The good news is that the growth rate of health care costs is falling — but the bad news is that employers are paying more for employee benefits as a percentage of pay.
As the expansion of health care coverage due to the Affordable Care Act is slowing, so, too, is health care spending, according to the Altarum Institute Center for Sustainable Health Spending's Health Sector Trend Report June 2017.
"The 2016 decline in prescription drug spending and net cost of insurance is indicative of the slowing expanded coverage from the ACA," the authors write. "Spending on health care services dropped to 5.1 percent growth in Q1 2017, perhaps signaling that the expected slowdown has finally begun."
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Paul Hughes-Cromwick, Altarum's codirector of the Center for Sustainable Health Spending, says that prices across hospitals and in other health care sectors have only increased by 1.6 percent in May, compared with a year ago. That's the slowest rate of increase since June of 2016. And hospital prices were even slower to rise, at just 1.5 percent in May.
Hughes-Cromwick says that an April rate of 1.8 percent has driven down the 12-month moving average for health care prices to 1.9 percent for the third straight month. Hospitals have been trying to get ahead of slowing prices by several years of cost-cutting, so that they can protect their margins against pricing pressures.
Meanwhile, the health care services industry now accounts for more than 15 million jobs, about 10.8 percent of all U.S. jobs — an all-time high, according to the report. While hospitals account for 45 percent of health services spending, their share of health services jobs is only 33 percent. Physician practices account for 28 percent of spending, but only 17 percent of jobs. The remaining services, including nursing homes, home health, dentists, and other ambulatory services, account for more than half of all jobs, but only 27 percent of spending.
In addition, with consumers shopping around and looking for better pricing and transparency for care, Hughes-Cromwick says, the downward pressure on pricing will only continue—particularly since ever more consumers have to fork over increasingly growing deductibles before their insurance kicks in.
"The big unknown is how these recent trends have been affected by the uncertain future of the Affordable Care Act," the authors write. "Should repeal and replace occur in the near future, one would expect these downward trends to happen even more quickly (although there may be an intervening period where individuals rush to access health care before they lose it)."
Several more Senate Republicans have announced their opposition to the replacement bill, prompting Senate Majority Leader Mitch McConnell on Tuesday to acknowledge that effort was dead — but that the Senate would still move forward with an effort to repeal the ACA, according to the Washington Times.
But all the downward pressure isn't of much help to employers. According to a Willis Towers Watson analysis, U.S. employers' cost to provide employee benefits, measured as a percentage of pay, increased 24 percent between 2001 and 2015, fueled largely by a doubling in health care benefit costs. In fact, employers now spend more on health care for employees than they do for retirement.
The analysis, Shifts in Benefit Allocations Among U.S. Employers, finds that the total cost of employer-provided benefits, including health care, retirement and postretirement medical, increased from 14.8 percent of pay in 2001 to 18.3 percent of pay in 2015. That's an increase of 24 percent.
During this period, the report says, health care costs for active employees more than doubled, going from 5.7 percent of pay to 11.5 percent. On the other hand, total retirement benefits, including defined benefit, defined contribution and postretirement medical plans, fell by 25 percent between 2001 and 2015, from 9.1 percent to 6.8 percent of pay, primarily due to employers switching over from DB to DC plans.
While in 2001, health care costs for active employees accounted for 42 percent of benefits, retirement benefits made up the remaining 58 percent, by 2015, it had reversed, with health care benefits accounting for 64 of costs while retirement fell to 37 percent.
The analysis also suggests that this reversal, with retirement dollars being reallocated to health care benefits, might not align with employee preferences and needs. WTW says in a statement that while "employees value their health care benefits just as highly as their retirement benefits, many employees appear to have reached the limit of how much they are willing or able to pay for health care benefits. Additionally, many employees are worried about their current and future financial situations, and fear they won't have saved enough for retirement and will have to work past normal retirement age."
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