U.S. workers and businesses are getting soaked

Today, Bob Herman launched a series on the crumbling employer-based health insurance system. He wrote about it for his Health Care Inc. newsletter, so with his blessing, I’m going to cut-and-paste some of that here. Enjoy.

There’s a very high likelihood that you, dear reader, get your health insurance from your job or the job of a loved one. There’s also a very high likelihood your earnings have suffered over time, quietly behind the scenes. It’s arguably never been worse than now, and it isn’t likely to get better.

The notion that employer-based health coverage — which covers 150 million Americans — is costly is hardly new. And many people, especially those who don’t have to use their health plan frequently, may be thinking, “Everything is fine!” But over the past seven months, as I spoke with dozens of people across the field, industry, and country, the clear message is that everything is not fine. — Bob Herman

small business

The small business burden of health benefits

Nearly all large companies offer health insurance. Panic, despair, and anger are most apparent among smaller shops and firms.

The costs of health insurance are a massive disadvantage for small businesses. Big corporations not only have more resources to absorb the costs, but they also can lure employees who want and need that protection. The system, as a result, discriminates against the small companies that power local communities and are beloved by all politicians. Read the main story.

More small businesses than ever are throwing in the towel on health insurance. Many have pivoted to or are considering alternatives, like providing employees money to buy coverage on the Affordable Care Act marketplaces. — Bob Herman

Subscribe to Health Care Inc. and read the other stories in the series.

drug development

Clinical trial diversity is not DEI

Clinical trial diversity caught a stray in the Trump administration’s attack on diversity, equity, and inclusion. Congressional Republicans are making at least somewhat of an effort to fix that.

Clinical trial diversity aims to study medical treatments in people who are similar to the patients who would use the drugs and medical devices being tested. Supporters say the policy has nothing to do with the hiring practices and communications goals of DEI that the administration disdains.

Congressional Republicans seem to agree, at least as far as FDA policy is concerned. Read more.

hospitals

More than one-third

That’s how much of a pay cut Medicare is proposing for drugs acquired through the 340B drug discount program, Tara Bannow reports.

Medicare currently pays hospitals the average sales price of a drug, plus 6%. Under Thursday’s proposal, hospitals would get 33.4% less than the average sales price.

During President Trump’s first term, Medicare tried cutting payments for 340B drugs to ASP minus 22.5%. That effort failed, but this time the administration is better prepared.

medicare advantage

Oh my stars

Elevance Health is suing the U.S. government over its recalculation of Medicare Advantage star ratings that cost the insurer $115 million, Bob reports.

Star ratings are supposed to measure the quality of a health plan’s care and customer service. Higher star ratings equal more taxpayer-funded bonuses and rebates.

Two years ago, a federal court ruled that Medicare underpaid another insurer, which led to the Centers for Medicare and Medicaid Services redoing star ratings. That recalculation led to more lawsuits.

What we’re reading

Online GLP-1 prescriptions are often fast, easy — and low on clinical oversight, STAT
Conservatives rage over re-funding of Planned Parenthood, Politico
What a Brooklyn bodega reveals about the craze for an experimental weight-loss drug, CBS News
Obamacare rolls shrank dramatically in many states over the past year, new federal data shows, AP