CHART OF THE DAY: On the future of employer based health care benefits

Is it Spring Break where you live?

It is where I live - so I am going to be trying to balance some Spring Breaky things along with the blog, work, the HR Happy Hour Show and some other things.

So if you are trying to reach me on something this week please be patient more patient than normal.

But on to today's topic and Chart of the Day - and with a special bonus chart.

A few weeks ago on the HR Happy Hour Show I was joined by benefits expert Shan Fowler to talk about the Employer Health Care Benefits Update for 2018.On the show, we discussed changes (or potential changes) to the Affordable Care Act, how some employers may shift the health care burden back to employees, and what the future of employer-based health care benefits might look like. In that same vein, I wanted to present two charts today - one directly related to this topic of the future of employer health care benefits, and a second chart that may help to give some depth and context towards understanding the first chart.

Chart 1 - Courtesy of the Kaiser Famlly Foundatain's March Health Tracking Poll, which asked a representative sample of over 1,200 US adults whether or not they were in favor of a 'national health plan, or a Medicare for all plan', and also if they favored such a plan that was 'opt-in' only?

Here are the results which showed 59% of Americans in favor of a national health plan, and 75% in favor of such a plan with an 'opt-in' provision.

  

Let's go to Chart 2 before offering up some comments and observations about what the data might mean.

Chart 2- From the Brookings Institute, 'Rethinking worker benefits for an economy in flux', a look at the growth (and comparative growth) of non-employer firms, basically independent workers in the 'gig' economy.

 For nearly two decades, the growth of nonemployer firms - firms that have no employees and mostly constitute incorporated self-employed freelancers (workers in the “gig economy”), has consistently outpaced traditional payroll growth. More and more workers in the 'gig' economy generally translates to more and more workers who lack access to 'tradtional' employment benefits - health care, paid time off, retirement and 401(k) plans, etc.

And it's this trend in workplaces, and truly, in the nature of work and jobs themselves, that probably is driving the increases in interest and/or support for some kind of nationalized, and more importantly portable, set of health care benefits. Increased workplace fluidity, less growth in traditional payroll employment compared to gig work, and additional pressures on workers to provide child and elder care are all conspiring to make the idea of national/portable health care coverage more appealing to Americans.

Politics (and passions) on both sides of the spectrum will likely make the passage of any kind of nationalized or Medicare for all plan really unlikely in the near term. But that is not the only mechanism to create platforms for more portable health care - programs that would be more easily accessible to the growing number of workers who lack access to traditional employer-based plans.

A number of states, (most notably Washington) are proposing programs that would create non-profit benefit providers, to which employers of 1099 workers would contribute, and who would then collaborate with workers to determine which kinds of benefits to offer - like heath care, retirement, and PTO. Other state and local laws that have expanded access to retirement plans and paid time off and family leave are all being pressured to expand access to independent worker as well.

The growth of the gig economy has changed and will continue to change the way we think about work, workplaces, jobs, and careers. It just might also change the way we think about and ensure access to, affordable health care in our country too.

Have a great week!

Job Titles of the Future: Director of Mental Health and Wellness

While there definitely has been increased focus on wellness and wellbeing in the workplace in the last 10 or so years, most of that focus has been on the physical dimension of wellness - with programs and tools designed to help employees get more physically active, to quit smoking, to get a handle on better ways to manage long-term and (often) preventable health risks. But less attention (it seems to me anyway), has been paid to other aspects of wellness/wellbeing - and in particular, mental health. And mental health, and how employee mental health impacts people and the organization is a huge deal. I mean huge.

How huge?

According to some data from the Depression Center from the University of Michigan:

Depressive illnesses, including major depression and bipolar disorder, are highly prevalent in the United States, affecting nearly one in five adults at some point in their life. These conditions are also among the top five causes of disability globally, and depression ranks as the #1 contributor to disability in the U.S. and Canada. An estimated 6.7% of adults in the U.S. had at least one major depressive episode in the past year. Depression is one of the most costly health conditions for American employers. The annual cost of depression in the U.S. is estimated at $210.5 billion, with approximately 45% attributable to direct costs, 5% to suicide-related costs, and 50% to workplace costs. A majority of these workplace costs are due to lost productivity in the workplace from both absenteeism (missed days of work) and "presenteeism" (reduced productivity at work). Presenteeism represents nearly 75% of workplace costs and 37% of the overall economic burden of depression.

And that is just one set of data points from one source on the significant impact the mental health challenges and depression in particular makes on organizations, not to mention the personal and family impact depression has on people, families, and communities.

So it makes sense that organizations are and should be addressing mental health and depression as just as important a dimension of employee wellness with as much focus as they have with physical wellness. And at least one organization, maybe one you wouldn't think would 'have' to worry about the mental health of its workforce is doing just that.

The organization is the National Basketball Association, (don't worry, this is not turning into a 'sports' post). From a recent piece on the NBA.com site:

Kevin Love and DeMar DeRozan -- two All-Stars -- who became the latest NBA players to detail their public battles with mental wellness. Love wrote a first-person account last week in The Players’ Tribune of the panic attack he suffered earlier this season. DeRozan spoke last month of the depression he’s dealing with during what may be his most successful NBA season.

Their disclosures came as the NBA and the National Basketball Players Association are close to naming a Director of Mental Health and Wellness, who will run an independent mental wellness program that is being jointly funded by the league and union.

It might seem surprising that NBA players - generally young, wealthy, successful, admired, and in great physical health would be affected by mental health issues, panic attacks, and depression. But the fact that we can have that kind of a reaction - 'Gee, what do these guys have to be depressed about?', reminds us that it is too easy to fail to take mental health issues seriously, or to want to treat them as not real issues for employees because we can't 'see' them.

And I am pretty sure that is going to change, or it will have to change, as these issues become more common in the US and by extension, in the workplace. The National Institute of Health’s National Institute of Mental Health estimates that, in 2016, more than 44 million Americans suffered from some form of mental illness, ranging from mild to moderate to severe, and impacting more than 18 percent of all U.S. adults.

As an NBA fan, I like that the league is doing more to actively recognize, address, support and mostly not to hide from the mental health challenges that players are facing - even if we think these don't or shouldn't exist, the accounts of Love, DeRozan, and others show us the problems are real. And with the data showing that mental health issues and illnesses growing at a consistent rate, it makes sense for organizations to think about today's Job Title of the Future - Director of Mental Health and Wellness. Maybe you should too.

Have a great weekend!

PODCAST: #HRHappyHour 314 - The Employer Health Care Benefits Update for 2018

HR Happy Hour 314 - The Employer Health Care Benefits Update for 2018

Host: Steve Boese

Guest: Shandon Fowler

Listen HERE

This week on the HR Happy Hour Show, Steve is joined by Shandon Fowler, Founder and Principal of Four8 Insights, a benefits technology and communication consultancy based in Charleston, South Carolina to talk about important employer health care benefits issues, trends, and what HR and Benefits pros need to know in 2018.

On the show, Steve and Shan reviewed what the changes in the ACA and other regulations have meant for employers in 2017 and so far in 2018, how employers might be shifting (at least some) of the traditional employer-based health care benefits back to employees themselves, and what the recent Amazon, JP Morgan Chase, and Berkshire Hathaway announcement about their intentions to form a 'new' kind of company to help provide health care and benefits to their 1.1M combined employees might mean for the future of employer-based health benefits.

Shan also shared he is the best selling author of an advice book for Grooms, (and is very popular in Slovenia), Malcolm Gladwell and the concept of the 'Risk Pool', and (shameless plug), why the HR Technology Conference is so awesome, (use my code STEVE300 for $300 off your registration).This was a fun show - thanks so much to Shan for coming on.

You can listen to the show on the show page HERE, your favorite podcast app, or the widget player below:

Thanks to HR Happy Hour Show sponsor Virgin Pulse - www.virginpulse.com

Subscribe to the HR Happy Hour Show wherever you get your podcasts - just search for 'HR Happy Hour'.

#BenefitsConf Opening Message: Meet people where they are, not where you want them to be

I am out at the 4th Annual Health & Benefits Leadership Conference for the next few days and will (if plans don't get derailed because, well, Vegas), be sharing some ideas and highlights from the event, including at least one HR Happy Hour Show from the event.

The opening keynote at the show was given by Alexandra Drane, Co-Founder of Eliza Corp and was titled Mentioning the Unmentionables: Is 'Life' the Missing Link?', an examination of where health and wellness approaches have possibly been misaligned with the needs, desires, and actual, practical situations and lives of the people the healthcare industry is trying to serve.

Let's unpack that a little bit by referring to a chart we have all seen a thousand times, Maslow's hierarchy, and one that Ms. Drane referred to several times during her talk. Take a look at my (slightly out of focus) pic of the chart below, and then some FREE comments from me on the key points of the talk after that. Note: the person on the lower right of the pic is an artist doing a sketch of the talk in real time - really pretty cool!

Alexandra's primary message on where health and wellness initiatives have gone wrong is in that so many of the efforts and outreach have been focused on individual and employee behavior modification that impact and reside at the very peak of the self-actualization pyramid - ignoring the fact that many, if not most people are wrestling with life issues much further down.

We (or our employers), bug people to exercise more frequently, to eat healthier, to make sure they are up to date on all preventive medical screenings, etc., but often do not even attempt to address the myriad of issues that would prevent people from even thinking about doing more exercise or the other things that happy, secure people can spend time on.

These are very basic, and fundamental issues and challenges like elder or child care, financial challenges and troubles, divorce, lack of intimacy, or even something as elementary as loneliness or disconnection from people.

These issues, she argued, are the more important drivers that lead towards negative health outcomes that manifest in 'real' diseases like diabetes, alcoholism, heart disease, hypertension, and many more. And trying to motivate people into behavior changes that might lead to say a reduced risk of diabetes will not be effective if they are completely stressed out with family or personal crises that dominate their ability to cope.

Health care providers spend so much time and effort on 'real' diseases but not enough time on 'life sucks' disease. @adrane #benefitsconf

— Steve Boese (@SteveBoese) March 30, 2016

Until we are able to meet people where they are, many if not most of them dealing with tremendous pressures, stress, and personal challenges in their real lives, will we be able to better provide tools, resources, support, and empathy needed to try and move them to where we want (and hope) they can be - as people who can actually take the time to jog for 45 minutes a day, and spend an extra hour at home each night preparing healthy meals.

It was a really important message I think, and one we'd all be wise to remember.

People are really complex. Life can really suck sometimes. And the combination of the two makes trying to drive behavior change much, much more than just suggesting they choose a salad instead of a Big Mac.

Thanks to Alexandra Drane for such an interesting and compelling talk this morning. 

CHART OF THE DAY: The U.S. Uninsured Rate

With all the news and talk and debate about the ever evolving and complex set of requirements on organizations (and individuals) from the Affordable Care Act, it seems to me that one (fairly important) macro statistic often goes underreported, namely the percentage of people in the U.S. who still lack medical insurance.

If you had to guess, (don't peek at the chart below), what would you guess the percentage of U.S. adults uninsured to be?

It feels like it should be kind of high, right? Maybe 25% or 30%? 

But you'd also guess that with the opening of the ACA exchanges late in 2013 and with all the news and attention surrounding getting folks to navigate the buggy Healthcare.gov website and actually getting them enrolled in Medical coverage, that the uninsured rate should be dropping I would bet.

So what's the actual/estimated rate of uninsured adults in the U.S.? Check out the below chart from Gallup from their survey of 14,700 people in April 2014:

So according to the Gallup survey, the uninsured rate among U.S. adults sits at 13.4% and does show a gradual decline since the launch of the ACA exchanges. When I first saw the chart and the 13.4% figure, I felt it was kind of low, I am not sure why. It just 'felt' like there would be more uninsured folks than that.

The Gallup survey also breaks down this data into age/income groups, (click here for those details), but essentially they reflect what you'd expect - older, wealthier people are much less likely to be uninsured than younger and poorer people. But the trends in getting more people insured are improving across all age cohorts, which seems like a good thing.

I suppose I don't have any big lesson/takeaway from all this, just thought it was interesting.

Happy Thursday.