Losing Options

Are you feeling like those of us with a chronic condition(s) are losing our health care options or that our choices are being limited?  We seem to be increasingly under attack by insurance, regulation, and other people’s good idea to save money with little regard to how these decisions impact our health.  I could rattle off dozens of examples.  But here are a few:

Medtronic agreement with United Health Care to limit insulin pump choice,
Using increasingly more Step Therapy before approval of appropriate biologic medications National conference of state legislatures
The pending limits placed on test strips by Express Scripts
Medicare bidding system for diabetes supplies
Denial of CGM’s by Medicare

And the list goes on…

Organizations such as The Diabetes Patient Advocacy Coalition (DPAC), DiaTribe and CreakyJoints are important; but they alone cannot turn the tide.  Largely because they cannot make employers understand the issues they are causing their employees.

Employers are not the enemy, but they have responsibility

Despite what we may think, employers do want employee’s to live longer healthier lives.  That is the reason that employers purchase health insurance.   Many of us in the U.S. feel disconnected from our employer’s choices regarding health insurance coverage.  In March of 2016, ZaneBenefits published “How Much Does Group Health Insurance Cost?” a simplified explanation of a Kaiser Foundation report “2015 Employer Health Benefits Survey” which provides an overview of the cost of health insurance and who is paying that cost.  They found that for a single plan, employers still pay about 83% of the cost of the premium.  For family coverage, it is about 73%of the cost of coverage.

So why are we feeling so pinched?  The reason is that the plans being purchased are more restrictive and have higher copays and deductibles.  So even though the percentage of employer contributions for policy cost has remained nearly level on a percentage basis over the last few years, employee cost has soared according to this fine article by CNBC titled “Employers shifting more health-care costs to employees”.

When employers purchase these highly restrictive plans, they are being sold a false notion that restrictions on insulin types, pump supplies, and step therapy will be good for employees and restrict the cost of escalating health insurance.  Having sat in such meetings, I can attest that no health insurance company ever says these restrictions will make your employees happier, healthier, and let them live longer.  The discussion is about savings and costs.

The Human Side of Health Insurance

So if insurance companies are not talking about the human side, then how does employee satisfaction and wellbeing enter the discussion?   The simple fact is employees must raise that issue.   We are about to enter one of those periods in the U.S. when according to CNN “The U.S. is ‘basically at full employment’” and as we reach near full employment, benefits will begin to  determine where employees choose to work. Wages are the main driver of where people choose to work but for many of us the availability of health choice is just as big a factor in where we work.

I will not argue that the U.S. economic recovery is stable or that we are entering a period of labor strife, but I will argue that keeping employees happy is something most employers want to do in a near full employment economy.  Assuming the shift in health care costs will not be reversed, then the next best thing we can do is tell employers to stop further restrictions on choice.

Employers know the lack of choice is something that can cause employees to become dissatisfied but what they probably do not know is that this extends to health care as well.  We are paying more, so the least they can do is give us the choice of where to spend our funds.

What We Can Do

Here are four things you can do to help educate your employer about the need for choice in spending our ever increasing share in our health plans:

1. If a new provision of your health policy affects you negatively call your personnel or benefit office to let them know this matters to you,
2. File appeals with insurance even if those appeals seem to be a long shot,
3. If you are part of a labor organization, tell your representatives that these restrictions are harmful,
4. Tell those in charge of your organization that these restrictions are counterproductive and that they hurt your care,
5. If you leave your company for a new position, make certain to note the lack of healthcare choice as one of the issues in your exit interview.

Truthfully those contacts are powerful and they do more to shape your health care plan than you can imagine.  It is doubtful that acting as individuals will get us more choice in the short run.  But like a rock climber, we have to plan five steps ahead to make certain that our voice is heard.

Yes, our organizations are good at talking to state legislatures, the FDA and Congress, but you hold far greater power. You have the power to tell your employer that these choices are counterproductive to your health and wellbeing.  Trust me I have been on the employer side of the table when employees complain, and it matters, a lot.

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 Take aways for September 10, 2016

• Choice matters a lot
• As an employee, you have more power than you think
• Our organizations are doing a lot, but they cannot do it all