Employer Health Costs Are Expected to Spike 11% in 2027

[ergophobe]

Highest increase in a couple of decades
https://www.nytimes.com/2026/09/02/business/health-insurance-increases.html

[rcjordan]

It's my understanding that NC has already made coverage reductions (weight loss drugs) and other shifts & downgrades are in the works.

Big changes ahead for State Health Plan as trustees work to lower costs 
https://www.northcarolinahealthnews.org/2026/03/21/big-changes-ahead-for-state-health-plan-as-trustees-work-to-lower-costs/

"We fundamentally have two short-term options," said Friedman. "We can make everyone's benefit worse and charge people much more money for everything. The other option is to get physicians, doctors, hospitals to lower their prices."

[ergophobe]

But physicians are already complaining that Medicare reimbursement rates are not sufficient to cover costs. Medicaid reimbursement rates are quite a bit lower than that.

https://www.mgma.com/mgma-stat/2026-medicare-reimbursement-changes

https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2027-medicare-physician-fee-schedule-proposed-rule

We could, of course, just say that doctors make too much and should get paid less which would mean that the reimbursement would cover costs. But for primary care and some specialities, we have a doctor shortage, so you can only squeeze that lemon so hard.


https://www.sgu.edu/school-of-medicine/blog/us-doctor-shortage/
https://pmc.ncbi.nlm.nih.gov/articles/PMC11838062/

[rcjordan]

We're in the final countdown of our move to senior living.  We picked a huge, major provider network last week. Our 1st choice no longer accepts Medicare. Looking through the roster, it appears about half of the doctors in this firm do not accept Medicare.  THAT was a wake-up call.

[rcjordan]

Large employers drop health benefits as costs rise
https://www.axios.com/2026/09/04/employer-health-insurance-benefit-cut-costs

[ergophobe]

Employers are particularly focused on GLP-1 coverage for weight loss.

I wonder sometimes whether for a drug like this, the US government should just pay up front for rights to the drug in the US. There are huge savings overall to getting rates of obesity and diabetes down, so as a long-term thing, buying the rights up front and enjoying 20 years of savings makes sense. From the perspective of a private health insurer, though, it doesn't make sense because people can switch plans every year.

In general, when I'm King of the United States, immediately making employer-sponsored health plans illegal will be one of my first acts. It was an idiotic idea to begin with that only came into being due to wage freezes during WWII and it becomes a forcing function that distorts all discussion of healthcare in the US

My other two measures:

1. Providers cannot negotiate different deals with different insurers. Every insurer pays the same price for the same thing.
2. You can get an up-front cost on any non-emergency procedure

>  half of the doctors in this firm do not accept Medicare.

Another insanity of US healthcare. You have no idea whether or not your insurance works. If I wreck my car, it doesn't matter who crashes into me or which garage I go to for repairs, it is covered. But of course, car insurance doesn't cover oil changes and new tires.

During the initial Covid lockdown when non-urgent surgeries were all cancelled, an anesthesiologist told me that that shifted the patient mix to where it was almost entirely Medicaid and Medicare and at the lower reimbursement rates, the reimbursement was enough to pay the lease on office space and the non-physician salaried employees, but there was no money left over for the physicians.

Because they have contractual obligations with the nurse anesthetists and the office staff and the office landlord, they all get paid first. So he was working 80 hours and getting "less than minimum wage" during that period. A month or two into the lockdown, their financial person told them that if they don't get private insurance patients back within something like 90 days, they would be facing insolvency.