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Presidential Candidates: Take the Pledge to Serve ‘We the People’

This Op-Ed was published by the Des Moines Register on August 21.

I write this not as a Republican, nor as a Democrat – I’m politically agnostic. When it comes to addressing healthcare, a critical election issue, Iowa voters have the first crack at drilling down and asking presidential candidates for details on how costs will be meaningfully lowered, who will be covered, what will be covered, how it will be paid, and how higher-quality care will be delivered consistently to all populations.

The candidates we eventually elect must thoroughly analyze the details of their plans, including the possibility of unintended consequences that will invariably result. Acknowledging the pros and cons of the plan they support is both honest and crucial.

For presidential candidates to successfully make it out of Iowa and live to compete in future primaries and caucuses, Iowans must require each to articulate the specifics of their plan. Generic responses of supporting “Medicare for All” or “Single-Payer” does little to inform voters, other than allow candidates to merely checkoff one of many issues they support. In healthcare, the devil is definitely in the details.

During the Democratic debates this summer, many candidates singled out insurance and pharmaceutical companies as being responsible for the cost predicament we have across the nation. In fact, Sen. Bernie Sanders, (I-Vt), pledged to reject any donations over $200 from political action committees, lobbyists and executives of insurance and drug companies. Sen. Sanders called on other Democratic candidates to do the same.

Per Sanders’ pledge, “Candidates who are not willing to take that pledge should explain to the American people why those corporate interests and their donations are a good investment for the healthcare industry.”

This pledge, although well-intentioned, does not go far enough. The narrative that insurance companies and pharmaceutical manufacturers are the lone villains is grossly naïve because it excludes other major contributors to the cost problem – hospitals and physicians.

Healthcare prices in the U.S. are considerably higher when compared to other industrialized countries, and a large part of this comes from those providing this care. In fact, providers do not want their negotiated fees with private payers to be transparent, largely under the guise that once prices are publicly known, costs would go even higher because lower-paid providers may want better deals through higher prices. This is merely a convenient approach to keep prices opaque and largely unknown. This status quo only benefits the intended stakeholders, not most Americans.

According to MapLight, a nonpartisan research organization, the American Medical Association and the American Hospital Association are the fifth and sixth largest lobbying spenders over the past decade. In the first half of 2019, the AMA has spent $11.5 million on lobbying while the AHA has spent $10.2 million. The AHA amount is equal to the combined lobbying contributions of three large insurance organizations: America’s Health Insurance Plans, Blue Cross and Blue Shield Association and UnitedHealth Group. Since 2008, the AMA has spent almost $228 million in lobbying, while the AHA spent over $205 million.

Sen. Sanders and all candidates (congressional included) should pledge to avoid donations and other influential contributions from all key healthcare stakeholders, including the AMA and AHA. Candidates must distance themselves from external influences that undermine a system that needs to be designed for the people, not by special interests.

These three foundational healthcare cornerstones – cost, coverage and quality – are the overriding factors that should determine whether our reformed healthcare system is run solely by the government, as some “Medicare for All” proposals tout, or through public-private reforms that improve or replace the existing Affordable Care Act (ACA).

Candidates of all parties – do the right thing – rid yourselves of conflicts of interest and represent all Iowans and Americans.

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Lindex® Score Remains Unchanged in 2019

Four color-coded quartiles represent the strength of benefits offered.

We’ve just released the new Lindex®scores based on our 2019 Iowa Employer Benefits Study©. Introduced in 2012, the Lindex is an innovative tool that allows Iowa employers to distill voluminous and complicated benefits data into one relevant number.

An organization’s Lindex score may help Iowa employers to:

  • Determine the competitiveness of their benefits package.
  • Attract and retain a high-quality workforce.
  • Decide whether benefit changes are required to keep your employee benefits competitive.

The Lindex is a composite score used as a reference when determining the quality of benefits offered by Iowa organizations. This index is the result of a sophisticated calculation based on the benefits data submitted by 999 Iowa organizations from the latest 2019 Iowa Employer Benefits Study©.

Calculated once a year, the Lindex ranges from 0 to 100, with low scores reflecting fewer benefits offered at a higher cost to employees, while higher scores indicate more benefits being offered at a competitive cost.

In 2019, the overall Lindex score for Iowa employers (regardless of employer size and industry) is 76 – which is unchanged from 2018.

The Lindex score will vary based on the employer size and industry, which are two determining factors that affect employee benefits. For example, employers with fewer than 10 employees have a Lindex score of 64, while employers with 1,000+ employees averaged 89.  Below is a summary graphic of the Lindex scores based on organization size:Employers in the construction industry averaged 64, while colleges and universities averaged a score of 92. Below is a summary graphic of the Lindex scores based on industry:The Lindex calculation began during the 2012 survey year. As depicted in the graphic below, between 2012 and 2015, the Lindex was calculated using five employer size categories: 2-9, 10-19, 20-49, 50-249, 250-999 and 1,000+. The top of the graphic provides the Lindex score based on size categories (by year), while directly below this is a color-coded chart showing the Lindex scores based on quartiles for each year. For example, the scores of the smallest organization-size category (2-9) is depicted in red, meaning this size typically scores in the lowest-scoring quartile. The scores of the next two size categories, 10-19 and 20-49, fell in the second quartile (orange). Without fail, the next size category of 50-249 scored in the third quartile (yellow), while organizations with over 250 employees were offering the most comprehensive benefits – noted in green, the fourth quartile.Beginning in 2016, the organization-size categories were altered somewhat, primarily to shadow many provisions found in the Affordable Care Act (ACA). The graphic below depicts the average Lindex scores by organization size and the quartiles that each size category are found. The quartile results are similar to the results found in the previous graphic.Finally, with any selected industry, it is interesting to compare the Lindex scores by size categories.  As an example, the following graphic compares ‘for-profit’ organizations with ‘non-profit’ organizations. With the exception of organizations that have 1,000+ employees (both scored equally at 89), all ‘for-profit’ size categories scored less-favorably when compared to scores of ‘non-profit’ organizations (see graphic below).  Non-profit organizations clearly offer more comprehensive benefits than their for-profit counterparts.Should you wish to learn more about the Lindex, and how your organization can obtain your own Lindex calculation, please visit the Frequently Asked Questions (FAQ) section of our website.

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2019 Iowa Employer Benefits Study©
Employers Report 7.1% Increase in Health Premiums

Today, we issued our 20th Iowa Employer Benefits Study© results. As with past studies, the wealth of data is immense. This year’s study found that Iowa employer health insurance premiums increased an average of 7.1 percent from 2018 to 2019.

The 7.1 percent increase is an average that factors in employers receiving no rate change, an increase or decrease in their health premiums. This number represents the average increase in premiums employers received PRIOR to making design changes to their medical plans – such as increasing cost-sharing arrangements with employees.

The 2019 Iowa Employer Benefits Study© found that average annual premiums for employer and employee contributions (combined) were $7,017 for single coverage and $19,335 for family coverage. Since 1999, the year this study began, the single premium has increased by 240 percent while the family premium has jumped by 251 percent. (NOTE: In a number of slides below, the year 2017 was excluded because no survey was performed.)

During the post-ACA period (2011-2019), total family premiums increased by 45.4 percent, while employees with family coverage experienced a 30.5 percent increase to their payroll-deducted premiums. Employers continue to make sizeable contributions to keep the employee cost ‘manageable.’ This information is depicted in the following graph.

How did Iowa employers respond? They continue to ratchet up employee cost-sharing arrangements by increasing employee premium contributions and plan-sharing responsibilities, which results in higher deductibles and out-of-pocket maximums.

For the first time in this study’s history, employers were asked to gauge their ‘cost-shifting fatigue.’ On a 10-point scale, where 1 means the employer has a minimum cost-shifting fatigue and 10 means the employer has reached its limit of shifting costs to employees and is now considering to no longer offer health coverage, Iowa organizations reported their fatigue level was 3.5 out of 10. Despite experiencing rate hikes for years, Iowa employers are not yet likely to discontinue offering health coverage. Below is a slide that depicts employer responses by employee-size categories.

Iowa employees were asked to contribute an annual average of $1,313 for employee-only coverage, while employees with family members were asked to pay $5,794 annually. Over the course of 20 years (1999-2019), employee contributions have increased by 196 percent for single coverage and 173 percent for family coverage.

The overall 2019 statewide weighted-average deductible for single coverage is now $2,192, while the family weighted-average is $3,975. Since 2004, deductibles for both single and family have risen by 288 percent and 235 percent, respectively.

The post-Affordable Care Act (ACA) period (2011-2019) reveals the deductibles continue to climb for both single and family coverages, approximately 46 percent and 25 percent respectively.

In addition to revealing updated results for dental coverage, group life insurance, short and long-term disability coverages, the 2019 Study also reveals whether Iowa organizations offer a large number of work-life and convenience benefits in their workplace setting. The top five benefits offered by Iowa employers include:  Jury Duty Leave (89.2 percent), Bereavement/Funeral Leave (87.5 percent), Unpaid Leave (83.7 percent), Maternity Leave (72.6 percent), and Personal Days (63.6 percent).

The above information is just a small fraction of our survey results. The complete 2019 Iowa Employer Benefits Study© is available for purchase and download on this site.

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