Direct Primary Care and Four Ways Employers Can Add it to Their Plans

 

Sick, Drugged, and Billed

 All Economic Stakeholders in American Healthcare Are Incentivized by Perpetual Sickness – Except One

Surround Yourself with Your Weakness

 To give yourself the best opportunity for career success, surround yourself with your weakness.

Required Leave for Any Reason, Ozempic, and Coverage for Gender Affirming Care

Tools & Webinars:

• McGriff's 2023 Benefits Survey Results
• McGriff's Quarterly Pharmacy Newsletter: covering Diabetes, obesity, and new weight loss drugs.
• Trending Topics in Retirement Webinar on July 27th
• In case you missed it, the July It Benefits You Newsletter
• Our Monthly Mineral Demonstration - robust web-based resource with live advisors, reliable content, and interactive technology solutions that provide an end-to-end People Risk Management solution

Compliance News:

Pharmacies are Sharing Sensitive Health Data with Facebook - "Looking for an at-home HIV or Plan B test on CVS’ website is not as private an experience as one might think, and CVS is not the only pharmacy sharing this kind of sensitive health data, according to a KFF Health News investigation. We found trackers collecting browsing- and purchase-related data on websites of 12 of the U.S.’ biggest drugstores, including grocery store chains with pharmacies, and sharing the sensitive information with companies like Meta (formerly Facebook); Google, through its advertising and analytics products; and Microsoft, through its search engine, Bing."

The IRS recently issued Notice 2023-37 to update its guidance for high deductible health plans (HDHPs) on expenses related to COVID-19 testing and treatment. The notice also clarifies whether certain items and services are treated as preventive care under the tax rules for HDHPs, and confirms that for plan years ending after Dec. 31, 2024, an HDHP is not permitted to provide benefits for COVID-19 testing and treatment without a deductible. 

Open Issue: Employer-Sponsored Health Plans and Coverage of Gender-Affirming Care

June 28, 2023 – Jackson Lewis P.C.

Whether an employer-sponsored health plan must cover gender-affirming care is often dependent on whether the employer’s health plan is fully-insured or self-insured; fully-insured plans must provide gender-affirming care to the extent required by applicable state and federal law, while the law on categorical exclusions for gender-affirming care in self-insured plans continues to develop. 

Talk about an FMLA leave headache! This one was a migraine

June 27, 2023 – HR Morning

A federal appeals court rejected claims filed by terminated employees who sought FMLA leave along with many others, ruling that the employer had good reason to believe the employees acted dishonestly and sought leave for an improper purpose. Employers can also take away from this article a few tips to curb FMLA leave abuse.  

July Is the New January: The Pace of New State Laws Heats Up

June 26, 2023 – Littler Mendelson P.C.

This article offers insight into an array of labor and employment laws and ordinances from across the country, state by state, that take effect mid-year and will implicate employers’ compliance obligations. 

New Trend in State Laws, Paid Leave for Any Reason - "In May 2019, Maine became the first state in the nation to require private employers to provide paid leave for any reason when Gov. Janet Mills (D) signed LD 369. Nevada followed a month later, in June 2019, when then-Gov. Steve Sisolak (D) signed SB 312, which also granted paid leave for any reason. Illinois is poised to join their ranks on January 1, 2024. In March 2023, Gov. J.B. Pritzker (D) signed SB 208, which says that beginning on January 1, 2024, private employers must offer their workers five days paid time off for any reason after they’ve completed a 90-day probation period."

• In Nevada, for example, Employers may limit the use of paid leave to 40 total hours per benefit year and may prevent an employee from using any accrued paid leave until the employee reaches their 90th day of employment. Employers may also set minimum increments of paid leave which an employee may elect to use, so long as that limit does not exceed 4 hours.

Benefits News:

A Couple Retiring in 2023 Needs $315,000 in Retirement Savings Just to Cover Medical Expenses in Addition to Medicare - "The after-tax cost for medical expenses throughout retirement for a single, 65-year-old retiree held steady at $157,500 ($315,000 for the average retired couple at the same age), according to the new 2023 Retiree Health Care Cost Estimate, which tracks retiree healthcare expenses annually."

Renewals Not Looking Good for UHC Clients: "UnitedHealth Group extended its streak as the most profitable company among major national insurers in the first quarter of 2023, reporting $5.6 billion in earnings. By comparison, fellow healthcare giant CVS Health reported the second-highest profit in the quarter at $2.1 billion, less than half of UnitedHealth's haul. CVS' profit also declined year over year, as it posted nearly $2.4 billion in the first quarter of 2022. UnitedHealth also takes the top spot on revenue for the quarter, reporting $91.3 billion. That's up from $80.1 billion in the prior-year quarter. CVS again lands at No. 2 on revenue, posting $85.3 billion."

Will the Doctor See You Now? The Health System's Changing Landscape - "About 48% of primary care physicians currently work in practices they do not own. Two-thirds of those doctors don’t work for other physicians but are employed by private equity investors or other corporate entities, according to data in the “Primary Care Chartbook,” which is collected and published by the Graham Center.... it now takes an average of 21 days just to get in to see a doctor of family medicine, defined as a subgroup of primary care, which includes general internists and pediatricians. Those physicians are many patients’ first stop for health care."

Health and Wellness:

Watch The Truth About Weight Loss Drug Ozempic with Dr. Peter Attia - a one-minute short.

Trusting The Science: The following is a list of the 20 largest settlements reached between the United States Department of Justice and pharmaceutical companies from 1991 to 2012 - Pfizer claims the largest criminal fine in U.S. history, while GlaxoSmithKline holds the largest pharma-fine in history when combining civil and criminal penalties.

What you need to know about Ozempic & Mounjaro - "But I want all my patients and the public to know that the appetite and weight loss effects do not last forever. Effects on hunger, cravings control, sweet cravings, mood & fullness are TEMPORARY and return to baseline between years 1 & 2. This was shown in surveys taken from patients using the medication over the long term."

Just 3% of adults show no major health risk factors linked to death - "Overall, most of us have something wrong with us, and we’re more likely to have a lifestyle health-risk factor now than in the ’80s and that’s actually associated with even greater mortality risk now than before."

Ozempic, Weight-Loss Drugs Probed Over Reports of Suicidal Thoughts - "Novo Nordisk A/S’s weight-loss medications are under investigation by the European Union’s drugs regulator after a small number of reports of suicidal risks were referred to the watchdog. The European Medicines Agency is looking at adverse events noted by the Icelandic Medicines Agency, including two cases of suicidal thoughts linked to the drugs Saxenda and Ozempic, the EMA said in a statement Monday." 

Shred Me! One Man's Intriguing Response to Super Size Me (Eating Only McDonalds Patties for 2-Months Straight)

You may recall that in "Super Size Me," documentarian Morgan Spurlock explored the effects of consuming a diet consisting solely of fast food from McDonald's.  He decided to eat only McDonald's food three times a day for 30 days while following certain rules like always accepting the option of "supersizing" his meals whenever offered. He documents the effects of this diet on his physical and mental health, as well as on his weight and general well-being.

The film received critical acclaim and sparked public discussions about the health impacts of fast food, leading to changes in the fast-food industry, such as the introduction of healthier menu options and the discontinuation of the "supersize" option in some fast-food chains.

@garyfixstuff  https://twitter.com/garyfixstuff/status/1626301885572386820

Throughout the film, medical professionals monitored Spurlock's weight and blood health. At the start of the experiment, Spurlock weighed 185 pounds with a body mass index (BMI) of 23.2, which is considered healthy. 

After just a few days of consuming only fast food, Spurlock began to experience negative health effects. He gained a significant amount of weight, and his BMI increased to 25.5, which is considered overweight. By the end of the experiment, he had gained 24.5 pounds, and his BMI increased to 30, or obese.

In addition to the weight gain, Spurlock's blood health also deteriorated over the course of the experiment. His cholesterol levels increased by 65 points, and his liver function tests showed signs of damage akin to that of an alcoholic. He experienced dramatic mood swings, headaches, and decreased energy levels. He would get flat-out hangry when he'd gone more than a few hours with his Mc-y-D fix, and then upon diving into a Big Mac, he'd be as mollified as a heroine junking staving off the demons.  

But did Spurlock prove that all fast food is unhealthy, or did he highlight the deleterious effects of highly refined carbohydrates, the industrial byproduct of seed oils, and the chemical cocktail of preservatives? 

One of the most intriguingly disturbing parts of the documentary was when Spurlock purchased an order of McDonald's fries and kept them in a container for 10 weeks to see how long they would last without molding or decomposing.  He stored the fries in the container at room temperature and did not add any preservatives or chemicals to the fries. He also did not open the container or disturb the fries in any way.  After 10 weeks, Spurlock checked the fries and found that they had not molded or decomposed whatsoever.  

Well, I think we have our answers, as this chap loses weight, experiences no loss in athletic performance (rock climbing), and generally maintains similar blood health (with a remarkable improvement in triglycerides). 

If you want to skip to the results, jump to the 45-minute mark and just watch for about 20 to 25 minutes. Petty staggering how well things turned out. 

Are Treatments for Therapy, Nutritional Counseling, and Supplements HSA/HRA/FSA Friendly?

FSAs (Flexible Spending Accounts), HSAs (Health Savings Accounts), and HRAs (Health Reimbursement Arrangements) are all types of tax-advantaged accounts that can be used to pay for qualified medical expenses.

Physical therapy, nutritional supplements, and gym memberships may be eligible expenses that can, in rare cases, be reimbursed using these accounts, but there are some specific rules and limitations about which, you must be cognizant. 

For FSAs, eligible expenses are determined by your employer's plan and may vary. You can usually use FSA funds to pay for physical therapy with a prescription from a healthcare provider. Nutritional supplements and gym memberships are likely not eligible expenses, unless they are prescribed by a healthcare provider for a specific medical condition.

For HSAs, physical therapy, nutritional supplements, and gym memberships may be eligible expenses, again, if they are deemed medically necessary by a healthcare provider.  In that case, you can use HSA funds to pay for these expenses as long as they are not considered cosmetic or meant for general health and wellness purposes.

For HRAs, the rules and eligibility requirements will vary depending on your employer's plan. It's important to check with your employer or plan administrator to see if physical therapy, nutritional supplements, or gym memberships are eligible expenses.  In most cases, these procedures will only be covered if they are deemed necessary by a healthcare provider. 

In general, it's important to keep receipts and documentation of your expenses, and to check with your plan administrator to make sure that the expenses you are considering are eligible before using your FSA, HSA, or HRA funds to pay for them.

The IRS recently issued new guidance on this topic. There was nothing earth-shatteringly new in their statement, but more clarity has been provided.  Here is a summary of the IRS's pronouncement by Thompson Reuters: 

For the cost of therapy to be a medical expense, the therapy must treat a disease—thus, amounts paid for therapy to treat a diagnosed mental illness are medical expenses, while amounts paid for marital counseling are not. Likewise, the costs of nutritional counseling and weight-loss programs are medical expenses only if the counseling or program treats a specific disease diagnosed by a physician (e.g., obesity or diabetes); otherwise, these costs are not medical expenses. The cost of a gym membership is a medical expense only if the membership was purchased for the sole purpose of affecting a structure or function of the body (e.g., a prescribed plan for physical therapy to treat an injury) or treating a specific disease diagnosed by a physician (e.g., obesity or heart disease). However, the cost of exercise for the improvement of general health is not a medical expense, even if recommended by a doctor.

How Weaponized Corn Syrup and Diabetes Water Permeate Taxpayer-Funded "Nutrition"

Healthcare and processed food are the two largest industries/employers and lobbyists in the United States. Pharma alone spends five times what the oil industry spends on lobbying and three times more than any other industry. Congress, the FDA, USDA, CDC, HHS & CMS will not bite the hand that funds them. To be sure, from time to time, well-meaning government classers do question the status quo and make noises indicating that they might do the right thing. They are swiftly crushed.

In 2010-11, members of Congress questioned whether U.S. taxpayers should be paying for Diabetes Water (soda) for Americans on food stamps (officially now called SNAP, Supplemental Nutrition Assistance Program). Note the word NUTRITION.

The Ten Companies Controlling Nearly All We Buy in a Grocery Store

Fifteen percent of Americans rely on SNAP for their “food.” Seventy percent of SNAP dollars are spent on highly processed garbage (essentially, what you find in the middle aisles of your grocery store – stuff that didn’t exist pre-1900). The number one SNAP expenditure? You guessed it – Diabetes Water! How did the company whose product was formerly spiked with cocaine decide to handle the matter? Why with more lobbying, of course!

They deployed their billions to call African American and Hispanic interest groups. They noted that the Diabetes Water Industry would like to share some of its resources with those interest groups, assuming said interest group wanted to support “low-cost calories and choice for its members.” The other implication floated was that Congress’ contemplation of eliminating soda from SNAP smacked of racism. Of course it did.

But they weren’t done there. Big Diabetes lobbyists then reach out to right-leaning legislators and interest groups to point out that the Big Government Nannyists were at it again, wanting now to micromanage what people could drink right here in the formerly free, good-ole, U. S. of A!

The result? Yeah, you know. Soda (or do you say pop, ya heartlander) remains the top food product purchased with taxpayer-funded nutritional subsidies.

And this is just about food stamps. Meanwhile, school lunches have regulatory controls that limit the amount of saturated fat those meals can contain. Cattle ranchers and pig farmers clearly aren’t doing their fair share to buy a legislator. Sugar’s upper meal limit? Infinity.

Need more evidence? This is the latest taxpayer-funded food pyramid advice, indoctrinating that Frosted Mini-Wheats and Lucky Charms are healthier than beef or eggs. 

This is a crime against humanity. Do I care if people want to guzzle Diabetes Water or gobble Diabetes Kibble? No! The state should not be involved in any of this. But to the extent that it is and to the extent that I’m forced to pay for others’ “nutrition,” that advice and food should not poison them.

For more on this story, check out this interview with insider-turned-whistleblower @calleymeans and @KenDBerryMD. He gets right to the juiciest nuggets toward the very beginning of the video. Diabetes Water hired Calley to cultivate a list of civil rights organizations and African American pastors to fan the flames of racism whenever Congress stepped out of lined and threatened to curtail taxpayer funding of weaponized corn syrup.

I also publish long-form work on other topics; you can sign up here at my new Substack covering bass fishing, writing, and life. https://gottwals.substack.com/

How We Find and Accept the "Truth"

I thought this piece from J. Sanilac was superb on the topic. I particularly dug his list of twenty "techniques that can help us to navigate the chaotic sea of character and find the truth." 

In his Substack Trust Networks: How We Actually Know Things: 

1. Stop pretending ad hominem judgments are irrational and avoidable. Instead, accept that they're necessary and use them consciously and intelligently. As I explained in Part I, even the smartest and best informed person needs to rely on ad hominem judgments for much of his knowledge. If you pretend you can know everything directly, or even that you can suspend judgment for any question you haven't answered directly, you'll only sink yourself deeper into delusion, and your beliefs will be less rather than more accurate.
2. Don't delude yourself into assuming your own claims will be evaluated entirely on their merits. Instead, accept that you too will be the object of ad hominem judgments, and these judgments will significantly impact the reception of your claims. To be an effective knowledge disseminator you should signal trustworthiness with your track record, your outward presentation, your credentials, your character, and your alliances. Even if he has a brilliant idea, a man with no credentials, no connections, shabby clothes, and poor interpersonal skills will lose far more time lobbying to get that brilliant idea taken seriously than he would have spent if he'd polished his signaling first. Businessmen and politicians understand this intuitively. Unfortunately the kinds of men who invent important new ideas usually do not, perhaps because it's precisely indifference to signaling and partisanship that enables them to discover what other people overlook.
3. Use the black box method to test claims whose details you can't understand or evaluate directly. Just check the final outputs: if they're good, the information within the box is probably good too; if they're bad, the information within the box is flawed at best, and likely wrong.
4. Evaluate your sources' record. Do they have a history of making accurate predictions or producing good practical results? Those who've been right in the past are likely to be right again. And you too should try to build a track record of reliability, because in the course of time it will add weight to your claims. However, there's an important caveat, which I'll explain below.
5. Distrust prestige transfer. Some public figures try to leverage their record of success in one domain to create the impression of reliability in another, unrelated domain. For instance, someone who's distinguished himself as a linguist or chess player might try to transfer the prestige he's accrued in his original field to a new field, like political theory, where it hasn't been honestly earned. But success in different domains requires a different cognitive style, different strengths, a different knowledge base, and years of different experience. It's not uncommon for successful CEOs to have naive views about topics that don't directly impact their business operations. You can't assume the composers of masses are experts in theology, nor vice versa. So prestige transfer should awaken your distrust.
6. Evaluate your sources' incentives and disincentives. Sources who are incentivized for telling the truth are inherently more reliable. Yet when it comes to topics of public relevance, they rarely exist, and the best one can hope for is to find sources who aren't too highly incentivized for lying. Of course, a few rare people do compulsively seek and tell the truth due to an innate altruistic instinct, but they usually lack the motivation to explore complex topics in depth, and are therefore less useful than one would wish. (As previously mentioned, betting markets are an attempt at solving this problem.)
7. Evaluate your sources' cognitive styles and use this information to interpret their claims. Some people tend to be paranoid and overstate possible negative outcomes, others are indisciplined and jump on new ideas without thoroughly examining them, others are especially prone to partisanship, others are stubborn and never back down when they're wrong, etc. By identifying the character of a speaker you can estimate the risk he'll make a habitual error or exaggeration, and use this to translate his claims into a more accurate form. For instance, a paranoid thinker can be expected to overestimate risk, treating low probability futures as if they're matters of pressing concern, so when absorbing his warnings (e.g. about asteroids) you should downgrade their urgency.
8. Build a stable of trusted sources. Because past record is a good indicator of present reliability, it's important to observe your sources over a period of years. This is a time-consuming process by nature, so when you discover a reliable source you should consider him a valuable long-term acquisition.
9. Lower your confidence in the most popular sources. Sources and claims that are afflicted by higher than average epistemic load are amplified, especially in the social media ecosystem. Because of this the most prominent people are not the most reliable people. You should interpret great popularity among the general public as a negative sign with respect to trustworthiness.
10. Give obscure outsiders a chance. If you always follow the obvious signals of trustworthiness, like credentials, respectable presentation, and uniformly palatable opinions, you'll sometimes trap yourself in a cul de sac of mutually reinforcing conformists who've shut out dissenters. Once in a while you should make a foray into the wilderness, because obscure and disagreeable outsiders who are ridiculed, denounced, ostracized, and shamed by the mainstream occasionally are right when everyone respectable is wrong. Usually, of course, they're a waste of your time.
11. Estimate the effect of signaling load and attempt to correct for it. Comb through all your beliefs to determine which function as positive social signals, and lower your confidence in these beliefs. You should lower your confidence even more if you've fallen into the habit of using them as signals yourself. Of course, they might be true; but the expected pattern is for them to be exaggerated in the direction of optimal signaling, and they could even be empty fabrications. You should also raise your confidence in beliefs that send negative signals. It's likely that some of these are correct, but socially unpalatable, and therefore unfairly denounced. Of course, it goes without saying that you should try to avoid overcorrecting. (Note that a dissident subculture isn't immune to signaling load, but rather develops its own local signals that aren't functionally different from those of society at large. Thus, being a dissident, or contrarian, or minority does not in any way exempt you from the need to correct for signaling load.)
12. Estimate the effect of partisan load and attempt to correct for it. Most people already assume the truth falls somewhere between the extreme statements of opposing factions, so it might seem that correcting for partisan load is as simple as embracing moderation and aiming toward the center. However, this type of lazy centrism isn't actually a good way to find the truth. Political actors are experts at manipulating it. For instance, as we discussed earlier, they can use propaganda to portray their favored views as normal and centrist even if they're partisan minority views in reality. They can also can encourage their extremists to be more extreme in order to move the perceived center closer to their side. (E.g. Trust Network A says the answer is 1, Trust Network B says the answer is -1, a lazy centrist concludes the answer is 0. Whence political operators in Trust Network A can use a common sales tactic to get their way: by overshooting and claiming the answer is 3, they cause lazy centrists to conclude that it's 1, their original desideratum. Because they're vulnerable to this tactic, lazy centrists can actually encourage extremism!) There are, furthermore, plenty of historically verifiable cases where one side turned out to be wholly correct and the other wholly wrong, so that centrism would not have arrived at the truth. Thus, when you try to correct for partisan load, you shouldn't just take a moderate position between two sides and stop there. It's better to analyze the effects of partisan load carefully first.
13. Don't assume that partisanship as such is bad. Partisan load does degrade the accuracy of our beliefs, but that doesn't necessarily mean you should reject partisanship. The reason partisanship isn't wholly bad, and indeed the reason it's a natural instinct in the first place, is that it's entirely possible—even likely—that an enemy is really your enemy. In other words, one trust network may be a real antagonist whose members really wish to deceive you and do you harm because they have interests that are contrary to yours. Humans are individuals who exhibit tribal coherence. If you insist on being naive and judge everyone only as an individual, you and your allies risk defeat, and in the worst case, even annihilation. Someone who encourages you to ignore partisanship when a genuine conflict is underway is not your friend, but your enemy, or at best a fool. Before rejecting partisanship you should evaluate the whole landscape in detail and choose a side if need be.
14. Hide or camouflage unpopular views and signals of partisan alignment when trying to communicate to moderates, opponents, and general audiences. If you send the wrong signals or create the wrong associations you'll trigger an immediate rejection of your claims, no matter how good or true they are, because you'll be identified as an enemy and therefore dismissed. One solution to this is to focus narrowly on your issue of interest and avoid addressing other topics entirely. This prevents any controversial or partisan-aligned views you may hold from becoming a divisive distraction and reducing your impact. Another tactic is to advocate for positions that are more moderate than your actual beliefs, pushing for a direction and then pushing again rather than selling your ultimate target up front. Both of these approaches are in common use.
15. Use your instincts. We have fine intuitions for making ad hominem judgments in context, and the rational judgments we make in the abstract are quite myopic in comparison. Good instincts are a serious asset, so if you have them you should value them. This is not, of course, to say that they can never be wrong.
16. Use sensory information. Factual information is conveyed most efficiently in text form. However, information about the human subjects who transfer this factual information is conveyed most efficiently in audiovisual form, and some of the information that can be found in appearance and voice is completely absent from text.
17. Look out for hackers. Look for signs that someone is intentionally manipulating ad hominem signals to induce trust or distrust where they aren't merited. Unfortunately it's not always possible to identify bad actors before they've done harm.
18. Be forgiving of humans who are in the grip of bad ideas. I'm not so keen on this one myself, dear readers, but I feel at least obliged to mention it in order to signal care. All of us have some wrong and indeed outright stupid ideas we can't recognize as such. This isn't necessarily because we're stupid ourselves, although often that is indeed the case. Rather it's because ad hominem judgments, while unavoidable, are an imperfect source of knowledge, and they can't be relied on to filter out every bad idea percolating through our trust networks. We ought to be forgiving of others who are also in the grip of foolish ideas thus acquired, especially when they're young and inexperienced.
19. Avoid overconfidence. It feels good to be confident in the beliefs of your trust network. But for the reasons just mentioned, it's inevitable that this confidence will sometimes be misplaced. If you want to form a probabilistically accurate picture of the world you should abstain from the joy of overconfidence, and always remain open to the possibility that some of your beliefs are false. In fact, it's safe to assume that some of your beliefs are false.
20. Read fiction. As a writer, of course I would tell you to read fiction. So obviously you shouldn't trust me. But the reason I've littered this essay with so many examples is that, outside of real-world experience, narratives are the best means we have for thinking about and understanding ad hominem judgments and trust networks. Trust is the stuff novels are made of. Even cheap soap operas often take trustworthiness and trust networks as their main topic, with the drama unfolding around questions like: who's conspiring with whom, who's really on whose side, who's lying and who's telling the truth? If you keep your nose buried in numbers and make the mistake of dismissing everything else as wordy nonsense, you might end up trusting the wrong people and pay the price for it.

The Lifelong Power of Close Relationships

From Robert Waldinger and Marc Schulz writing at the WSJ: 

... What if we could study people from the time that they were teenagers all the way into old age to see what really matters to a person’s health and happiness, and which investments really paid off? For 85 years (and counting), the Harvard Study of Adult Development, which we now direct, has tracked an original group of 724 men and more than 1,300 of their male and female descendants over three generations, asking thousands of questions and taking hundreds of measurements to find out what really keeps people healthy and happy.

Through all the years of studying these lives, one crucial factor stands out for the consistency and power of its ties to physical health, mental health and longevity. Contrary to what many people might think, it’s not career achievement, or exercise, or a healthy diet. Don’t get us wrong; these things matter. But one thing continuously demonstrates its broad and enduring importance: good relationships.

In fact, close personal connections are significant enough that if we had to take all 85 years of the Harvard Study and boil it down to a single principle for living, one life investment that is supported by similar findings across a variety of other studies, it would be this: Good relationships keep us healthier and happier. Period. If you want to make one decision to ensure your own health and happiness, it should be to cultivate warm relationships of all kinds. ...

[I]t wasn’t their middle-aged cholesterol levels that predicted how they were going to grow old; it was how satisfied they were in their relationships. The people who were the most satisfied in their relationships at age 50 were the healthiest, mentally and physically, at age 80....

[F]or older people, loneliness is twice as unhealthy as obesity, and chronic loneliness increases a person’s odds of death in any given year by 26%....

Just 2 Minutes of Intense Exercise Every Day Could Extend Lifespan

From StudyFinds: 

The first study included 71,893 adults without cardiovascular disease or cancer. The median participant age was 62.5 years old, and just over half (56%) were female. Study authors measured weekly levels of vigorous activity and the frequency of exercise bouts lasting two minutes or less. This was a long-term study; subjects were tracked for an average of 6.9 years.

Then, associations between volume and frequency of vigorous activity with death (all-cause, heart disease, and cancer) and incidence of heart disease and cancer after excluding events occurring in the first year were analyzed by researchers. Sure enough, as both the volume and frequency of vigorous activity increased, risk of all five considered adverse outcomes declined. ... 

[S]ubjects who didn’t exercise vigorously at all had a four percent risk of dying within five years. That risk was cut in half (2%) with less than 10 minutes of weekly vigorous activity. Death risk fell to one percent with 60 minutes or more.

When compared to two minutes of intense exercise per week, 15 minutes of vigorous exercise was associated with an 18 percent lower death risk and a 15 percent lower risk of cardiovascular disease. Meanwhile, 12 minutes was linked to a 17 percent lower risk of cancer.

Generally, the more exercise the better. For example, roughly 53 minutes of physical activity on a weekly basis was associated with a 36% lower risk of death from any cause.

New CA Employment Laws, Trends in Rx Spending, Telemedicine Challenges and More

Benefits in Brief

Employees can put an extra $200 into their health care flexible spending accounts (health FSAs) next year, the IRS announced on Oct. 18, as the annual contribution limit rises to $3,050, up from $2,850 in 2022. The increase is double the $100 rise from 2021 to 2022 and reflects recent inflation. 

Compliance News

A Group Health Plan Without a Public Website may satisfy the new transparency and price disclosure requirements if the plan’s TPA posts the required information on its public website - (Q 11, pg. 12) Federal regulators have now made it clear that self-funded employers can rely on their administrator (TPA) to make the necessary price disclosure files publicly available so long as there is a written agreement in place. One original federal interpretation was that employers had to provide that on their websites, and if they did not have a public website, they had to create one for that purpose. Of course, that seemed ludicrous. And thankfully, regulators now agree it was.

California Expands Who an Employee Can Care for Under the CFRA and California Paid Sick Leave Law - "Beginning January 1, 2023, employees throughout California will be able to use sick leave or take leave under the California Family Rights Act (CFRA) to care for a 'designated person' ... defined as any individual related by blood or whose association with the employee is equivalent to a family relationship. An employee can designate this person at the time they request leave." 

California Unleashes Last-Minute Onslaught of New Employment Legislation - California Governor Newsom recently signed several pieces of employment-related legislation into law including: Supplemental Paid Sick Leave Extension, an expansion of the California Family Rights Act and California Paid Sick Leave, Unpaid Bereavement Leave, Emergency Working Conditions, Reproductive Health Decisionmaking, and Cal/WARN Act Enforcement for Call Centers.  

Benefit News

Trends in Prescription Drug Spending, 2016-2021 - This HHS Issue Brief presents the Agency’s findings on prescription drug spending trends between 2016-2021. 

• In 2021, the U.S. health care system spent $603 billion on prescription drugs, before accounting for rebates, of which $421 billion was on retail drugs. 
• Spending growth on drugs was largely due to growth in spending per prescription, and to a lesser extent by increased utilization (i.e., more prescriptions).
• Expenditure growth was larger for non-retail drug expenditures (25%) than for retail expenditures (13%). 
• Between 2016 and 2021, the location where people received their drugs changed. Americans increasingly received their drugs from mail order pharmacies (35% increase), clinics (45% increase), and home health care (95% increase). During the same time period, there were decreases in drugs received through independent pharmacies (5% decrease), long term care facilities (17% decrease), and federal facilities (9% decrease). 
• Drug spending is heavily driven by a relatively small number of high-cost products. The cost of specialty drugs has continued to grow, totaling $301 billion in 2021, an increase of 43% since 2016. Specialty drugs represented 50% of total drug spending in 2021. While the majority (80%) of prescriptions that Americans fill are for generic drugs, brand name drugs accounted for 80% of prescription drug spending in both retail and non-retail settings, with little change over time. The top 10% of drugs by price make up fewer than 1% of all prescriptions but account for 15% of retail spending and 20%-25% of non-retail spending.
• Prescription drug spending trends have been less affected by the COVID-19 pandemic than health care services. 
• Several provisions in the Inflation Reduction Act address drug pricing, including allowing the Secretary of HHS to negotiate prices in Medicare Parts B and D for selected medications and introducing Medicare rebates for drug prices that rise faster than inflation. These provisions may impact future drug spending trends.
• There were 1216 products whose price increases during the twelve-month period from July 2021 to July 2022 exceeded the inflation rate of 8.5 percent for that time period. The average price increase for these drugs was 31.6 percent.

Telemedicine was made easy during COVID-19. Not any more - "Over the past year, nearly 40 states and Washington, D.C., have ended emergency declarations that made it easier for doctors to use video visits to see patients in another state, according to the Alliance for Connected Care, which advocates for telemedicine use. Some, like Virginia, have created exceptions for people who have an existing relationship with a physician. A few, like Arizona and Florida, have made it easier for out-of-state doctors to practice telemedicine. Doctors say the resulting patchwork of regulations creates confusion and has led some practices to shut down out-of-state telemedicine entirely. That leaves follow-up visits, consultations or other care only to patients who have the means to travel for in-person meetings."

Health and Wellness

Sore Throat, Now the Most Common Sign of COVID - "where once a fever and loss of taste or smell were early warning signs of the bug, the symptom tracking app has revealed the most common symptoms have changed."

People who sleep 5 hours or less a night face a higher risk of multiple health problems as they age - "The study, published Tuesday in the journal PLOS Medicine, took a closer look at a group of nearly 8,000 civil servants in the United Kingdom who had no chronic disease at age 50. Scientists asked the participants to report on how much sleep they got during clinic examinations every four to five years for the next 25 years. For those whose sleep was tracked at age 50, people who slept five hours or less a night faced a 30% higher risk that they would develop multiple chronic diseases over time than those who slept at least seven hours a night. At 60, it was a 32% increased risk, and at 70, it was a 40% greater risk."

Compliance and Benefit News, October 3, 2022

Compliance Updates

CA Legislature Expands Pay Transparency and Data Reporting Requirements; Extends COVID Supplemental Paid Sick Leave - "If signed into law by Governor Newsom, the current amended version of SB 1162 would increase employers’ pay transparency obligations as follows: 1) upon request, all employers will be required to provide the pay scale (i.e., hourly rate or salary range) for the position in which the employee is currently employed; 2) employers will be required to maintain records of job title and wage rate history for all employees for the duration of employment plus three years; and 3) all employers with 15 or more employees will be required to disclose pay scales in all job postings.

SB 1162 also expands California employers’ current pay data reporting requirements, which were initially passed into law in 2020 as part of the nation’s first such state-imposed obligations. The current requirements mandate that private employers with 100 or more employees report annually the number of their employees by race, ethnicity, and sex in specified job categories to the Department of Fair Employment and Housing (recently renamed the Civil Rights Department (CRD))."

California Slated to Usher in New Era of Pay Transparency in 2023: What California Employers Need to Know - "The Act expands pay data reporting to all California employers with 100 or more employees regardless of whether or not they are exempted from the EEO-1 filing requirement. The Act also significantly expands the types of pay information employers must report each year. The first deadline to report is the second Wednesday of May 2023 (May 10, 2023). Covered employers must now also provide the “median and mean hourly rate” within each job category (discussed above), for each combination of race, ethnicity, and sex."

Benefit News

The Cost Of Long COVID To Employers Is Skyrocketing -"two types of claims were sorted out: those labeled long COVID, and those attributed to diabetes. When the numbers were crunched, here’s what came up: Per-member employer spend on long COVID was on average $2,654.67, more than 26% higher than the average diabetic spend....The study also finds that long COVID patients reported a 3.6 times greater likelihood of missing work for medical reasons than plan members without the symptoms. ... [T]he average predicted cost of long COVID to patients is nearly $9,500 within the first six months following a diagnosis."

Segal Trend Survey, 7.4% Plan Increases in 2023 - "The projected annual cost trend for outpatient prescription drugs is expected to be approaching double-digit levels, the highest rate observed since 2015. Double-digit specialty Rx cost trend, mostly driven by price increases and new-to-market specialty drugs, continues to be a major driver of Rx cost trends. Survey respondents project per-person cost trends for open-access PPO/POS plans to be 7.4 percent."

Yet Another Reason to Look at Reference-Based-Pricing (another hidden cost shift against employers) - Employer plans pay an average of 224% of what Medicare pays for the same hospitalizations. This cost shift away from Medicare and onto employers has led to growth in employers moving away from traditional insurance and reverence-base-pricing their plans. I spoke about it with Armstrong and Getty in September here. And I wrote about it becoming a growing trend in the 2020s here. A new study now shows that the same hidden tax/cost shift is happing with Obamacare Exchange plans.

‘Gaming’ Of U.S. Patent System Is Keeping Drug Prices Sky High, Report Says - Four pharmaceutical companies have filed hundreds of patents to keep their drugs out of the hands of generic competition and prolong their “unprecedented profits,” according to a report published Thursday. The excessive use of the patent system — by drugmakers Bristol-Myers Squibb, AbbVie, Regeneron and Bayer — keeps the prices of the medications at exorbitant levels, often at the expense of American consumers, according to the report from the Initiative for Medicines, Access & Knowledge, or I-MAK, a nonprofit organization that advocates drug patent reform. ... The U.S. patent system is meant to reward innovation by permitting drug companies to sell new medications on the market and barring other manufacturers from making generic versions for a set period of time — usually 20 years. Once the patent expires, generics are allowed on the market, often at a lower list price than the brand-name drug. But drugmakers often extend their patents by making small tweaks to the drugs, sustaining their monopolies for several years. Legal experts refer to this tactic as “evergreening...”

Health care spending for mental health disorders increases between 2013 and 2020 -

• Overall spending on mental health services increased from 6.8% to 8.2% between 2013 and 2020, according to a new study published by the Employee Benefit Research Institute (EBRI).
• The percentage of the population under the age of 65 with employment-based health coverage diagnosed with a mental health disorder increased from 14.2% in 2013 to 18.5% in 2020.
• Among enrollees with a mental health diagnosis, average annual spending on mental health care services increased from $1,987 to $2,380 between 2013 and 2020 — an average of 3% per year.

Physician Burnout Has Reached Distressing Levels, New Research Finds - "Results released this month and published in Mayo Clinic Proceedings, a peer-reviewed journal, show that 63 percent of physicians surveyed reported at least one symptom of burnout at the end of 2021 and the beginning of 2022, an increase from 44 percent in 2017 and 46 percent in 2011. Only 30 percent felt satisfied with their work-life balance, compared with 43 percent five years earlier."

The perks that work to retain employees now - "Among employed adults, 56% say that the work schedule attracts them most in their current role ­— a factor valued more by women (61%) than men (51%). Almost half of the workers surveyed say that colleagues (48%), fair pay (46%), and work-life balance (43%) are most appealing, with 34% also appreciating their health benefits. In fact, 58% of Gen Z are attracted to their job because of colleagues and work friends, while men (52%) are more likely than women (39%) to be drawn to their job because they are paid fairly."

Health and Wellness

Antidepressants Work Better Than Sugar Pills Only 15 Percent of the Time - "Five years ago Mark Horowitz seemed an unlikely skeptic of psycho-pharmaceuticals. He had been taking the popular antidepressant Lexapro virtually every day for 15 years. He was so fascinated by the drugs that he spent three years hunched over a dish of human brain cells in a laboratory at King's College London, measuring the effect of human stress hormones and drugs like Prozac and Zoloft. Then, when he tried to wean himself off the medication, he suffered panic attacks, sleep disruptions, and depression so debilitating that he had to move back to his parents' house in Australia—symptoms that he says were far worse than anything he experienced prior to going on the drugs. He went online and found thousands of others in a similar pickle. They had been unable to kick one of the psychiatric drugs known as Selective Serotonin Reuptake Inhibitors, or SSRIs, which include Lexapro, Zoloft, and Prozac, among others. Since withdrawal symptoms were thought to be mild and temporary, many of them, like him, had been told by doctors that they were experiencing a relapse of their depression. ..."

How to maintain peak brain health: Scientists say it comes down to these 3 factors - "The three identified keys to strong brain health are:

1. Physical exercise
2. Social activity
3. Strong, passionate interests and hobbies

Simple, right? Let’s break down each factor a bit further. ..."

CDC no longer recommends universal masking in health facilities - "The Centers for Disease Control and Prevention no longer recommends universal masking in health care settings, unless the facilities are in areas of high COVID-19 transmission. The agency quietly issued the updates as part of an overhaul to its infection control guidance for health workers published late Friday afternoon [Sept. 23rd]. It marks a major departure from the agency’s previous recommendation for universal masking."

Being unhappy or lonely speeds up aging — even more than smoking - "Being unhappy or experiencing loneliness accelerates the aging process more than smoking, according to new research. An international team says unhappiness damages the body’s biological clock, increasing the risk for Alzheimer’s, diabetes, heart disease, and other illnesses. The team reports that they detected aging acceleration among people with a history of stroke, liver and lung diseases, smoking, and in people with a vulnerable mental state. Interestingly, feeling hopeless, unhappy, and lonely displayed a connection to increasing a patient’s biological age more than the harmful impact of smoking."

Compliance and Benefit Updates, June 6, 2022

Compliance Updates

The California Supreme Court unanimously ruled that an employee’s meal and rest period "premium pay is subject to the same wage statement and final pay requirements as other wages earned by employees. 

• Employers must pay all wages, accrued vacation earned and other premium pay immediately upon termination.
• Employers cannot withhold final paychecks to induce employees to return tools or equipment, pay back money owed or turn in forms or reports.
• Final paychecks or deposits must be delivered at the time of termination. Employers should be conscious of possible delays caused by delivery or deposit."

FDA: Pharmacists and wholesalers can import drugs from Canada - "Pharmacists and drug wholesalers can import prescription medicines from Canada for up to two years as part of state programs aimed at bringing down drug costs, according to final FDA guidance released Thursday.

• Why it matters: With President Biden's drug pricing agenda still stalled, the FDA is further clarifying how states could take advantage of lower drug costs abroad without the need to limit prices in the U.S.
• Background: Both the Biden and Trump administrations embraced limited importation to bring down health costs, though experts view the policy as having limited impact."

Newsom Signs Compromise Law Raising The Limit On Medical Malpractice Damages - "California’s $250,000 limit on damages for pain and suffering caused by medical malpractice, a ceiling enacted by lawmakers in 1975 at the insistence of doctors and insurers, will be lifted next year. Gov Gavin Newsom signed compromise legislation Monday, sponsored by consumer advocates and supported by medical groups, that will not remove all limits on malpractice damages but will raise them to account for some of the inflation in the past 47 years. Under AB35 by Assembly Majority Leader Eloise Gómez Reyes, D-Colton (San Bernardino County), the new limits for noneconomic damages in 2023 will be $350,000 for nonfatal medical malpractice by a physician and $500,000 for malpractice causing death. The maximum will rise gradually over the next decade, to $750,000 for non-death cases and $1 million for fatal cases, and increase by 2% a year thereafter for inflation."

Pandemic Fatigue Dooms California’s Excessive Covid Vaccine Mandate Aspirations - "In January, progressive California Democrats vowed to adopt the toughest covid vaccine requirements in the country. Their proposals would have required most Californians to get the shots to go to school or work — without allowing exemptions to get out of them. Months later, the lawmakers pulled their bills before the first votes. One major vaccine proposal survives but faces an uphill battle. It would allow children ages 12 to 17 to get a covid-19 vaccine without parental permission. At least 10 other states permit some minors to do this. Democrats blamed the failure of their vaccine mandates on the changing nature and perception of the pandemic. They said the measures became unnecessary as case rates declined earlier this year and the public became less focused on the pandemic. Besides, they argued, the state isn’t vaccinating enough children, so requiring the shots for attendance would shut too many kids out of school."

Benefit News

HR managers are more burned out than ever. Who is supporting them? "Ninety-eight percent of HR professionals have felt burned out at work in the last six months, according to a recent survey conducted by workplace communication app Workvivo, and nearly 4 in 5 are open to leaving their jobs. ... HR teams and managers should work in tandem to share and clearly outline any mental health benefits their company offers"

Will the Pandemic’s Missing Workers Ever Return to the Labor Force? "Looking at those who have exited the labor force and are not retired:

• 23 percent said that available jobs are not in their field of work interest.
• 17 percent said they haven't been able to find a job that pays enough.
• 9 percent said they have chosen to learn new work skills or want to pursue a different career path.
• 27 percent said that if their savings ran out or ran low, it would motivate them to return."

Employers Pay 224% Of Medicare Prices For Hospital Services - Employer-sponsored health plans paid on average 224% of what Medicare paid to hospitals for the same services at the same facilities, according to a new study from RAND Corporation. The report covers billing for hospital inpatient and outpatient services in 2020. The study said that there were significant variances in prices across states or geographic areas and added that the difference in cost seemed to be linked to hospital market share rather than hospitals’ share of Medicare and Medicaid patients.

• The researchers found that in Hawaii, Arkansas, and Washington, relative prices were under 175% of Medicare.
• Other in states, such as Florida, West Virginia, and South Carolina, relative prices were at or above 310% of Medicare.
• Prices for COVID-19 hospitalization were similar to prices for overall inpatient admissions and averaged 241% of what was paid for Medicare patients.

Note from Craig: This is why I wrote that "America Will Dramatically Change the Way It Provides Health Care by 2030." This trend cannot continue. The federal government controls prices by arbitrarily slashing what it will pay for services in Medicare and Medicaid. This forces hospitals to inflate what they charge for all services to private employer plans. Hence, the tax subsidy is really a cost shift to employers that far exceeds anything any of us pay in FICA. In short:

1. Companies that are large enough (over 300 employees) will self-fund and reference base price their plans. Why pay 224% of Medicare when you can pay 140% and have 97% of your claims sail through without pushback. This saves an employer 20% to 30% on healthcare in the first year alone.
2. Smaller companies will be forced into some sort of defined contribution scheme where the employee is punished for the year over year 6% to 9% increases. Perhaps, as I wrote in the above article this will be done mainly through individual HRAs.
3. Lastly, I believe we'll end up with some sort of Medicaid (not Medicare, that is too expensive) safety net for all who are not fortunate enough to end up in numbers one or two above.

Ninth Circuit Rules That a Temporary Impairment Can Qualify as a “Disability” Under the ADA - "The U.S. Court of Appeals for the Ninth Circuit, the federal appellate court with jurisdiction over much of the western United States (including Washington, Oregon, California and Idaho), ruled last week that an employee’s temporary impairment can qualify as a disability under the Americans with Disabilities Act (“ADA”). The Ninth Circuit’s decision resolves an important question under federal disability law and could signal a significant change in how employers are required to address employees’ short-term medical limitations.

In Shields v. Credit One Bank N.A., plaintiff Shields was employed by Credit One Bank ('Bank') as a human resources generalist. Shields underwent biopsy surgery. The biopsy revealed that Shields did not have cancer, but she had a number of post-surgery limitations (e.g., unable to use her right arm to lift, pull, push, type, write, tie her own shoes or use a hair dryer), and these limitations indisputably precluded Shields from performing the essential functions of her position. The Bank put Shields on a short-term leave of absence, but when she was not ready to return to work after two months the Bank terminated her employment. Shields’ lawsuit alleges the Bank violated the ADA by terminating her rather than offering her a reasonable accommodation, specifically, extending her leave of absence to allow her additional recuperation time. The Bank defended on the grounds that Shields did not have a disability under the ADA because her post-surgery limitations, while significant, were not sufficiently 'permanent or long-term' to meet the law’s requirements. The District Court agreed and dismissed Shields’ claim. The Ninth Circuit reversed. Under the ADA, a disability is defined in relevant part as 'a physical or mental impairment that substantially limits one or more major life activities,' without any reference to how long the 'substantial[] limit[]' might last."

Health & Wellness

The caregiver crisis: How employers can support workers in this new reality - "America faces a caregiving crisis. Whether it’s caring for an aging parent, a sick spouse or a child, more than 50 million Americans are unpaid caregivers for family members and loved ones. Tens of millions of those caregivers are also balancing work with caregiving responsibilities. And while caregiving is a rewarding experience, recent data show that 71% of family caregivers with full-time jobs suffer from mental health challenges and more than half of caregivers say they are too burned out to do their job well. It’s no wonder so many family caregivers are thinking about leaving their jobs."

Half-cup of blueberries a day could keep dementia away, scientists say - "An apple a day may keep the doctor away, but a new study finds blueberries may be better for your brain. Researchers from the University of Cincinnati have found that a half-cup of blueberries can keep middle-aged adults from developing dementia as they get older. Moreover, the study finds adding the fruit to your diet lowers insulin levels and improves metabolic function — making it easier to burn fat for energy."