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Health Benefits/Pricing Implosion

Posted on by John Santilli
Contracting With Specialty Pharmacies (SPs) At Your Own Peril
Health Benefits/Pricing Implosion – The announcement by the Obama administration that it would begin rating health insurance plans based on how many doctors and hospitals they include in their networks along with the announcement the ACA will now (2017) allow the individual deductible to increase to $7150 and $14,300 for family coverage will contribute to a pricing/benefit implosion.

The addition of the Cadillac plans, despite extended to 2020, will add to the implosion. Employer penalties are indexed according to the same procedure, which means that companies will face a penalty of $2,260 per full-time worker in 2017 (with an exemption for 30 workers), up from $2,160 in 2016, if they fail to offer health coverage that meets Obamacare standards. The result could be a significant burden for middle-income people who need a substantial amount of care.

Many employers have limited work hours to avoid the fine while avoiding the cost of providing health benefits for some modest-wage workers.

The health insurance market is ripe for “disruptors” focused on consumerism which eliminate the middleman and waste today. Historically, every American industry except healthcare has used consumerism in varying degrees to maintain market competitiveness.