Californians Bracing to Pay More For Health Care

February 8, 2011 J Roberts

It’s 2011 and healthcare costs continue to rise. California’s are bracing themselves for large increases in their medical insurance costs. Unfortunately, California is not the only state. The winds of rising healthcare costs and insurance premiums traditionally blow from West to East.

Anita Vogel

It’s the perfect storm in California when it comes to rising health care costs, with millions bracing for huge increases in their monthly insurance bill. What’s happening? The Golden State is one of many states that doesn’t allow for rate regulation. In addition, California is home to most all of the big insurance companies and the largest market of uninsured people. At the same time major insurers are racing to beat a July 1st deadline requiring these companies to publicly justify their rate hikes.

So, what the people of California are left with are massive increases in their health insurance premiums, to the tune of nearly 60 percent when it comes to Blue Shield in particular. Just today they caved in to public pressure and agreed to join every other insurance company in California like Aetna, Anthem Blue Cross and Pacificare to wait sixty days to raise their rates, but there’s little doubt those rate hikes are still coming later this spring.

In the meantime economists say the tough economy is also playing a role in causing insurance companies to raise their premiums. “Healthy people are dropping out of insurance,” says Dr. Neeraj Sood of the University of Southern California, ” and what happens then is it is basically the unhealthy people who are left with insurance and they cost much more and therefore premiums have to rise.”

But patients are not the only people affected by rising prices; Doctors are also feeling the heat. Dr. Mark Weiss, a long time podiatrist in Century City, California, is also a victim of bigger health care bills. “About a year and a half ago, I opened up my mail and there was a 600 dollar a month increase in my premiums for a policy that was less than good,” says Weiss. His Anthem Blue Cross coverage had gone up more than 20 percent, at the same time his patients were experiencing huge rate hikes. As a result, some of his patients dropped their insurance coverage and Weiss and other area doctors say they had little choice but to concentrate on patients who pay cash for their visits. “My overhead keeps on going up, my reimbursement goes down and that is why a lot of the doctors in the community don’t take any insurance,” adds Weiss.

And as insurance companies gear up for the new federal health legislation to take effect in 2014, many expect they’ll continue to raise their rates, out of concern for how the rules might change in the future. That prospect has patients around the nation worried what that means for them.

Ely Zimmerman, who is a regular patient of Doctor Weiss admits he knows many who have thought of taking their chances and dropping their health insurance all together, but says he won’t do that. “I can’t go without health insurance,” says Zimmerman. “You hear stories of friends who have heart attacks or strokes, so you can’t be without health insurance, I feel like there’s no choice.”

More Americans oppose health-care law, but few want a total repeal

January 31, 2011January 31, 2011 J Roberts

The nation still appears divided over the Affordable Care Act. According to the below Washington Post article, a recent poll by ABC shows an even split over those in favor of the law and those who want a total repeal. What’s your position? We’d like to know.

Jon Cohen

The Washington Post

Republican claims that the new health-care law will hurt the country’s fragile economic recovery and inflate the deficit resonate with the public, according to a new Washington Post-ABC News poll. But few opponents of the law advocate an immediate, wholesale repeal of the legislation.

Overall, Americans’ views of the sweeping health-care overhaul, again under debate on Capitol Hill, remain firmly entrenched, with little change in stiff partisanship on the issue. Some 45 percent of those polled support the law, and 50 percent oppose it, numbers that exactly match their averages in Post-ABC polls going back to August 2009.

Three-quarters of Democrats support the new law, and 80 percent of Republicans oppose it; both are within a few points of their long-term averages. Independents tilt against the legislation, just as they have in most previous polls.

Republicans surveyed in the poll overwhelmingly see negative consequences if the law remains unchanged: 80 percent say it is likely to hurt the economy, 78 percent say it will increase the deficit, and 67 percent say it is apt to cost the country jobs. On each of these points, a majority of independents also take the pessimistic view.

On the economy generally and on jobs, most Democrats see long-term positive effects of the current law. But on the deficit, they divide down the middle, with 46 percent saying the law is more likely to increase the federal budget deficit and 46 percent saying it is more apt to decrease it.

Despite the relative popularity of the detractors’ arguments, there is still little consensus among opponents about the right approach to amending the legislation.

Those who do not support the law are split about evenly between advocating for its complete repeal (33 percent), a partial repeal (35 percent) and a wait-and-see approach (30 percent). Fully two-thirds of all Republicans say they want the law repealed, at least partly.

Recent polls on repeal yield very different answers depending on how the question is asked and how many answer categories respondents are offered. In every iteration of the question, a relatively split verdict on the law appears intact.

As reported Monday, for the first time in Post-ABC polling, congressional Republicans are now tied with President Obama on the question of whom the public trusts when it comes to dealing with health-care change. Overall, 43 percent of Americans approve of the way the president is handling the issue, matching a career low; 52 percent disapprove.

Another factor in the debate is that a quarter of those who oppose the health-care law say the legislation is faulty because it did not go far enough, not because it pushed change too far.

The poll was conducted by telephone Jan. 13 to 16, among a random national sample of 1,053 adults. The results from the full poll have a margin of sampling error of plus or minus 3.5 percentage points.

Single Payer System Takes Center Stage in Vermont

January 17, 2011 J Roberts

Looks like single payer healthcare coverage is very much alive in Vermont. Even though the national public outcry over a single payer system, deemed as socialized medicine, is very much real, Vermont is not the only state exploring and looking for alternatives to curtail the unsustainable rise in healthcare costs. The article makes good points about those who have no insurance and those that are underinsured with only the basic minimum coverage.

Vermont Public Radio

While healthcare reform came under fire in many parts of the country, a single payer system is very much on the horizon in Vermont.

Vermont’s new governor-elect Peter Shumlin makes the case for a single payer system first and foremost as an economic issue based on the trajectory of cost increases for the state, employers and individuals. Shumlin campaigned on a platform that calls for implementation of a single payer system, with benefits that follow the individual and are not a requirement of the employer. The system would reimburse based on outcomes rather than fee for service using technology for medical records and payment. It would also eliminate private insurers and their administrative costs.

Earlier this year, Harvard Economics Professor William Hsiao, an expert on health care systems, was commissioned by the Vermont legislature to develop implementation plans for healthcare system options including a single payer system. In a New York Times interview, Hsiao contends that “you can have universal coverage and good quality health care while still managing to control costs. But you have to have a single-payer system to do it.”

Vermont would require a waiver from the federal government to implement a single payer program. Shumlin is already lobbying President Obama about this waiver. According to Shumlin, “the waivers is the easy part. The hard part is designing a single payer health care system that works and that delivers quality health care, gets insurers off our providers’ backs, has a reimbursement system that makes sense. … I believe if we design that system, we can sell it.”

There is solid evidence to back up Shumlin’s belief. Exit polls tallied 59% of Vermont voters either backing national health care reform as-is (16%) or backing expansion of reform (43%). And with the Vermont executive and legislative branches firmly controlled by one political party, there is the very real opportunity for a viable single payer system to be enacted.

According to Shumlin, “in Vermont, the cost of health care is estimated to increase by $1 billion from 2010 to 2012. For the average Vermont family of four that’s a $7,000 increase on top of the $32,000 that we now spend for health care coverage each year. Our rate of increase exceeds the national average. It is not sustainable. Health care costs are crippling our economy, hampering business growth, driving up property taxes, and bankrupting too many individuals. These costs must be brought under control. The only way to do this is for the state of Vermont to lead the nation in comprehensive health care reform. 47,000 Vermonters have no insurance. When these Vermonters become sick, they are faced with a choice—seek the care they need and risk bankruptcy, or avoid care and face debilitating health or even death. When they do choose to seek care, it is the insured that pay for it. This is an unacceptable choice in a civilized society. It also imposes ethical dilemmas on health care professionals trying to treat the uninsured. Unfortunately, this problem isn’t confined to the uninsured. Tens of thousands of Vermonters are underinsured. All too often Vermonters don’t get the care they need because of unaffordable deductibles, co-pays, and coinsurance.”

Va. Judge Says Healthcare Reform Law Is Unconstitutional

January 11, 2011January 11, 2011 J Roberts

HFMA

Could be trouble for the Obama administration and Healhcare in general if the December 12 ruling by Federal Judge Hudson is upheld. Whatever the decision, 2011 will prove to be a year of polemics and intense debates as healthcare will be at the top of the political agenda.

A federal district judge in Virginia ruled on December 12 that the individual mandate, a key provision of the Affordable Care Act, is unconstitutional. The action today marks the first time that any court in the country has ruled to invalidate any part of the legislation. However, according to Virginia Judge Henry E. Hudson, there should be no immediate effect on the ongoing rollout of the law.

In a 42-page opinion, Judge Hudson wrote that the law’s individual mandate to buy health insurance exceeds the regulatory authority granted to Congress under the Commerce Clause of the Constitution. The judge wrote that his survey of case law “yielded no reported decisions from any federal appellate courts extending the Commerce Clause or General Welfare Clause to encompass regulation of a person’s decision not to purchase a product, not withstanding its effect on interstate commerce or role in a global regulatory scheme.”

Obama administration officials said they are confident that the law eventually will be upheld and stressed that any actual impact on the law would be deferred for years. They noted that the insurance requirement does not even take effect until 2014, when the Supreme Court presumably will have ruled.

Federal health care site arrived July 1

November 1, 2010November 10, 2010 J Roberts

Guess what became available July 1^st 2010? A federal government website that gives consumers access to all the various health insurance plans. Eventually, the site will give consumers a list of all private and government health care plans for individuals and small businesses in their areas. Read on to understand the purpose and what consumers can expect to find on the site.

By Phil Galewitz, Kaiser Health News

Wish finding health insurance were as easy as shopping for an airline ticket?

A federal government website that starts July 1 takes a step in that direction. The site, for the first time, will give consumers a list of all private and government health care plans for individuals and small businesses in their areas.

The nation’s new health care law requires the site (www.healthcare.gov). Initially, it will provide just basic facts, such as the names of companies, health plans and Web links. Beginning in October, it will list detailed cost and benefits information. Consumer groups and insurers already are clashing over exactly what information should be displayed.

“What we are trying to do is create some order in the marketplace,” says Karen Pollitz, a top official at the new Office of Consumer Information and Insurance Oversight at the Department of Health and Human Services. She acknowledges the site won’t be the Expedia of health care any time soon: “This ain’t like buying a plane ticket; it is much more complicated.”

For example, unlike the popular travel sites where people can immediately buy an airline ticket, consumers will have to contact insurers directly to sign up.

Insurers including United Healthcare and Aetna say HHS is going too far in planning to list certain data, such as the percent of claims that health plans deny, the rate at which they cancel policies after customers get sick and the number of times patients appeal coverage decisions. They say the data would mislead potential customers.

“Let’s do what the legislation sets out and not overcomplicate, which will lead to consumer confusion and higher costs,” says Aetna spokesman Mohit Ghose.

Consumer groups such as AARP and Families USA counter the data are vital in helping people pick a plan.

The site can “be the great equalizer so consumers can have equal access to information and be on the same playing field as insurance companies,” says Elisabeth Benjamin, co-founder of Health Care for All New York, a consumer health care coalition. “The government needs to make the information as open as possible.”

The site aims to help consumers navigate the insurance market. The main part of the health overhaul law takes effect in 2014, when there’s a major expansion of insurance coverage and the creation of new state-based health insurance exchanges, which are marketplaces to make it easier for individuals and small businesses to buy insurance. These exchanges will have their own websites.

“It is a very important first step to give consumers the information they need … so insurers are competing on quality of care and customer service,” says AARP lobbyist Paul Cotton.

HHS has said that in October, when it will begin listing premiums for insurance plans, it will use what Pollitz calls “sticker prices.” Actual rates could be significantly higher based on an individual’s health status. Until 2014, insurers are allowed to charge sicker people more, and to deny applications altogether.

UnitedHealthcare is concerned that consumers could misinterpret even those base prices. The company wants the site to list average prices.

Meanwhile, consumer advocates such as Benjamin say consumers should be able to get exact prices from insurers on the site. That could require patients to submit detailed medical histories — at least until 2014.

NEW REPORT: How Will The Affordable Care Act Affect 15 Million Uninsured Young Adults?

October 19, 2010 J Roberts

Here’s some good news! According to a recent report from The Commonwealth Fund, the majority of young adults uninsured in America could gain health insurance coverage by 2014. Looks like the Patient Protection Affordable Care Act may make some significant difference regarding the uninsured.

New York, NY, October 8, 2010—Young adults continue to represent one of the largest groups of Americans without health insurance, with nearly 15 million people aged 19-29 uninsured in 2009—an increase of more than 1 million over 2008, according to a Commonwealth Fund report released today. However, the Affordable Care Act (ACA) is poised to make a significant difference for this population, as up to 12.1 million could gain subsidized insurance once all of the law’s provisions go into effect in 2014.

The report, Realizing Health Reform’s Potential: Young Adults and the Affordable Care Act of 2010, by Commonwealth Fund researchers Sara Collins and Jennifer Nicholson, is an update of a May 2010 report, with new numbers reflecting the latest data on the number of uninsured Americans released by the U.S. Census Bureau last month.

According to the report, by 2014, when most of the bill’s provisions will have taken effect, up to 7.2 million uninsured young adults will gain coverage through Medicaid expansions and up to 4.9 million will gain subsidized private coverage through new insurance exchanges. About 1 million uninsured young adults up to age 26 are projected to join their parents’ policies beginning in 2010. The report estimates that 1.8 million uninsured young adults are not legal residents and will not be eligible for federally subsidized health insurance under the new law.

The authors conclude that, “when fully implemented, the ACA will allow young adults of all income levels to undergo a new rite of passage: establishing necessary ties with the health care system, without fear of accumulating medical debt, as they pursue their educational and career goals.”

What’s Happening To Your Health Plan?

October 13, 2010October 18, 2010 J Roberts

It’s open enrollment season regarding health plans and 2011 benefits. While no one is sure how the Patient Protection Affordable Care Act will play out, one thing is for certain – the immediate impact is a rise in annual premiums for most employers. This translates to a larger share in health-care costs for employees. Who is on your side to manage health care billing issues?

By AVERY JOHNSON

It’s open-enrollment season, the annual rite of fall when health-care costs hit home for most people.

Companies typically allow employees to elect their benefit packages once a year. Making this season especially tricky: the health-care overhaul, which is leading to confusion—and sticker shock—for many employers and workers alike.

For the first time in years, your benefits could well be getting more lavish—but they could cost more, too.

Companies are scrambling to comply with early provisions of the Patient Protection and Affordable Care Act, such as a requirement that plans cover dependent children up to the age of 26. Many employees will be able to count on their companies paying all their bills for preventative care, and plans must eliminate lifetime limits on coverage.

But some companies, citing the new mandates, say costs are rising too fast: In a survey of more than 1,000 employers, Mercer, a human-resources consulting firm, found that corporate health-care costs would rise by 10% next year if firms made no changes to their plans. Many are finding that they have little choice but to switch a greater share of costs to employees.

Last year, when the outcome of the health-care overhaul was still uncertain, some employers held off on making any significant alterations in their plans. That is one of the reasons the number of changes this year is so great, says Tom Richards, senior vice president for U.S. products at health insurer Cigna Corp. (more…)

Health Insurers Plan Hikes

September 29, 2010 J Roberts

Expect more premium increases and greater out-of-pocket expenses beginning October 1^st as insurers begin to roll out their plans to employers for January 1.

Health insurers say they plan to raise premiums for some Americans as a direct result of the health overhaul in coming weeks, complicating Democrats’ efforts to trumpet their signature achievement before the midterm elections.

Aetna Inc., some BlueCross BlueShield plans and other smaller carriers have asked for premium increases of between 1% and 9% to pay for extra benefits required under the law, according to filings with state regulators.

These and other insurers say Congress’s landmark refashioning of U.S. health coverage, which passed in March after a brutal fight, is causing them to pass on more costs to consumers than Democrats predicted.

Insurers say the law mandates free preventive care that raises premiums.

The rate increases largely apply to policies for individuals and small businesses and don’t include people covered by a big employer or Medicare.

About 9% of Americans buy coverage through the individual market, according to the Census Bureau, and roughly one-fifth of people who get coverage through their employer work at companies with 50 or fewer employees, according to the Kaiser Family Foundation. People in both groups are likely to feel the effects of the proposed increases, even as they see new benefits under the law, such as the elimination of lifetime and certain annual coverage caps.

Many carriers also are seeking additional rate increases that they say they need to cover rising medical costs. As a result, some consumers could face total premium increases of more than 20%.

While the increases apply mostly to the new policies insurers write after Oct. 1, consumers could be subject to the higher rates if they modify their existing plans and cause them to lose grandfathered status.

The rate increases are a dose of troubling news for Democrats just weeks before an election in which they are at risk of losing their majority in the House and possibly the Senate.

In an interview with WSJ’s Alan Murray, Aetna Chairman and CEO Ronald Williams says that a side effect of the health-care reform bill is that costs will increase. He also criticizes leaders in Washington for the demagoguery of his industry that persisted during the health-care debate.

In addition to pledging that the law would restrain increases in Americans’ insurance premiums, Democrats front-loaded the legislation with early provisions they hoped would boost public support. Those include letting children stay on their parents’ insurance policies until age 26, eliminating co-payments for preventive care and barring insurers from denying policies to children with pre-existing conditions, plus the elimination of the coverage caps.

Weeks before the election, insurance companies began telling state regulators it is those very provisions that are forcing them to increase their rates.

Aetna, one of the nation’s largest health insurers, said the extra benefits forced it to seek rate increases for new individual plans of 5.4% to 7.4% in California and 5.5% to 6.8% in Nevada after Sept. 23. Similar steps are planned across the country, according to Aetna.

Regence BlueCross BlueShield of Oregon said the cost of providing additional benefits under the health law will account on average for 3.4 percentage points of a 17.1% premium rise for a small-employer health plan. It asked regulators last month to approve the increase.

In Wisconsin and North Carolina, Celtic Insurance Co. says half of the 18% increase it is seeking comes from complying with health-law mandates.

The White House says insurers are using the law as an excuse to raise rates and predicts that state regulators will block some of the large increases.

“I would have real deep concerns that the kinds of rate increases that you’re quoting… are justified,” said Nancy-Ann DeParle, the White House’s top health official. She said that for insurers, raising rates was “already their modus operandi before the bill” passed. “We believe consumers will see through this,” she said.

Previously the administration had calculated that the batch of changes taking effect this fall would raise premiums no more than 1% to 2%, on average.

U.S. workers paying 14% more in health care costs

September 22, 2010 J Roberts

Looks like healthcare costs continue to rise. Is there any help for employees and consumers who are getting stuck with larger out-of-pocket expenses?

The Star Ledger – on line

Strained by rising health care costs and the sour economy, U.S. employers are pressing workers to shoulder the added burden alone as employees pay higher insurance premiums and more out-of-pocket expenses for their medical care.

The average employer-provided family health plan now costs workers nearly $4,000 a year, up 14 percent from last year, according to a survey by the nonprofit Kaiser Family Foundation and the Health Research and Educational Trust.

That is the largest annual increase since the survey began in 1999 and a marked change from previous years, when employers generally split the cost of rising premiums with their employees.

Indeed, the average employer contribution to a family plan did not increase at all this year, meaning the entire increase was borne by workers.

Overall, premium growth slowed slightly this year to 3 percent, with the average annual cost of a family health plan reaching $13,370. Workers picked up 30 percent of that bill.

The average plan for a single individual cost $5,049.

At the same time, workers also saw average co-payments for routine office visits rise 10 percent and deductibles continue their surge upward.

In 2010, more than a quarter of American workers with employer-provided health coverage are in plans with deductibles of $1,000 or higher.

“It’s really bad news for everybody,” said Helen Darling, president of the National Business Group on Health, an organization of large employers that provide coverage to about 50 million workers, retirees and dependents.

The squeeze, reported by employers between January and May, largely reflects the fallout of the ongoing economic slowdown and may be ameliorated in future years as the new health care law is implemented.

But it could also further complicate the Obama administration’s efforts to rally support for the law, which is expected to do relatively little in the short term to contain rising medical bills.

“There have been times when employers been able to absorb costs. This is not one of those times,” said James Gelfand, health policy director at the U.S. Chamber of Commerce, a leading critic of the new law.

Report: Health costs burden rests on workers’ shoulders

September 9, 2010 J Roberts

It’s a fact, health care costs continue to increase. Insurers are raising premiums while offering less comprehensive coverage. To complicate matters, many employers are putting price before quality when searching for a health plan.

By Lydell C. Bridgeford

American workers continue to see their health care costs increase, while receiving less comprehensive coverage. To complicate matters, employers are doing a lackluster job of shopping for quality health plans.

According to research by the Kaiser Family Foundation and the Health Research and Educational Trust, U.S. workers are paying, on average, about $4,000 for family health care coverage, a 14% or $482 jump from 2009 costs.

The spike occurred despite the total premiums for family coverage, which includes employer contributions, only increasing by 3% to $13,770 this year, researchers found.

Employer contributions for family coverage, however, remained steady, meaning companies are shifting more of the health care costs onto workers.

In the survey report, “2010 Employer Health Benefits Survey,” analysts also indicate that companies are raising the annual deductibles employees must pay before their health plans start to pick up the costs.

For example, a total of 27% of covered workers face annual deductibles of at least $1,000, up from 22% in 2009, according to the survey results. Among small employers with 3 to 199 workers the number rose to 46% for such deductibles.

Researchers conducted the survey between January and May of 2010. It included 3,143 randomly selected non-federal public and private employers with three or more workers. Of which 2,046 responded to the full survey and 1,097 responded to a single question about offering coverage.

“Much of the survey collection was done before the health reform law passed and most of the benefits arrangements described in the report occurred before there were any reasons to know what the health reform law would actually say,” explains Gary Claxton, vice president and director of the foundation’s health care marketplace project and the study leader author.

Still, since 2005, workers’ contributions to premiums have rose 47%, while overall premiums increased 27%, wages jumped 18%, and inflation spiked 12%.

“With the economy struggling, businesses have been shifting more of the costs of health insurance to workers through premiums, deductibles and other cost-sharing,” says Dr. Drew Altman, president and CEO at the Kaiser Family Foundation.

“This may be helping to stem the rapid rise in premiums that we saw in the early 2000s, but it also means employer coverage is less comprehensive. From a consumer perspective, the cost of health insurance just keeps going up faster than wages,” he adds.

In addition, 30% of employers admitted they reduced the scope of health benefits or increased cost sharing because of the economy.

Health plan quality

Meanwhile, the report reveals employers are not considering quality in their decision-making process on health plans.

Overall, large employers with 200 or more workers were more likely (34%) to review performance indicators on health plans than small employers with 3 to 199 workers (5%). The most common indicators used were the Consumer Assessment of Health Care Providers and System (77%) and hospital outcomes data (61%), according to the survey results.

About 75% of employers indicated that they were “somewhat satisfied” or “very satisfied” with the information available on health plan quality. However, only about 50% of firms claimed that the information was “somewhat influential” or “very influential” in their decision to select health plans.

Moreover, only six percent of employers said they review information on health plan performance, and the ones who did look at information on plan quality only half said it was influential to the their selection of a health plan, says Megan McHugh, research director at the Health Research and Educational Trust.

“With quality improvement efforts expanding and with increased focus on transparency, employers do have the ability to find data on quality of care and use it when they are comparing health plans,” says McHugh. “The lack of comparison shopping based on quality … is troubling. We are finding employers don’t hold health plans accountable for the care they offer,” she adds.

McHugh speculates that employers are choosing health plans based on price and quality might not rise to the same level of importance.

In addition, perhaps, employers are “weary of the value of quality indicators and don’t understand the indicators that are available to them. They also might believe that the quality monitors can be entrusted to others, such as the health plan and the accreditation organizations,” she explains.

Other key findings from the survey include:

Consumer-driven plans have established a foothold in the employer market, tripling their market share from 4% in 2006 to 13% in 2010.

Preferred provider organizations (PPOs) continue to dominate the employer market, enrolling 58% of covered workers. Average PPO family premiums topped $14,000 annually in 2010.

Single-payer coverage increased 5% in 2010 to reach $5,049 annually. Workers on average are paying $899 annually for single coverage, up from $779 in 2009. Forty-seven percent of covered workers are in single coverage plans.

Physician office visits: Among covered workers with a co-payment for in-network physician office visits, the average co-payment increased a small but statistically significant amount from 2009 to 2010 – from $20 to $22 for primary care and from $28 to $31 for specialty care.

Mental health benefits: In response to the 2008 Mental Health Parity and Addiction Equity Act, 31% of firms with more than 50 workers made changes to the mental health benefits they offer. Most of this group eliminated limits on coverage to comply with the law, though a small share (5% of those making changes) dropped mental health coverage altogether.

Wellness benefits: About three-fourths (74%) of employers offering health benefits offer at least one of the following wellness programs: weight loss program, gym membership discounts or on-site exercise facilities, smoking cessation program, personal health coaching, classes in nutrition or healthy living, web-based resources for healthy living, or a wellness newsletter.

Health risk assessments: Among firms offering coverage, 11% give their employees the option of completing a health risk assessment to help employees identify potential health risks. Within this group, 22% —or a relatively small two percent of all employers—offer financial incentives such as lowering the worker’s share of premiums or offering merchandise, gift cards, travel, or cash to their workers. Large firms are more likely than small firms both to offer assessments and to offer financial incentives.