You won't believe latest on employer health benefits

The most shocking thing about the Kaiser Family Foundation's 2014 report on employer health benefits may be the lack of shocking data.

The foundation,  which has been tracking health benefits since 1999,  reports that 2014 continues a period of  "historic moderation" in premium increases,  in the words of CEO Drew Altman.  The average premium for family coverage rose 3 percent,  to $16,834 a year,  with employers covering about $12,000 and employees about $4,800.

Altman and Kaiser VP Gary Claxton,  the study's lead author,  said Wednesday they know that talking about moderation clashes with the experience of many employees,  who are seeing out-of-pocket costs rise while wages stagnate.  And it contradicts some people's expectation that the Affordable Care Act would send rates through the roof.

Altman

"If you say that to an average person,  they may look at you like you're out of your mind,"  Altman told reporters.

Deductibles  --  the amount people are required to pay out of pocket before coverage kicks in  --  have been climbing steadily for the last few years.  Sometimes high-deductible plans are accompanied by a pre-tax savings account with employer contributions,  but the biggest recent growth has been in  "plain old vanilla high-deductible plans,"  Altman said.

Thirty-four percent of employees in small firms  (fewer than 200 employees)  and 11 percent of employees in larger companies have deductibles of at least $2,000 for an individual,  the report found.  That's up from 20 percent and 4 percent,  respectively,  in 2010.  Sixty-one percent of employees in small firms and 32 percent of those in large ones must cover at least $1,000 for an individual.  (Some preventive services are covered before the deductible is met,  as required by the ACA.)

"You've got both the ACA and market forces reinforcing each other on the issue of deductibles,"  Altman said.

The report,  done in partnership with the American Hospital Association's Health Research & Educational Trust, is based on a survey of more than 2,000 employers,  done between January and May.  Almost 150 million people are covered by employer-sponsored insurance.

While the Affordable Care Act is forcing changes in costs and coverage,  it also follows years of soaring costs for insurance and health care.  From 1999 to 2004,  for instance,  premiums increased 72 percent while average earnings rose 17 percent.  In the most recent five-year stretch,  premiums rose 26 percent while wages rose 11 percent.  Thus changes that feel extreme for workers  --  especially those whose plans are changing  --  can look modest in the historic context.

Of course,  the ACA is just starting to kick in.  And the health care market is very much in flux,  as my colleague Karen Garloch reported from this week's Carolinas HealthCare System board meeting.  As employers gear up for 2015 insurance enrollment this fall,  I'm working on a look at's happening locally and what lies ahead.  If you're willing to talk about your experience with a high-deductible plan in your workplace,  please get in touch  (my phone number and email are at right, below the photo).

Expert: Pain coming for N.C. businesses, workers

Employees can expect to see more high-deductible health policies as employers try to control costs,  a health researcher and former journalist told members of the Charlotte Chamber today.

Connolly

And North Carolina's economy will suffer from state lawmakers'  decision not to take federal money for Medicaid expansion,  said Ceci Connolly, managing director for PricewaterhouseCoopers' Health Research Institute.

"It's not a political commentary,"  said Connolly, a former health correspondent for the Washington Post and author of a book on the Affordable Care Act.  "It's pure dollars and cents."

Connolly was a keynote speaker at the Charlotte Chamber's health care summit,  which drew about 450 people to the Westin Hotel.  The event marked the chamber's Healthy Charlotte fitness campaign and its push to market Charlotte as a national health care destination for patients and businesses.

Hospitals,  doctors' offices and other health care businesses employ more than 116,500 people in the Charlotte region and generate more than $6.2 billion in annual wages,  the chamber reported.

But Connolly said those businesses lost out on  "a serious revenue opportunity"  when the state refused the  "Obamacare"  offer to expand Medicaid coverage for low-income residents with federal money.  North and South Carolina are among 21 states that opted not to participate this year,  leaving 689,000 low-income N.C. residents in a  "Medicaid gap" without coverage.

"Your industries are suffering because you're not getting the increased business,"  she said.

Update: An editorial in the News & Observer offers more details on the cost of refusing the Medicaid expansion.

Benjamin

Fellow panelist Dr. Georges Benjamin,  executive director of the American Public Health Association,  agreed that wasn't a smart business decision:  "Business people know the first principle of business is not to leave one dime on the table."

Benjamin,  a physician and former Maryland health secretary,  told the chamber crowd that federal Medicaid money could have been used to improve mental health services,  a need described earlier in the session by Dr. John Santopietro of Carolinas HealthCare System.  "The beauty of Medicaid is it is run by the states,"  Benjamin said.  "They can do this.  The governors can be creative."

Several local speakers talked about efforts to control health care costs while improving care.  Connolly said she expects to see employers take a leading role in coming years.  One likely strategy,  she said,  is a continuing shift to high-deductible policies that hold down premiums by requiring patients to pay a bigger chunk of medical bills from their own pockets.  Such policies force employees to think about spending their own money more wisely,  Connolly said.

Technology is likely to play a role in helping patients take charge of their own health,  from insurance companies offering online cost comparisons to a burgeoning industry in devices that monitor vital signs and exercise, several speakers said.  Connolly,  who was wearing a wristband that monitors her steps,  said she envisions a day when that data would feed to her doctor's office so the doctor would be aware of changes in activity.