Healthcare

[Farfromgeneva]

Health insurance costs near $24K after big jump this year: survey

Tina Reed
Data: KFF, BLS; Chart: Axios Visuals

The average cost of workplace health insurance premiums for family coverage reached nearly $24,000 this year, jumping 7% from 2022, according to the latest annual KFF survey of employer-sponsored coverage.

Not sure why health insurance is still tied to employment in 2023.

And don't get me started on small business insurance offerings. It's mind bogglingly stupid and expensive. And your employees generally don't comprehend or understand just how much you're paying. And if you don't offer insurance yet pay them extra? They complain. Want to give them cash to help pay for an ACA plan? They have to technically report that and their monthly credit is reduced by that amount. And if you do offer them cash to help out with a wink wink on the d/l? They pocket it, don't buy insurance, then complain when they have issues. And if an employee jumps ship to a competitor that offers insurance (mostly because it was a shorter commute)? And you ask them how much they're contributing, what the details are regarding their plan? They have no clue. We literally have a manager sit down with prospectives to show them how to get insurance in the marketplace and how stupidly cheap it usually is compared to anything we could offer.

Not sure why the small business lobbies aren't the loudest group calling for a single payer option or other reform.

I was asking this question of my liberal arts econ professors in the late 90s and early 2000s wathing all the pension/defined benefit plans get dumped on the PBGC in the 80s and 90s...A structural flaw that has cost our citizens more economic consideration than almost anything flawed in the healthcare system. An anachronism from Auto manufacturers and the Supermarkets not wanting to establish higher base rate wages in the early 60s.

Also always found the excellent benefits and lifetime employment security (at least compared with the private sector) and so many "40hrs and that's it" a week salaried federal employees when I lived in DC and they were whining for more cash comp while I'm learning in grad school about HR and Org Behavior as a requirement and how they already have meaningfully higher total economic comp and are just whining.

I'm only capable of starting a business and running independent last half dozen years becuase of my wifes family owned employer cadillac family plan. Trust me at times it's crept into my "should I stay or should I go" home/personal life evaulation in the past few years...

Having state oversight and fixed at state borders is beyond idiotic too.

[youthathletics]

Interesting thread:

https://x.com/zaidkdahhaj/status/172518 ... 89564?s=20

[NattyBohChamps04]

Interesting thread:

https://x.com/zaidkdahhaj/status/172518 ... 89564?s=20

I don't have a twitter account, why does the thread suggest we banish sunglasses?

[youthathletics]

Interesting thread:

https://x.com/zaidkdahhaj/status/172518 ... 89564?s=20

I don't have a twitter account, why does the thread suggest we banish sunglasses?

If you don't have a twitter account, how'd you know it was about glasses?

[NattyBohChamps04]

Interesting thread:

https://x.com/zaidkdahhaj/status/172518 ... 89564?s=20

I don't have a twitter account, why does the thread suggest we banish sunglasses?

If you don't have a twitter account, how'd you know it was about glasses?

It says it on the first post. This is what you see if you visit the link and aren't logged in:



But you can't view any of the replies or the thread or anything, just the first post.

[Farfromgeneva]

The Medicare Gold Rush Is Slowing Down

UnitedHealth’s disappointing outlook and the Humana sale talks intensify concerns that the Medicare Advantage business isn’t what it once was

David Wainer

The most immediate red flag came from the industry leader, UnitedHealth. During an investor day last week, it predicted its Medicare Advantage enrollment would grow by 450,000 to 550,000 seniors in 2024. That translates to around 5% growth next year, a significant slowdown from the 11% it grew so far this year, according to TD Cowen analyst Gary Taylor. As UnitedHealth executives were presenting in New York, The Wall Street Journal reported that the second-largest Medicare plan provider, Humana, was in merger talks with Cigna. While Cigna’s interest in Humana surely attests to insurers’ continued desire to expand into the Medicare market, some investors took it as a sign that Humana isn’t so sure about the strength of the business going forward.

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“One line of thinking is: If Humana is willing to sell itself or do a merger of equals that doesn’t represent a huge takeout price, then what are they signaling about the future of Medicare Advantage?” said Taylor. (Humana and Cigna shares are both down since the Journal reported the talks.)

Medicare Advantage is still a highly attractive business, and it will continue to grow indefinitely as seniors age into it. The opportunity just might not be as stellar as it once was as fewer seniors convert into it, competition grows and government scrutiny increases.

In recent years, the popularity of the private plans has exploded, with enrollment growing from about one-third of Medicare beneficiaries in 2016 to about half in 2023, according to KFF, an independent provider of health-policy research. Many seniors opt for the private plans because they often come with no monthly premium and offer appealing extra benefits such as dental coverage and gym memberships. But not everyone will convert because the plans tend to limit your choice of doctors and force you to jump through hoops to get care.

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SHARE YOUR THOUGHTS

What is the future of Medicare Advantage? Join the conversation below.

The question then becomes at what point do the conversions hit a ceiling. Using Miami as an example, analyst John Ransom at Raymond James noted that once the city reached about 75% market penetration, growth flatlined, suggesting that might be a ceiling for other places. Some seniors, especially wealthier ones less concerned about higher out-of-pocket costs, will continue to prefer regular Medicare coverage, where there is more flexibility in choosing providers and types of care.

As conversions slow down, competition is intensifying. One reason UnitedHealth will have slower growth next year is that CVS Health (which owns insurer Aetna) was more aggressive in its plan offerings. During its investor day Tuesday, CVS said it would add more than 600,000 members to its Medicare Advantage plans next year, confirming that it is grabbing some of the growth away from the industry leaders. The competition is a sign that the market is doing what it should, and that isn’t a bad thing for seniors. Beneficiaries are now able to pick from an average of 43 plans based on their location, compared with just 20 in 2018, according to Ransom. As companies compete for market share, supplemental benefits expand while premiums fall, reducing insurers’ margins.

Payments from the government are going to be less favorable starting next year because of changes in the way the Centers for Medicare and Medicaid Services scores risks. The changes came after insurers were accused of gaming the system by overcharging the government through coding practices that overstate patient sickness. The new plan will eliminate or trim the payments associated with some conditions.

Insuring seniors is just one way that increasingly vertically integrated insurers make money. Another way to capture the billions flowing through the system is for insurers to buy up providers, and make sure to funnel money from their insurance arms to their medical arms. And that is exactly what some are doing, with UnitedHealth leading the way. During its investor day, UnitedHealth noted that its Optum unit now employs, or is affiliated with, some 90,000 doctors.

That is a striking number, which one industry publication highlighted amounts to 10% of the country’s physicians. CVS and others are likewise jumping onto the bandwagon.

As Medicare Advantage markets become more saturated, managed-care companies will double down on their strategy to be not just your insurer, but your doctor, too.

Write to David Wainer at [email protected]

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[CU88a]

Amazing

https://thehill.com/homenews/4400342-ob ... tive-year/

"With six days left to still get covered, 8 million more Americans have signed up for ACA coverage than when I took office," President Biden said in a statement on Wednesday, adding that most enrollees will be eligible to select a plan that could cost just $10 a month — or even less.

[cradleandshoot]

Amazing

https://thehill.com/homenews/4400342-ob ... tive-year/

"With six days left to still get covered, 8 million more Americans have signed up for ACA coverage than when I took office," President Biden said in a statement on Wednesday, adding that most enrollees will be eligible to select a plan that could cost just $10 a month — or even less.

I'm curious what type of healthcare coverage you can purchase for 10 dollars a month. I'm on Medicare now and it costs me a 40 dollar copay just to walk into my orthopods office. Last month I went to an Urgent Care center and was advised I needed to make an appointment. An appointment for an Urgent Care center?? I might have understood if it wasn't for the fact that my wife and I were the only 2 people in the office. We were advised they were swamped and overwhelmed by other patients who apparently were invisible.

[RedFromMI]

Amazing

https://thehill.com/homenews/4400342-ob ... tive-year/

"With six days left to still get covered, 8 million more Americans have signed up for ACA coverage than when I took office," President Biden said in a statement on Wednesday, adding that most enrollees will be eligible to select a plan that could cost just $10 a month — or even less.

I'm curious what type of healthcare coverage you can purchase for 10 dollars a month. I'm on Medicare now and it costs me a 40 dollar copay just to walk into my orthopods office. Last month I went to an Urgent Care center and was advised I needed to make an appointment. An appointment for an Urgent Care center?? I might have understood if it wasn't for the fact that my wife and I were the only 2 people in the office. We were advised they were swamped and overwhelmed by other patients who apparently were invisible.

Subsidized is the word - most of the people who would sign up for this insurance have low enough family incomes to get a 'healthy' reduction in premiums. When the ACA was first put into place I checked out similar plans to the State of SC plan I had through my wife and the premiums were quite similar if not more expensive.

Now that I am on Medicare and a plan for post federal employees, the rates are quite a bit better than my widower rate with the state of SC, but still _way_ above $10/month...

[Farfromgeneva]

cant recall wehre we discussed govt negotiating with pharma but this was on my mind when I saw this piece and related humana earnings today.

HEALTH
HEALTHCARE
HEARD ON THE STREET
It Is Going to Be a Bad Year (or More) for the Medicare Business
Humana’s disappointing guidance suggests insurers aren’t prepared for higher medical costs among the elderly
By
David Wainer
Follow
Jan. 25, 2024 10:06 am ET


Humana on Thursday said a previously communicated 2025 target is no longer achievable. PHOTO: JON CHERRY/BLOOMBERG NEWS
America’s seniors are going to keep up their elevated use of the medical system throughout the year. That is the message from Humana’s HUM -12.26%decrease; red down pointing triangle earnings release on Thursday, which is sending stocks of insurance giants sliding.

The health insurer plunged over 10% on Thursday morning while competitors UnitedHealth UNH -6.50%decrease; red down pointing triangle, CVS Health CVS -3.67%decrease; red down pointing triangle and Centene CNC -4.28%decrease; red down pointing triangle were all down sharply. All four companies have significant Medicare Advantage businesses that have been facing pressure from slowing growth and tougher scrutiny by the Centers for Medicare and Medicaid Services. The higher costs, which Humana says it expects will affect the whole industry, are only the latest bit of bad news, one which raises questions about how insurers’ internal modeling could be so off.

Humana said it believes the elevated Medicare Advantage costs “are an industry dynamic, not specific to Humana, and that they may persist for an extended period or, in some cases, permanently reset the baseline.”

On Thursday, Humana forecast an adjusted earnings per share of about $16 for 2024, much lower than analysts’ expectations of $29.10 per share on FactSet. The company also reported an adjusted loss of 11 cents a share for the fourth quarter, widely missing a consensus estimate for a profit.


Investors thought Humana had already somewhat reset expectations when it pre-announced earlier this month that medical costs were running higher than expected in the fourth quarter. It said then that its fourth-quarter medical loss ratio—the share of premiums spent on medical care—would be 91.4%, versus its prior projection of 89.5%, sending its stock down sharply that day too. UnitedHealth Group had also disclosed higher fourth-quarter medical costs.

Humana’s results on Thursday make matters worse, though, because they mean that the entire year might be spoiled for the company. That is because health insurers set their pricing for a full year, so if they underestimate their costs, that could hurt all of 2024. The issue also extends into 2025 because to gain back margins, Humana, and potentially others, might have to cut back on benefits to enrollees.

The company on Thursday also said a previously communicated 2025 target is no longer achievable. Cutting back on benefits might result in better margins but slower growth, explains Jefferies analyst David Windley. In other words, there could be at least two years of rebasing for Humana and perhaps others.

Take CVS Health, the parent company of Aetna, which reports earnings next month. It was very aggressive in growing its 2024 Medicare Advantage business. Earlier this month it said it expects enrollment in those plans to grow by at least 800,000 members this year, versus its previous forecast of adding 600,000. That might come back to bite it now.

At the same time there is an emerging dichotomy in the insurance world, with those who have avoided entering the Medicare business now benefiting from increased investor interest.

Elevance Health ELV -0.64%decrease; red down pointing triangle, which is more focused on the commercial market and therefore exposed to younger enrollees, this week issued strong fourth-quarter earnings and an upbeat outlook for 2024. While Elevance acknowledged pockets of higher utilization across its business, it said it was within expectations. Shares of Cigna CI -3.03%decrease; red down pointing triangle and Elevance, two large insurers with a bigger focus on the commercial market, have been less affected by recent concerns of higher Medicare costs. Thankfully for Cigna shareholders, the company abandoned its pursuit of Humana late last year. Some investors had been warning that Humana’s willingness to sell itself could be a sign of difficulties in the Medicare business.

The fast-growing Medicare Advantage business led to a gold rush for insurers. That is now over.

Write to David Wainer at [email protected]

[NattyBohChamps04]

After Appalachian Hospitals Merged Into a Monopoly, Their ERs Slowed to a Crawl

A real time look at the free market working its magic.

[a fan]

After Appalachian Hospitals Merged Into a Monopoly, Their ERs Slowed to a Crawl

A real time look at the free market working its magic.

Not possible. Free market medicine is best, especially for the working class, and socialized medicine is "bad" because you have to wait for services in a socialized system. And in a private system? Oh, there's no wait times for anything.

Especially in rural America, where patients are flush with cash. Don't change a thing, this system is great.

Oh, and America's private system doesn't work? It's Obama's fault. It was perfect before that guy showed up.

[CU88a]

Off topic, but 30 years ago today the US Labor Dept proposed ban on all smoking in the workplace.

https://www.nytimes.com/1994/03/26/us/l ... place.html

With a bill to ban smoking in virtually all buildings in the country except private homes stalled in Congress, the Labor Department seems prepared to do by regulation what the Congress has not done by law.

The Occupational Safety and Health Administration has proposed a rule to ban smoking in the workplace, Labor Secretary Robert B. Reich announced today. Of the more than 70 million Americans who work indoors, OSHA estimates that 21 million are exposed to poor indoor air and that millions of others are exposed to secondhand smoke. Trying to Prevent Deaths

"OSHA has taken this action to prevent thousands of heart disease deaths, hundreds of lung cancer deaths, and the respiratory diseases and other ailments linked to these hazards," Mr. Reich said.

According to the Environmental Protection Agency and the Centers for Disease Control and Prevention, secondhand smoke causes 3,000 deaths each year from lung cancer, 150,000 to 300,000 cases of bronchitis and pneumonia in youngsters, and asthma attacks in more than twice that number. Secondhand smoke has also been implicated in deaths from heart disease and other forms of cancer.






My how the world can change.

[a fan]

Off topic, but 30 years ago today the US Labor Dept proposed ban on all smoking in the workplace.

https://www.nytimes.com/1994/03/26/us/l ... place.html

With a bill to ban smoking in virtually all buildings in the country except private homes stalled in Congress, the Labor Department seems prepared to do by regulation what the Congress has not done by law.

The Occupational Safety and Health Administration has proposed a rule to ban smoking in the workplace, Labor Secretary Robert B. Reich announced today. Of the more than 70 million Americans who work indoors, OSHA estimates that 21 million are exposed to poor indoor air and that millions of others are exposed to secondhand smoke. Trying to Prevent Deaths

"OSHA has taken this action to prevent thousands of heart disease deaths, hundreds of lung cancer deaths, and the respiratory diseases and other ailments linked to these hazards," Mr. Reich said.

According to the Environmental Protection Agency and the Centers for Disease Control and Prevention, secondhand smoke causes 3,000 deaths each year from lung cancer, 150,000 to 300,000 cases of bronchitis and pneumonia in youngsters, and asthma attacks in more than twice that number. Secondhand smoke has also been implicated in deaths from heart disease and other forms of cancer.






My how the world can change.

My bar was at the very tail end of restaurants/bars before the County and State it was in banned smoking.

You want to know how bad second hand smoke is? All you have to do is clean the interior windows in any building where smoking is allowed.

Your white paper towel will turn into a horrible mix of yellow and black, from all the residual smoke. It's disgusting.

[OCanada]

Kenneth Arrow, among others, identified the pre-conditions necessary for markets to work in the public interest and how difficult it is for societies to make collective choices that account for members needs and desires. A key thinker in developing the ideas informing economic thinking about healthcare.

If we spent the same share of national income as Switzerland, second globally to our first. We would save a trillion dollars a year. That would cover our entire military budget with money left over. Alternatively, we could give every one the Swiss system, an annual check for 3,000 and the five additional years of expected life they have.

America dies not have a free market system in anything. A couple of big factors include a lack of data on which to make sound decisions. Another is the amount of money involved. There are six healthcare lobbyists for every member of Congress in DC alone. It also serves as one of the main conduits for funneling money into politics