SICKER SHOCK: Employers Slammed by Biggest Health Insurance Premium Increase in Years

Brace yourselves for the biggest health insurance premium increase in years: Employer group health insurance premiums are going up yet again this year. In fact, small business owners are already reeling at their projected costs for the next plan year.

Biggest Health Insurance Premium Increase in Years

Benefits consulting giants Mercer, Aon, WIllis Towers Wilson all see employer health insurance premiums rising between 5.5% and 8.5% in 2024.

These are averages. A few carriers are increasing prices by 10%, 20% and even more in the individual market.

This year, the chief culprits behind soaring employee group health insurance costs are: medical inflation, increasing demand for costly weight-loss drugs. and increased fielding  of expensive gene therapies.

For example, Skysona, a new gene therapy treatment for a rare neurological disorder, just hit the market in the summer of 2022 at a cost of $3 million per course of treatment.

Zynteglo, a gene therapy for a rare blood disorder, costs $2.8 million.

Additionally, with commonly-prescribed weight loss drugs like Ozempic and Wegovy listing for $936 and $1,300, respectively for a one-month supply—and taken month after month—insurance carriers have been under pressure to increase premiums to reflect the additional costs.

Meanwhile, general inflation continues to take its toll: U.S. consumer prices accelerated 3.7% in the 12 months through August, down from a peak of 9.1% in June last year.

However, medical cost increases usually lag general inflation effects. This is because contracts between insurers and hospitals negotiate pricing contracts as much as a year in advance.

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Other Factors Contributing to Health Insurance Premium Increases

These three main factors don’t occur in a vacuum, however.

There are multiple other factors putting constant upward pressure on medical costs and, by extension, health insurance premiums in general.

General medical Inflation

The steady increase in healthcare costs, often referred to as medical inflation, is a persistent challenge in the United States.

This trend is driven by various factors, including the rising costs of medical services and goods. Hospitals, pharmaceutical companies, and healthcare providers frequently adjust their prices upward, contributing to the overall inflationary pressure in the healthcare sector. As the cost of providing medical care increases, these expenses are passed on to patients, insurers, and employers, resulting in higher healthcare premiums and out-of-pocket costs.

Technological Advances

Advancements in medical technology, while providing innovative and often life-saving treatments, come at a price.

New diagnostic tools, medical devices, and therapies are typically more expensive than their predecessors. The development and adoption of cutting-edge technologies in healthcare contribute to the overall escalation of healthcare costs.

While these advances lead to improved patient care and outcomes, they also pose a financial challenge for individuals, employers, and insurers who bear the brunt of the increased expenses associated with incorporating the latest medical innovations into routine healthcare practices.

Prescription Drug Costs

The rising costs of prescription medications significantly impact overall healthcare expenditures.

Pharmaceutical companies, facing the high expenses of research, development, and regulatory compliance, set prices that reflect these investments. Additionally, the lack of competition in certain drug markets allows manufacturers to maintain higher prices. As a result, patients and healthcare payers face escalating costs for essential medications, impacting their ability to afford and access necessary treatments.

The challenge of balancing the need for pharmaceutical innovation with the imperative of making medications affordable for the broader population remains a complex issue in the ongoing debate about healthcare reform.

Chronic Health Conditions

The prevalence of chronic health conditions, such as diabetes, heart disease, and hypertension, plays a pivotal role in driving up healthcare costs.

Individuals with chronic conditions often require ongoing medical attention, including regular doctor visits, medications, and sometimes hospitalization. The management of chronic diseases demands a substantial share of healthcare resources and contributes significantly to the overall burden on the healthcare system.

Efforts to address the rising costs associated with chronic conditions involve not only treating these illnesses but also emphasizing preventive measures and lifestyle modifications to reduce the incidence of chronic diseases in the first place.

Aging Population

The aging of the U.S. population contributes to an increased demand for healthcare services.

As individuals grow older, they tend to require more medical attention and treatment for age-related conditions. This demographic shift places added strain on healthcare resources and infrastructure. The challenge lies in adapting the healthcare system to meet the specific needs of an aging population, including preventive care, long-term care, and management of chronic diseases.

Policymakers and healthcare providers must grapple with the implications of this demographic trend to ensure that the healthcare system remains both sustainable and effective in meeting the evolving healthcare needs of an older population.

Administrative Overhead Costs

The administrative complexities within the healthcare system contribute to the overall cost of healthcare.

Billing processes, claims processing, and compliance with a myriad of regulations necessitate a substantial allocation of resources. The administrative burden is not only a financial challenge but also a source of frustration for healthcare providers and patients alike.

Simplifying administrative processes and reducing inefficiencies within the healthcare system are critical steps toward alleviating the burden of administrative costs, potentially leading to more cost-effective and streamlined healthcare delivery.

Employee Lifestyle Factors

Unhealthy lifestyle choices, such as sedentary behavior, poor dietary habits, and tobacco use, contribute significantly to the prevalence of chronic diseases.

The impact of these lifestyle factors extends beyond individual health to the broader healthcare landscape. Unhealthy lifestyles increase the demand for medical services, including preventive care, diagnostic tests, and therapeutic interventions.

Addressing the root causes of unhealthy behaviors requires a comprehensive approach, encompassing public health initiatives, workplace wellness programs, and educational campaigns to promote healthier lifestyle choices among individuals.

Increased Utilization

The escalating utilization of healthcare services, including unnecessary tests and procedures, contributes to the overall rise in healthcare costs.

Factors such as defensive medicine (medical practices aimed at avoiding lawsuits) and patient demand for extensive diagnostic testing play a role in driving up healthcare utilization.

Striking a balance between providing necessary and effective healthcare services while avoiding unnecessary and costly interventions is a complex challenge. Efforts to optimize healthcare utilization involve promoting evidence-based medicine, enhancing care coordination, and implementing initiatives to educate both healthcare providers and patients about the value of prudent healthcare utilization.

Rising Labor Costs

The provision of healthcare benefits as part of employee compensation contributes to the overall increase in labor costs for employers.

As healthcare expenses rise, employers face the challenge of balancing competitive compensation packages with the need to manage operational costs. The impact of rising labor costs extends beyond the employer-employee relationship to the broader economy.

Employers must navigate the complex landscape of healthcare benefits, exploring innovative solutions to provide competitive compensation packages while addressing the financial realities of sustaining employee health coverage.

Regulatory Changes

Changes in healthcare regulations and policies can have a profound impact on healthcare costs.

Regulatory shifts may influence how healthcare services are delivered, reimbursed, and accessed. While certain regulations aim to improve the efficiency and quality of healthcare, others may introduce complexities and administrative burdens that contribute to rising costs.

Striking the right balance in healthcare regulation requires careful consideration of the potential economic implications, ensuring that regulatory changes align with the overarching goal of enhancing the accessibility, affordability, and quality of healthcare services for the population. Policymakers and stakeholders must engage in ongoing dialogue to refine and adapt regulations to best serve the evolving needs of the healthcare system.

High Deductible Health Plans (HDHPs)

Employers, especially smaller businesses with fewer than 30 employees, are increasingly turning to High Deductible Health Plans (HDHPs) as a strategy to manage healthcare costs.

HDHPs typically have lower monthly premiums, making them an attractive option for both employers and employees. With these plans, individuals pay higher out-of-pocket costs before insurance coverage kicks in. To sweeten the deal, many employers offer Health Savings Accounts (HSAs) to accompany HDHPs.

HSAs allow employees to set aside pre-tax dollars for medical expenses, providing a valuable financial cushion for both routine and unexpected healthcare needs. HDHPs empower employees to take charge of their healthcare spending and can be a budget-friendly option for employers seeking to provide coverage without breaking the bank.

Resource: HSA for America – HDHPs

Health Sharing Programs

For small employers aiming to explore alternative healthcare options, health sharing programs have gained traction.

These programs operate on a cooperative principle, where members share each other’s medical costs. Unlike traditional insurance, health sharing is often more flexible and cost-effective for both employers and employees. Small businesses can benefit from the simplicity of health sharing plans, which typically involve lower monthly contributions and fewer bureaucratic hurdles.

However, it’s crucial to note that health sharing is not insurance and may have limitations in coverage. As employers seek creative solutions to manage costs, health sharing programs provide an avenue for more personalized and community-driven healthcare arrangements.

Resource: HSA for America – Health Sharing

Direct Primary Care (DPC)

Direct Primary Care (DPC) is gaining popularity among small employers as a strategy to provide affordable and accessible healthcare for their workforce.

In a DPC model, employers pay a flat monthly fee per employee to a primary care provider. This fee covers a range of basic healthcare services, fostering a direct and unhurried relationship between the employee and their primary care physician.

By bypassing the traditional fee-for-service model, DPC reduces the administrative burden associated with insurance claims and allows for more personalized and preventive care. Small businesses embracing DPC can offer employees a simplified and comprehensive healthcare experience, often resulting in improved health outcomes and reduced overall healthcare costs.

Resource: HSA for America – Direct Primary Care

Wellness Programs

Implementing wellness programs is a proactive approach for small employers to promote employee health and, in turn, reduce healthcare costs.

These programs focus on preventive measures, encouraging healthy behaviors and lifestyles among employees. Wellness initiatives may include fitness challenges, nutritional guidance, mental health resources, and smoking cessation programs.

By investing in employee well-being, employers aim to mitigate the risk of chronic conditions and reduce the need for expensive medical interventions. Wellness programs contribute to a healthier, more engaged workforce, potentially decreasing absenteeism and boosting productivity. For small businesses with limited resources, even simple wellness initiatives can make a significant impact on employee health and, subsequently, healthcare costs.

Here are some additional blog for further reading:  1Complete Solution | Direct Primary Care for Employers: Pros and Cons Discussed | Why Accountants And Everyone Else Who Understands the Numbers Loves Health Sharing Accounts 

Here are some additional pages related to this article: Small Business Healthcare Plans | Health Sharing Plans for Small Businesses

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