November 18 webinar: A SYSTEM UNDER STRESS: The State of Job-Connected Health Insurance
Table of Contents
- All right everyone uh good afternoon and welcome to our...
- And make no mistake employers feel these increases as well...
- More with first dollar coverage better preventative care telemedicine...
- Quality and certainly not seeing improved experience so they are increasingly...
- Power in being able to purchase health insurance...
- Directly related to our economic health and what we see with...
00:08
all right everyone
uh good afternoon and welcome to our
webinar for today
entitled a system under stress the state
of job connected health insurance
um it's nice to have you here with us
today we have
um well over a hundred folks uh joining
right now and growing so that's exciting
um and thank you for sharing part of
your afternoon with us
my name is andrew schwab and i serve as
director of policy federal affairs and
partnerships at united states of care
00:39
and today we're going to hear from a
distinguished group of panelists
who represent various stakeholders in
the healthcare ecosystem
each with different perspectives about
the state of this system we rely on to
provide
health benefits in america and health
security to millions of people
first united states of care executive
director emily barson will help us
understand the basics of job-connected
health insurance
the challenges it poses for employers
and employees
and the work u.s of care intends to
engage in to surface conversations about
01:10
what is the largest health care coverage
piece in our american system
second we'll hear from annette juarisco
feitels
the president and ceo of the erisa
industry
the risa industry committee or eric
which is an
organization that helps america's
largest companies stay ahead of benefits
policies
and that is going to talk about how the
biggest companies in the nation struggle
with the cost and inertia that exists in
the jchi system
third we'll hear from elizabeth mitchell
01:41
president and ceo of the pacific
business group on health
a group which brings forward the
perspectives of both private companies
and public agencies about the cost of
health care
elizabeth will present on public and
private employers focus on the price of
health care being the main problem
but also in spite of that how employers
maintain a healthy workforce with an eye
towards innovation
and finally we'll hear from dr erica
gonzalez co-chair of the small business
for america's future where she
is a small business owner in san antonio
02:13
texas
dr gonzalez will talk about how small
businesses in particular
struggle against the ever rising cost of
providing their employees
many of which are like family quality
health benefits
and how they face competitive
disadvantage for talent as health
benefit costs continue to climb
year after year at u.s of care we hope
to continue this conversation
long after today's webinar uh but today
is our first step
together to talk about this structure
which provides health security to more
02:43
americans than any other
and now i'll turn it over to my leader
and colleague the executive director of
united
states of care emily barson emily
thanks andrew and good afternoon
everyone as you heard
i'm emily barson executive director of
united states of care
um on the next slide you can see just a
little about us united states of care
is a nonpartisan nonprofit with a
mission to ensure
everyone has access to quality
affordable health care
regardless of health status social need
03:14
or income
and we know this mission has never been
more important or more relevant than
right now during the covid19 pandemic
in order to expand access to healthcare
for all people we believe we must build
a better
more fair health care system in the wake
of coven 19.
while the public is not heavily focused
on health care policy
itself uh we know that the largest
concerns among voters
uh were related to health um the
coronavirus pandemic which certainly
ranks as one of the top
03:44
uh concerns and the economy which has
been deeply entwined and impacted by the
pandemic
next slide at u.s of care we value
diversity of background
ideology and experience we were founded
by andy slavitt the cms administrator
under president obama and also are lucky
to have as a board member
former gop u.s senate majority leader
bill frist
and an esteemed bipartisan group of
leaders from government healthcare and
business
and we're also advised by more than 100
04:14
members of our founders council
entrepreneurs council and our voices of
real life who bring a diverse array of
perspectives
to our work each of the members of all
these leadership councils and our board
can be found on our website
unitedstatesofcare.org
to begin today it's important for us all
to understand the basics of job
connected health insurance
and do some level setting as to why us
of care has chosen this part of the
health care system
for discussion examination and
stakeholder feedback
04:45
the first number to know is 178 million
which is the number of people in the
united states who get their health
insurance from their job
or the dependent of someone who does for
comparison around 60 million people are
on medicare
and over 75 million are enrolled in
medicaid
so the job-connected health insurance
market is bigger than those two
government health plans combined
the second number is 242 billion dollars
which represents the revenue the federal
government foregoes because
job-connected health benefits are
05:17
treated as pre-tax for both employers
and employees
known as a tax expenditure this loss of
revenue
for the government is the single largest
one in the tax code
14.6 million is a recent estimate of the
number of people in the u.s who may have
lost their health coverage
because they also lost their job of
course this is particularly concerning
during a pandemic
when the health of one individual is
more connected than ever
to the health of each of us and while
05:49
many of these folks may be eligible for
medicaid
or aca coverage some won't be and
in any event the disruption in terms of
having to potentially find new providers
and begin brand new deductibles part way
into the year is important to pay
attention to finally we see that
job-connected health insurance plans
represent the majority
of all health coverage in the country at
55 percent
this 75 year old system faces
significant challenges for the people
06:20
who rely on it
employees and the organizations which
pay for most of it employers
let's go a bit deeper according to the
congressional budget office
the amount you earn ends up being a
solid indicator of whether your job
offers you health insurance so just 36
of employees with salaries below about
39
000 for a family of four are estimated
to have access to employer coverage
on the flip side ninety percent of those
with incomes
06:50
of a hundred and three thousand or more
again for a family of four
are offered health and are offered
health coverage
we can see that the average cost in 2020
of family health coverage was 21 000
of which 70 was paid for
by employers and 30 percent uh by
employees
employers really pick up the ball um in
that regard
but we see that in this system the more
07:27
you earn
the bigger the tax deduction the
government provides to buy the same
product
it's like saying a base price for a box
of cereal is three dollars
we get twenty percent off if you make a
hundred thousand dollars per year
but only twelve percent off if you make
fifty thousand dollars per year
in addition to the unequal access to
people afforded in different
income categories job connected coverage
also
unfortunately tracks familiar inequities
along racial and ethnic lines that we
see elsewhere in the health care system
07:59
and as you can see in 2019 white
americans
were about 1.4 times more likely
to have employer coverage than black or
hispanic employees
disparity in access to coverage may
explain in part
some of the disparities for morbidity by
race
which we have seen clearly during the
pandemic
in addition to these critical racial and
economic
inequities there are other challenges
shared by employers and employees in
this system
08:31
many of which have been exacerbated
under the covet 19 crisis
first many workers in america do not
even have access to job-connected health
insurance
in 2018 just about one out of every
three workers
or 32 percent did not have access to
job-based health coverage
for those who do have health insurance
through their job median income workers
have seen a
47 increase in the combined cost of
deductibles
and premiums over the most recent
10-year period for which data is
available
09:03
and make no mistake employers feel these
increases as well
potentially stifling business investment
and expansion
i talked in the previous slide about
some of the inequities baked into this
system
in fact for those of the bottom 50
of the income spectrum health care
consumes
30 to 35 percent of their total
compensation package
far more than higher earners you can see
more of those distributions on the
charts at the bottom of this slide
including that about a quarter of
09:34
pre-tax income for those at the bottom
10
of the income scale is spent on health
insurance
so as we think about how to move forward
given all that i just laid out
we think there are critical and
questions that we need to work together
to answer
in general we believe answering these
questions in a collaborative way
with the broadest cross-section of
healthcare stakeholders at the table
can not only open up a space for us to
finally talk about this
under paid attention to part of our
system but also begin to
to build political consensus across
10:06
sectors
we welcome feedback from all of you
attending this webinar
on some or all of these questions and i
would challenge us to
to be thoughtful in developing
meaningful answers
so what does this all mean
this space is big but we don't talk
about its challenges enough
the tax code creates an inequitable
distribution of the benefits
of the job-connected health insurance
system
another wrinkle is that since federal
law governs the health benefits of large
10:37
employers
there's roughly a 60-40 split between
congress
and the ability of states to regulate
job-connected insurance
which makes policy progress difficult
employers large and small are key to
figuring out
a way forward finally i want to share
some visibility into what united states
of care intends to do in this space
on the next slide uh first we all need
to
come together to be part of the solution
um starting with uh
all of you joining this conversation
11:07
today uh we plan to bring together
people experiencing the health care
system
policy i think we may have lost uh emily
technical glitches we apologize for that
um we uh at united states of care uh
want to bring as many people as possible
into this system
um and to talking about the challenges
that it faces
and we're going to work with the diverse
set of stakeholders
some of which are on this webinar to
open a space to talk about it at the
state and federal level
and we intend to use a diversity and
11:39
inclusion view
to ensure that all voices are at the
table together in this conversation in
this debate
um and if you want to explore with us or
examine with us
please contact me at a schwab
usfcare.org
um and we can uh go from there uh
together
forward which we hope to do um i will
also add that we're going to have
question and answer period at the end so
uh you can put those into the question
and answer section now
um which we will get to after our last
12:09
speaker um
with that i want to turn it over to uh
the president and ceo of the arista
industry committee
annette juarisco finals annette
thank you so much andrew and emily that
was a great setup for us
it's really a pleasure to join you all
today we look forward to engaging with
you
and a healthy debate in how we can have
great health coverage available to
everyone in this country
at eric um we believe that
employer-sponsored health coverage
12:40
is the best coverage in the country and
that's the backbone of the u.s system
but it's on a path that's simply
unsustainable
our association represents a hundred of
the company's largest employers
you engage with them every day pandemic
or not
um whether you as it says here drive
your car
use your computer your cell phone
doesn't matter the companies we
represent
have incredibly diverse workforces from
people who are
climbing the poles um uh to uh
13:13
you know fixing to ensure that you have
electricity
at home um to those serving you in
restaurants across the country
um to bank tellers to
technology workers defense workers you
name it
um and they all want the same thing they
want their employees to have the peace
of mind
that they have really great health
coverage that they when they need
something they're going to have access
to the best doctors at an affordable
cost
and that this peace of mind will create
13:45
a sense of well-being on them
for them and their families because we
want them to be healthy and
and happy no matter what the industry
that they're in
so there's three things i'd like to talk
with you about if you could go please to
the next slide
and the first is as i said costs are
just out of control
we're on an unsustainable path and the
various things
um you know as an advocacy organization
i'm going to focus a lot on what
congress and the states can and haven't
been able to do
um because we need policy maker help
14:16
we're the only
organization that lobbies on the federal
level exclusively for the companies
that provide uh health and retirement
benefits to their own workforce whether
that's on the federal state local level
or in the courts as well
so the first thing is that costs are out
of control
um and the second is that employers
really are running out of options
the private sector companies that we
represent which comprise our entire work
membership don't need your
look to the government for solutions
14:47
they think the marketplace should work
competition transparency or what's
needed
but it's not working in healthcare and
at this point they want to look
seriously at some government
interventions
and the third is that employers and
their employees
their patients the beneficiaries of our
health insurance coverage
want transparency they want price they
want competition
they want to know that their dollars are
going for
high value care and not just spending
15:18
money because a service is being
provided
so let's go to the next slide and dig um
a little bit deeper
here is a list of policy measures
that really should frankly have been
enacted
they are addressing pending important
needs um but they were
defeated um if you will by various
sectors of the healthcare economy
um i've been doing this for a long time
and it's always easier
15:50
to stop something from happening than it
is to get something over the finish line
because all you have to do is focus your
efforts in one industry sector
um to to opposing something and that
usually works
take surprise billing for example i i
think we can all agree
no matter our background that when a
patient goes into a hospital situation
that's in network in under their
insurance plan
that that they shouldn't receive
bills from out network providers
16:22
especially
in situations where they were not um
able at the time to have the presence of
mind to say
are you in network before they're flown
off in an air ambulance
um or before um an emergency room
surgeon um you know takes out their
liver it's just really not
the situation where where and i think
there was bipartisan support
for addressing it but both the
administration efforts as well as
legislative efforts
16:52
were defeated um by hospitals and other
organizations
that were concerned particularly doctor
groups
that were concerned about the impact on
their bottom line
we have a system where health coverage
is increasingly
fragmented we have wall street interests
that are buying up various parts of the
health care sector
and profit motives are
dominant in this space now more so than
ever before
price transparency is another great
example the administration put out their
17:26
rule and it's being challenged in court
we can talk forever about drug costs and
reforming the pbm system all the players
in the system
can add value and as employers we
believe they're important partners
for us in providing health coverage to
our workforce
but we need to see through exactly what
the charges are
how much is being charged along the way
and are fair prices being
being given for our patients will we
17:57
even know what they are ahead of time
health savings accounts you know we have
companies that
after health savings accounts were
initially
put into the law in 2003 went full
replacement
they offered no other option to their
workforce but a high deductible health
plan
with a generously funded health savings
account but the rules haven't been
changed since then
and so rather than having bipartisan
efforts to
improve health savings accounts like the
allowing employers and insurers to offer
18:29
more with first dollar coverage
better preventative care telemedicine
services on-site clinics and the like
instead we had efforts to increase the
amount you could put into a health
savings account
we've got to come together on these
things so we can really improve the
quality of care
telehealth is another example rather
than
we go state by state to ensure that
there would be enough providers
for your for you and your families to be
able to access through telehealth
but a lot of times if they're not
18:59
located in the state in which they're
licensed and that they're sitting
your people can't get access to them so
we're working on reciprocity and payment
rules
so that telehealth can be more readily
available and it's a boom in this
pandemic situation
but what's happening now is rather than
focusing on how we can get access to
more providers
through licensed reciprocity and the
like instead
legislators and the administration and
others are pushing for
uh providers to
19:30
pushing for payment parity so that
telemedicine
providers will have to charge the same
amount as an in-person visit
when the costs are not the same and who
loses but the patient
so could we go to the next slide please
so as i shared in the beginning
employers are kind of
at the end of their rope um there's
really nowhere left for them to turn
we have employee population with you
know
studies showing um people don't have
more than 400
on average in their savings account we
20:03
cannot ask them to pay any more
and over the many years employers have
done a human's job
of trying to rein in the cost of care so
that they did not have to increase
employee premiums or deductibles or cost
sharing
but we're running out of options um
thank goodness the cadillac tax was
appear was repealed because we worked
long and hard to get that out of the way
because that was requiring employers
to begin early on cost shifting to their
employees
employers are looking at their older
20:35
workforces
early retirees they need some place to
go there's not a functioning
private marketplace out there for people
to buy insurance
should we look at expanding medicare and
and other ways to make the health
insurance marketplace more affordable
like a public option all of these things
need to be considered
and it's it's a challenge for us because
our companies have never really thought
this way before
but because costs are so out of the out
of control they're really being forced
21:06
to look at
at supporting these various options um
next
slide please my last point is on value
value employers my member companies
are huge companies and they have a big
presence all across the united states
and sometimes in a particular area
they have a big presence too but not
compared to the hospital system in all
likelihood
and the other players in that area so
you would think that they could demand
more for their value
for for the dollar that they spend but
21:37
they can't because the system is skewed
toward a fee-for-service model that is
out-loaded and doesn't help patients at
all we want to pay for value and we know
in the health care system
just because you pay more for it does
not mean that it's better
whether it's a drug or a service a
surgery you name it it doesn't mean that
it's better
we need more information about what's
better comparative effectiveness
information that we have so far hasn't
been able to say
um to look at costs also to see whether
22:08
or not we're getting more for the for
the value of our dollar
we need more information through the
transparency efforts that we've been
lobbying on
so that cost and quality information are
readily available to patients so they
can make really good decisions
all that we do for them in terms of
centers of excellence and
second opinion services and all the
counseling that we give them
is really valuable but they need some
raw data too
and we think that policy makers can make
it happen can we go to the last slide
22:39
which
i think should be my last slide um so
um as emily said it up in the beginning
a lot of people have
coverage from their employers more
people than get coverage from any other
system
and they like it and they want to keep
it um
erisa which is in the name of our
association is the law from the 70s
that provides employers that self-insure
their healthcare plan
healthcare plans federal preemption from
state and local mandates
despite that it's clear in the law we're
23:10
fighting in various states and
localities
for national uniformity states are very
anxious to improve health care within
their borders
but they can't do anything to regulate
self-insured plans
and it needs to stay that way because a
company with workforce
with with people who are have jobs in
every zip code
can't possibly be forced to comply with
state-by-state rules
congress has the ability to to give us
national solutions for health care
23:40
whether it's transparency
better telehealth reciprocity rules and
the like
we think a lot about expanding coverage
we need to
need to think just as much about reining
in the cost of coverage
we encourage policy makers to do what
they can and we stand at the ready to
help them
in usf care as well um as my other
panelists too
to try to figure out what the solutions
are thank you and i'd be glad to answer
questions
great thank you annette um and uh please
24:13
populate the question and answer
sections uh
uh on the zoom call here when we'll get
to that at the end
and with that i'd like to introduce uh
elizabeth mitchell who is the president
and ceo
of the pacific business group on health
elizabeth
thank you and thank you for having me i
am so
pleased that we are having this
conversation because
uh it is so clear that there are so many
misperceptions
about employers and employer-sponsored
coverage even
exposed in some of the questions that
24:45
were posed at the beginning
of this presentation the question about
how do we incent
employers to be invested and involved in
changing coverage is is
so misplaced because remember they bear
a hundred percent of the risk for the
cost for the coverage for their
employees
jumbo self-insured employers are fully
incented
in achieving higher value and i think
it's so important to understand their
25:14
perspective going into this because
remember we are pragmatists first and
foremost we
absolutely want and need policy
solutions and
uh we are very active in the policy
space but so far congress has not
uh delivered any of the relief that we
need on cost
or transparency so in the meantime we
are continuing to work
to improve the market but remain very
hopeful
that there will be movement on the
congressional front
uh next slide
25:47
so who are we uh the pacific business
group on health has actually been around
for about 30 years we
are an employer only uh
organization both public and private
of about 40 members who collectively
spend about a hundred billion dollars a
year on health care
on behalf of about 15 million americans
so we are very vested
in this conversation employers offer
coverage to ensure
the health and well-being of their
employees
they are committed to ensuring they have
the care they need
26:18
and that they are you know functioning
both in their homes and communities and
in the work
or workforce so some of the work that we
help our members with
are really redesigning care delivery
because they have realized that the
intermediaries on whom they have relied
have not done that job so they are
working in
in the market in the delivery system to
partner with high quality providers
driving affordability is absolutely
essential
we have had innovative programs designed
26:50
and incubated and scaled by employers
to actually reduce the total cost of
care while improving quality
and then as i said we have a very active
policy arm
i actually testified almost 18 months
ago on the surprise billing
legislation and in that testimony our
members were willing to commit to tying
prices for surprise billing
um to medicare so there is a readiness
for policy intervention where there
27:21
hasn't been before
to a net's point because there is so
much frustration
next slide
so our employers have been
diligent leaders in this space
working to change care and cost on
behalf of their employees
but as i mentioned they have uh really
relied on health plans and pbms and
brokers and others
and frankly they just have not seen the
results they are not seeing reduced
costs they are not seeing improved
27:55
quality
and certainly not seeing improved
experience so they are increasingly
willing to step in and take action in
the market
i will say that since covid that urgency
and that readiness has only accelerated
there is intense pressure on their core
business on wages
on job maintenance so they are willing
to look at health care
and identify ways to make it
appropriately affordable and take out
waste
next slide one of the examples that i
28:25
love to share because it actually
proves better care cost less was
a program incubated by walmart and
brought to pbgh to scale across our
membership
and these are results that were
published in the harvard business review
that showed when partnering with the
highest quality providers and we helped
identify those high quality providers
over 50 of unnecessary surgeries were
avoided
readmissions were avoided that meant
that employees got the right
28:55
care at the right time of the highest
quality
and it's not that prices were lower but
total cost of care came down
because the care was appropriate so we
know this can happen and we know
employers are leaders and
innovators in this space next slide
one of our biggest barriers to effective
purchasing
is a dysfunctional market and in
pbgh over 10 years ago jumped in on one
of the biggest cases in the country
to really take on anti-competitive
29:30
practices among consolidated systems
you've probably heard about the the
sutter case
it exemplifies some of the the
challenges employers face
trying to purchase effectively again
gag clauses uh all or nothing tiering
provisions
things that really make it difficult to
to purchase high-value care
so we have been active in that case and
there was a settlement announced
recently
that could really change the regulatory
landscape and enable more effective
purchasing
30:01
so we think it's incredibly important to
be involved in setting
the regulatory the regulatory system in
which we are all operating to make
markets work
next slide and you heard this at the
beginning
we absolutely do agree it's the prices
we've known this
the data just confirms it and frankly
one of the reasons we are so concerned
about market consolidation is we know it
doesn't drive up quality
we know it doesn't improve experience
what it does is drive up prices
so we need to find ways to effectively
30:31
address prices
to make sure that coverage and care can
remain affordable
next slide so
we are not um either or we do not
believe that this is
uh just a public fix or a private fix we
think it's both
we believe there are needed changes
in the private market we need the
transparency annette mentioned we need
regulatory changes to prohibit
anti-competitive practices
but we also know that there are public
31:03
fixes that could be helpful
um we do want action from congress on
drug pricing
on surprise billing on changing the
rules of the road for competition
so we believe this is a partnership and
we look forward to being part of it
thank you
thank you elizabeth and our last
presenter
is dr erica gonzalez
who is the co-chair of small business
for america's future
um and so let's go down to san antonio
31:36
texas
hello thank you so much for having me
here um i
am honored to be among the other three
phenomenal ladies
that have just presented i really
learned a lot from from their
presentations um
let's go ahead and go to the second
slide one that says about me
so um i am one of the four co-chairs
first fall business for america's future
and i am ceo and president of south
texas allergy and asthma medical
professionals which is an allergy clinic
here in san antonio
as well as stamp clinical research i'm
32:10
also
chair of the san antonio hispanic
chamber and before opening up my own
business i
served 10 years in the united states air
force as a medical corps officer
and so a little bit if we can go to the
next slide
a little bit of what the small business
for america's future
is is we are a national coalition of
business owners and leaders
who are working to provide a voice for
all small businesses
at every level of government we are
32:40
asking policymakers to prioritize
mainstream
by advancing economic framework and
covet 19 recovery plan
that works for small businesses and
their employees and of course part of
this work
includes trying to improve our health
care system for
and for entrepreneurs next slide please
and so why should policy makers care
about this and and what are exactly the
small businesses that we are advocating
for
well we know that small businesses are
33:11
at the center of the american economy
there are 30 million small businesses in
the united states
6 million of these small businesses
employ 60 million
people and 24 million are business
owners who are self-employed
in addition there's 80 percent of all
our small businesses that have fewer
than 10 employees so they are
truly what we consider those micro
businesses
as a doctor and a small business owner
i've really been able to see
close up what the negative effects of
our current health care system
33:43
is you know i've seen what happens when
a patient doesn't have insurance
but i've also seen how hard it is as a
small business owner to be able to
provide quality and affordable health
care for your employees and it seems
like
each year it just gets a little bit
harder
next slide please so even before the
pandemic
small businesses would list health care
as one of their
main challenges we have conducted a
survey of over 1500 small businesses
34:14
nationwide
and in that we found that 71 percent of
small business owners were still listing
lower health care costs as one of their
top policy priorities
to help small businesses succeed
next slide please
and so since the start of the pandemic
as previously mentioned in one of the
other slides there's been about 14
million americans that have lost their
health care insurance
this is a combination not only of
employees but maybe family members that
were also part of those
34:47
those insurance plans um the
skyrocketing costs
uh only make it harder it's difficult
for small businesses to compete with
large companies um that are able to get
them better
sometimes affordable plans it's an
economic i'm sorry an administrative
burden on small businesses that we have
to take on
and it eats into the profits on many
small businesses that already have a
slim profit margin to begin
and it makes it very very difficult for
us to be able to re
retain and recruit talent
35:19
in addition in that another thing that
we see is something that we call
job lock so this prevents
people from being able to leave their
current jobs to start their own new
businesses so
a lot of people can't venture out and
try to
you know go and do entrepreneur um
kind of activities or goals
because of the high health care costs
knowing that they can't afford to
lose health care for a variety of
reasons
35:50
next slide please i think it's hard for
us to look at health care the way it is
now
and think that it's working for small
businesses
most false businesses are not able to
afford
to offer their employees good health
care coverage
and one of the things that we need to
keep in mind is that small business
owners aren't partisan or
prescriptive they're open to
any solution that works and they're very
pragmatic so when we think about
how we can change our health care system
so that it is
36:21
able to better suit the needs of small
business owners
and their employers we saw some
interesting things when we
went ahead and did our survey
next slide please
so small businesses are actually open to
a variety
of solutions they love the idea of
having a public option for health care
so 80 of the people that filled out this
survey
supported allowing employees to be able
to buy into medicaid
and medicare 67 percent supported the
36:56
strengthening of the current affordable
care act
um 98 want the cost of prescription
drugs to be lowered
they want us lawmakers to focus on
correcting some of the market failures
that are currently in existence
to help bring down the cost of high
medical care and the surprise billing
that was also previously talked about a
little while ago
95 of the people that filled out the
survey
want to allow small businesses to be
able to band together to increase market
37:27
power in
being able to purchase health insurance
and when we talked about
how many of them actually oppose
repealing the affordable care act a
majority at 57
said they would not want to see the
affordable care act repealed because of
the
issue that that may have so even before
the pandemic we all knew that the health
care system
wasn't working for a lot of people it
particularly wasn't working for small
business owners and their employee
employees and now we are at a crisis
point you know our economy
37:58
is been hit hard it's in shambles our
small businesses
are going to play a key role in that
recovery
and in fact when we look at the great
recession it was the small businesses
that
led us out of the small recession by
merely creating two-thirds of the jobs
um after the recession and so
we're going to need to rely on our small
businesses at this point too to help us
get out of this economic crisis
38:29
if we don't have our leaders commit to
seeing our small businesses
succeed then we are only
doing damage to the economy further
by prolonging the amount of time that
it's going to take us to actually be
able to recover from all of this
improving our health care system has to
be a part of the equation for our
recovery
we're talking about physical health but
we're also talking about the health of
our economy
like we've been saying for months if
lawmakers don't take serious actions to
39:00
address the challenges that the small
businesses are facing
then we're not going to have any
mainstream after
this pandemic small business relief and
addressing the health care
has to be part of the recovery of that
in order for us to get to the other side
of this
um and so with that i'll hand it back
over and happy to answer any questions
thank you so much dr gonzalez and so
we're going to get to some questions and
answers we have a lot coming
in um if our panelists could um
39:31
join us again and uh crystal if we could
stop
sharing uh the screen um we can submit
your questions here
um and we'll get to some of those
um i think what we're hearing is a lot
of um
uh talk about cost we're hearing that
the pandemic is exacerbating the
existing problems in the job connected
health insurance system um
and that uh it is something that needs
to be
examined by policymakers and so our
40:03
first question is uh it was directed at
annette but we so we she could start but
we um
we can go uh to the full panel what
kinds of
state-based system changes would
uh the erisa industry committee support
um if the state were able to launch some
form of state administered
health care system for its residents um
and i think that this is a particularly
important net because
uh with uh congress very closely divided
it is likely that states are going to
lead the way on many of these uh
40:34
uh initiatives
thank you andrew it is very true that um
states
um have a very important role to play
and uh
have become quite activists because
there's been
an inability for federal policymakers
to reach consensus on anything and
there's such a great need for
health care to be addressed in their
states you know for the national
employers that we
represent anything that's a mandate on
the state level is something that we
41:06
would oppose
there are many instances in which a
national employer
will want to look at a state-based plan
for a smaller section of their you know
employees if they don't have a large
enough population there
for self-insurance to work properly um
then we certainly want a road
you know we always want a robust option
for for people across the country
whether they're employees or not
um but i don't see generally speaking um
you know
health care reform you know which is
41:39
often
considered paid for by the self-insured
population through assessments and the
like
to be a good approach for something that
that we would support
we'd like to see the state-based
marketplaces do really well
because they could be alternatives for
for
large employers with small populations
but generally speaking
um we don't support um they do
they're not options that make a lot of
sense for companies with
42:08
large national workforces
i jump in a couple of other observations
again we have primarily a national
membership base as well but we do also
have
state public purchasers as our members
calpers washington healthcare authority
and i think there's a lot that states as
purchasers can do
to align and you know just
insist on transparency quality
and and fair pricing and aligning with
42:40
the private purchasers
is a very effective strategy to do that
and reduces the burden on providers
another thing state attorneys general
need to look at consolidation we it is
surprising to me they have not done more
we are grateful that in california
um that has happened in the sutter case
we think there is significant
opportunity to look at consolidation
in in-state markets so again alignment
with public purchasers and even medicaid
43:12
and um increased sort of antitrust uh
investigation great thank you
um we also uh this is kind of like a
very basic question but an interesting
one
that i think uh annette and elizabeth
might answer
uh the same way and erica might answer a
different way
but what is the reason that
job-connected health insurance still
exists um and and why do your
uh companies still provide it uh
43:44
which was an interesting question to
come from our attendees
i guess i can take a crack at that first
um
it is for large employers just as for
small employers
a matter of competitiveness it is a big
attraction for people
when you think about it it's worry-free
your employer takes a lo you know pays
for the vast majority of your health
care coverage
um my member companies it's on average
80
of the premiums are paid by the employer
44:18
um
it's it's very attractive to them and
employers
play a great role as advocates for their
employee populations with the insurance
companies
um if something in a patient an employee
or their family member isn't being
treated well
we step in to help them and we also
work hard especially in communities
where we have a large presence
to push for quality improvements in
those areas
we sit on the boards of the local
hospitals and healthcare systems
44:48
to really drive the value and the
quality
um that the companies want for their
patient population for their employee
workforce
um so i think that employees sense all
of that
and most importantly there's no
alternative
i mean if an employer said to you well
come and work for me i don't provide
coverage
but i'm going to give you 50 000 to buy
it on your own
it would be quite anxiety provoking
amongst by an employee figuring
where am i going to go what's the best
network you know employers really help
shape the network and and um and ensure
45:21
that the coverage that the employees get
are high quality employers are the ones
who just design telehealth benefits
and first offer them to their workforce
versus an add-on benefit and then as
part of the healthcare plans
we're innovating because we're sensing
what employees need and we're giving it
to them
before the marketplace does so i just
don't think that there's anything
like it and i don't see anything on the
horizon
um for a long time and but maybe that
will change
yeah i guess i would just so if i'm
trying to understand even the the
45:53
question because i mean if you go to
the millions of americans who rely on
job-based insurance and say you know
what is the value of this i think it
would be a pretty clear
response and you know to annette's point
there is no alternative
and employers are playing a huge role
um caring for their employees and
spending enormous amounts of money to do
that so
it certainly isn't perfect and i would
say that the system is
far too unresponsive to the people who
46:24
pay for and receive care
but they are playing a significant
advocacy role
and you know carrying the cost burden
for for health care for
a large number of americans
so i think that what i would like to add
to that is you know when you think about
small
businesses um they are employing over 50
of all the people in the united states
right so
um they carry a great responsibility in
in trying to make sure that these people
have some type of health care
coverage the health of our community is
46:58
directly related to
our economic health and what we see with
the top reasons that people either
show up late to work or are less
productive at work or don't
show up to work said it cost about 60
billion dollars a year in lost revenue
and so you know when you think about it
from that standpoint you want
to try to keep your employees as healthy
as possible
because then they can be more productive
for you
but more importantly and i think andrew
47:28
you brought um
you commented on this small businesses
uh are like families um and so you know
i've got 20 employees who obviously
we get to know very well as they're
working for us
uh we see them commit and be loyal to
us and to our businesses and that means
a lot to us so we we want to be able to
take care of
them too now obviously i come from a
small business that is specifically
uh from the medical world so um even
47:58
more important for me to make sure
that i'm trying to offer health care to
to my employees
because otherwise you know i'd feel like
a really big hypocrite you know
what we were talking about how important
health care is but it was also mentioned
before you know if we want to be able to
recruit
good talent then we're going to have to
be able to offer
benefits that could even come close to
competing to some of these bigger
corporations because otherwise we can't
keep them
um you know there needs to be more than
48:29
just you know
hey the opportunity you know to work in
our setting
they have to have good benefits and i
think that people look at that
as part of the bigger package when
they're deciding where they want to work
great thank you so much um i i'd also
like uh
while the while the system is
particularly difficult for small
businesses
um it has been for a long time um
employers are
as annette and elizabeth um alluded to
uh leading the way on this and the us of
49:05
care put out a brief in september
where we profile uh both state
governments which are
um struggling under the costs of
providing health benefits for their
employees
uh which is a burden on state taxpayers
for sure
um but also uh cisco
walmart and boeing and they're
incredibly uh innovative things that
they're doing that our panelists shared
uh walmart's center
of excellence for instance um and so
these are all things that i think
49:35
are reasons why employers are a key cog
in this wheel of trying to figure out
how to make this
work better um and so uh on
on that end um what are some of the ways
that we might be able to make this
system
work better um particularly given
um the uh questions
and uh rise of uh uh
big racial questions for corporate
america in the last few
um months and during this year when we
50:08
saw that it is
uh there are inequities baked into the
system on income
um and race in particular
a tough question
yeah i mean i'm i'm not sure how to how
to really answer that question i mean i
think
the the more we could um
uh fight for a system
that has prices that are clearly
identified ahead of time
and ensures that every dollar is spent
is is worth the dollar that
50:47
you're spending um it's going to help
people of all income levels
um i think that what we don't recognize
is that
most of health care dollars go
to pay for the cost of a few um
you know in in if you look at a typical
plan
you know maybe there's 20 percent of the
costs go to
80 of the costs go to 20 of the people
because chronic conditions
are where all the dollars are are being
spent
51:18
and we spend a lot of money at end of
life
you know well we focus on those those
costs
which you can argue with certain chronic
conditions
have a racial disparity built into them
as well if we could make
the health care in those areas better
whether it's
kidney disease or diabetes and the like
if we could spend money more wisely in
that area
and have biosimilars instead of biologic
medications and the like which are
51:48
less costly alternatives it's going to
mean lower premiums lower cost low out
of pocket for every individual
and i think that's the best way that we
could go about it but if others have
ideas where we could address
racial concerns as well please bring
them forward because we need to
certainly consider them
and i don't want to go first every
single time so i'm just saying that
i think it's uh a little
go ahead i just want to i think it's
sorry i will be quick i just want to be
52:20
on record saying that
you you would be hard-pressed to find a
group who is
less satisfied than this with the status
quo than we are
we think that the system is deeply
inequitable and our board
voted recently to take on health equity
as a strategic priority we are actively
working
every day to address cost to improve
quality
and the resistance from the industry is
immense so we think that it is very
important to bring the leverage and
52:50
influence of jumbo purchasers paying the
bills
to try to address that so we in no way
defend the status quo we are actually
working every day to change the status
quo
and we we look for partners in that work
erica yeah so i mean i can definitely
agree
with the comments that are being made
you know coming from
a city that is 64 latino
and 10 african-american and there's more
uh minority community of colors one of
the biggest things that we see
53:22
is access to health care um it's a
problem for a lot of people because they
can't afford it so then they
go and they use the emergency care
system as their primary way of getting
health care
which then just drives the cost of
health care up and so it's the cycle
that we
can't get out of i think that one of the
places to start and i'm not sure
if um annette might agree with me or
elizabeth might agree with me but
the cost of pharmaceuticals when you
compare
medicines here to what we're paying for
53:54
them in europe or in central and south
america
the difference does not make any sense
where we can get medications lower
outside of the united states
and i think that even when people who
are in disadvantaged areas are
able to get health care plans they're
not able to get health care plans
that cover a lot of the medications that
they might need
and that's because these drugs are so
expensive so i think a lot of physicians
feel that
54:26
that may be a good place to start how do
we lower the cost of just these
preventative medications
that annette is referring to before we
go to these
biologics which are a lot more expensive
how do we get them
better with you know preventative
medications and lower cost medications
so that we don't have to
um bear such a big
stress economic stress on our health
care system
about out of time um i think another
theme that we've uncovered here is that
all three
54:56
of the presenters and then the data that
emily presented at the top about jchi
demonstrate that the status quo
is not working as well as it could be um
and that
all of the different sectors of the
health care system have a role in
playing
uh to try to work through this and
manage through and make it better
to work both for employers large and
small
and uh employees uh who rely on this for
their own
uh personal health security um we've had
some questions that
we will be sending out some additional
55:28
materials
um uh later today or tomorrow uh
along with uh the recording of this
webinar and uh we suspect that this will
not be the last time
that us care engages in this effort and
this discussion
and we're very very thankful to dr
gonzalez
uh annette and elizabeth for joining us
today
and emily for uh moving forward our
conversation
uh to uh surface this as a larger debate
and
uh public policy issue that we need to
55:58
deal with across the country
my name's andrew schwab again you can
reach me at a schwab
at usfcare.org um and we hope to be in
touch and have a good afternoon
thank you