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COVID-19: What Will Happen to Future Private Health Insurance Premiums?

As of April 6, COVID-19 cases have surpassed 1.35 million globally, with more than 75,000 fatalities…and counting. The U.S. accounted for 367,000 infections and almost 11,000 deaths. The world economy is spiraling disastrously downward with no clear consensus when the bottom will be reached.

While watching the evening news recently, my wife asked me how insurance companies will remain financially sound if the scenarios of COVID-19 cases and fatalities reach doomsday projections. This is a logical, yet difficult, question worth some exploration.

In the U.S., most healthcare is privately provided – except for the elderly (Medicare) and for the poor (Medicaid). The key issue in the U.S. and most countries is to enable rapid testing of people in vulnerable populations, such as the elderly and individuals with health conditions who may have compromised immune systems.

Overview on Treatment Cost, etc.

Most countries, thanks to government-directed health systems, will provide free testing and treatment, but in the U.S., when appropriate tests are available, it is largely dependent on whether each private insurer (and self-insured employers) will cover COVID-19 testing and treatment. However, the Families First Coronavirus Response Act that was recently passed by Congress mandates that Medicare, Medicaid, other government plans, and most private plans cover the entire COVID-19 testing.  It must be noted that ‘surprise’ billing issues could develop under some scenarios.  There are no curative treatments for the COVID-19 virus itself, so the treatment mentioned in this blog addresses the complications from COVID-19-related illnesses.

According to the Peterson-Kaiser Family Foundation Health System Tracker, the potential costs of COVID-19 treatment for Americans covered by employer health plans will vary greatly by location and insurance plans – in addition to complications and comorbidities. The average hospital stay for admissions due to pneumonia, a relatively similar comparison to treating COVID-19, with or without complications or comorbidities is 3.2 days – with a median total cost of treatment being about $13,000. Patients with respiratory conditions who require a ventilator (requiring less than 96 hours) will average 5.8 days – with a median cost of over $34,223. Finally, patients on ventilators for more than 96 hours will average 22.6 days – with a total median cost of over $88,000.

It is important to note that the actual number of patients and the medical efforts required will ultimately determine the true medical costs, both in Iowa and across the country. Medical costs in Iowa tend to dip below national average costs mentioned earlier.

As of April 5, a research center at the University of Washington estimated that 420 Iowans will die of COVID-19 by August 4. This figure is based on a moving target of assumptions, as it will be greatly dependent on a number of variables such as stay-at-home adherence by Iowans practicing social distancing, number of Iowans affected by the virus, healthcare workforce capacity and availability of medical supplies, adequate number of ventilators, etc. Just three days earlier (April 2), this Iowa estimate was 1,488 fatalities. Facts and assumptions are clearly very fluid at this time. The number of Iowa residents testing positive in the upcoming weeks is expected to peak in late April or early May. The Iowa Department of Public Health provides the latest update on the COVID-19 cases, including the number of Iowans currently hospitalized, discharged and recovering, never hospitalized and deceased.

The majority of people with COVID-19 can be managed at home, but as the cases in China have demonstrated, about 15 percent required hospitalization and another five percent ended up in critical care.

Postponed Medical Visits and Elective Surgeries

Hoping to free up more hospital beds and staff to deal with the COVID-19 surge of patients, many Iowa and U.S. hospitals have postponed elective surgeries and procedures. It is important to note that these ‘elective’ procedures cover many different areas, and in some cases, are still considered urgent, such as cancer, organ transplants and heart conditions, while other procedures, like joint replacements, are not considered to be a medical ‘priority.’ Elective surgery is any surgery that is scheduled.

Certain types of elective surgeries may be postponed for a long time – such as hip and knee replacements – but sometime later this year, or in 2021, there will be a pent-up demand for those types of surgeries. In fact, some procedures could develop into more serious medical conditions, including compromised mental well-being of having prolonged pain and discomfort.

Insurance Companies – Wellmark Blue Cross and Blue Shield of Iowa

On March 20, Wellmark Blue Cross and Blue Shield of Iowa, the state’s largest private insurance company, indicated that it is offering virtual healthcare visits for all appropriate medical and behavioral health visits at no cost to members until June 16. Additionally, Wellmark is covering diagnostic testing for COVID-19 at no cost-share to members. Early refills of prescription drugs are also permitted.

Wellmark then announced on April 1 they will retroactively waive members’ cost-share related to the treatment of COVID-19 – including copays, coinsurance and deductibles – when members seek care from an in-network provider, effective February 4 through at least June 16. By eliminating cost barriers to their fully-insured business and Medicare Supplement members, the desire is to ensure members seek the necessary testing and care regarding COVID-19. Self-funded employers that are administered through Wellmark will decide separately whether to replicate Wellmark’s policy or implement something different.

What Will COVID-19 Mean to Future Private Premium Costs?

How the COVID-19 medical costs will impact private Iowa medical insurance premiums is unknown at this time. Insurance companies, such as Wellmark, establish a ‘reserve’ for claims that are incurred but not yet paid. Additionally, certain statutory requirements for reserves are set aside to help cover unique medical situations that we are currently experiencing. If the COVID-19 claims erode the reserves, insurers may actually have a legal obligation to increase rates to build up those reserves for the next ‘emergency’ sometime later. This is a sound actuarial practice.

Insurers may need to price their 2021 premium rates upward to anticipate a surge in elective surgeries because people have delayed less urgent medical services. On the other hand, the decrease of elective procedures this year may help insurers financially weather the COVID-19 medical costs; their reserves may hopefully be stronger than expected when heading into 2021. A new report from Covered California, the Affordable Care Act marketplace in that state, projects that commercial carriers and employers could face between a $34 billion to $251 billion bill for COVID-19 testing and treatment in 2020, requiring insurers to increase premiums between four percent to 40 percent. Whether the federal government would help mitigate premium growth due to this pandemic is too soon to speculate.

All of this will largely depend on controlling the pandemic as soon as possible. If insurers have to dig deep into their capital reserves, then all bets are off on just how much higher health insurance premiums will need to be in 2021.

As one insurance professional mentioned to me last week, “Reserve adequacy is a function of rate adequacy.” In other words, rates will need to be adjusted upward to ensure the claims and reserves are adequate for future emergencies.

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‘Cabin Fever’ May Nudge Us to Suck at Something New

The COVID-19 pandemic poses many challenges, such as staying away from our work environment and being quarantined at home. For each of us, finding safe approaches to procure the necessities at the grocery store or the pharmacy can prove to be an uphill battle. Remotely navigating through job-related commitments also requires mental gymnastics. Unfortunately, others have been furloughed or no longer have jobs due to the limitation of travel and social distancing required for retail interactions. With these challenges, we search for ways to stay healthy – physically, emotionally, and hopefully, intellectually.

Given this short-term reality, I would like to share the following experience that has allowed me to cope with this new upside-down life. It can be challenging to stay both active and positive, especially while being indoors and practicing responsible social distancing.

Biking Outside – Prior to COVID-19

Early in the morning during the Spring, Summer and early Fall, I cycle between 22 to 30 miles each outing. Depending on the time the sun rises, my desire is to beat the traffic on the streets and impressive bike paths found in central Iowa.

For me, cycling in the morning is a sacred experience. This non-interrupted time allows me to plan out the day and hopefully solve problems – usually ‘marinating’ the facts that I know (or should know). Nature, it seems, serves as my inexpensive ‘office.’ Yes, cycling is a form of exercise, but really, it is about lubricating my mental well-being! My preference is to be on my own schedule. Because of this, I ride alone, pedaling as hard as I wish (or can!). I also must admit that I hate crowds!

But as we know, during the winter months, Iowa can be a challenging place to ride a bike. When it’s time to put away the bike, I will spend more time on the elliptical or walk outside. Running is no longer an option due to back issues.

Indoor Bike Trainers

This winter, two friends mentioned to me separately that I should consider purchasing a bike trainer that replaces my bike’s back wheel allowing me to bike indoors during the winter months. I did so in mid-January. And because of the COVID-19 challenges, I am so happy I did!

The equipment setup is actually quite simple:

  • Remove the rear wheel of the bike, attach the ‘smart’ bike trainer to the bike and chain.
  • Connect your bike trainer (via Bluetooth) to an indoor cycling software app which is loaded onto your preferred laptop, iPad or a smart TV. The software will simulate an assortment of road events around the world that a rider can choose while riding with local and international cyclists.
  • Put an appropriate table in front of your bike for your laptop, water bottle(s), etc.
  • Place a mat under the bike to catch your perspiration – the rides can be intense!
  • Have a fan to stay cool – it’s really a must!

One can choose to enter a ‘virtual’ race with others, or simply take a leisurely ride in New York’s Central Park or some other designated location around the world (found on the software app). The app that I use, Zwift, does a great job providing me with vital workout statistics, such as miles ridden, ride time, level of pedaling, and a host of other data.

The ‘Community’ Experience

With other ‘virtual’ riders before the beginning of a race.

Even though I am riding alone in my basement, I pedal with hundreds (and thousands) of other cycling enthusiasts who happen to be biking at the same time – regardless of where they live around the world. Riders can communicate with each other by using their phone app that allow for encouraging comments or by using a ‘thumbs up’ button on the app.  This sense of connection with others can be as much as you want it to be. Given the COVID-19 pandemic, one can still ride with others and yet maintain their social distance!

I share this experience because it does provide a sense of ‘community’ with others who desire to stay active and yearn to have some form of ‘safe’ interaction with the outside world. Since Americans and others around the world have been quarantined the past few weeks, the number of people biking on Zwift (and other apps) has significantly increased.

For me, this new exercise experience has been an excellent opportunity to release the tension that comes from the uncertainty of the stress and anxiety-filled COVID-19 environment. Truth be known, I’ve learned that my biking skills are not as accomplished as I once thought. There are many wickedly-good athletic individuals who can, through great endurance, pedal circles around this bike rider – regardless of age and gender! Put another way, virtual biking can potentially humble one’s self-perception of his/her cycling abilities.

During this period of virtual cycling, I have quickly learned that it’s ok to suck at something new…and actually feel good about it!

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Finally, working from home can have unintentional negative side effects, as I indicated in a 2018 blog.  To help combat some drawbacks, the Healthiest State Initiative has a nice site for those who wish to stay healthy and active while working from home.

Here’s to your continued health and safety!

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2020 Iowa Employer Benefits Study and COVID-19

Given the local and worldwide circumstances due to the COVID-19 pandemic, we are all taking things “day-by-day” for at least the foreseeable future – both personally and professionally. The ‘predictable’ lives we had just a few short weeks ago, no longer resemble what we have today.

Because of the unprecedented uncertainty for all businesses in this ‘new’ economic climate, we have found (while pursuing the 2020 survey) the response level of Iowa employers has dropped significantly compared to last year at this time. Frankly, ALL organizations are going through massive business and personnel upheavals that will require a ‘reboot’ of their workplace practices – and for some, perhaps ensuring mere survival. In light of this, because we have an annual goal of surveying 1,000 organizations, it will be very difficult to successfully ‘invite’ Iowa employers to participate in this year’s survey. My desire is to be mindful of the key issues facing employers and to refrain from our survey activity.

Due to this development, and with regret, I must suspend this year’s survey. At some undetermined time in the future, we will pursue a revised survey using newer, perhaps more pertinent questions, to gauge the benefit practices of Iowa employers.

I look forward to that time!

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While at home the past few weeks, I read the best-selling book by Erik Larson, “The Splendid and the Vile.” This book describes the one-year period – 1940 to 1941 – when Germany was incessantly bombing Great Britain, more specifically London. Despite not having the military support of the United States at that given time, the grit and courage that British Prime Minister Winston Churchill demonstrated would fundamentally decide the fate of his country, and frankly, the entire world.

During that difficult period of austerity, Churchill’s actions and words provided the necessary inspiration for his country citizens to persevere. Two of Churchill’s inspiring quotes are most poignant for me. No matter how difficult the circumstances are for us in today’s world, we have hope to overcome these obstacles.

“Victory at all costs. Victory in spite of all terror. Victory however long and hard the road may be. For without victory there is no survival.”

“It’s not enough that we do our best: sometimes we have to do what’s required.”

It is no wonder why Churchill is considered to be one of the most influential leaders of the 20th century.

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