems to be a sticking point. I've heard from more than one entrepreneur that this is a hiring problem. Is there a practical solution for this that anyone has found?