Latest / Becker’s Healthcare Podcast / Payer Shakeups, Rising Costs and the Future of Employer Health Insurance with Jakob Emerson

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Payer Shakeups, Rising Costs and the Future of Employer Health Insurance with Jakob Emerson · Becker’s Healthcare Podcast

• 0:01
  - The payer provider relationship has never been simple,
• 0:04
  - but what's happening now is something different.
• 0:07
  - Value based models are maturing unevenly,
• 0:10
  - prior authorization reform is reshaping workflows on both
• 0:13
  - sides, and affordability
• 0:15
  - pressure is intensifying.
• 0:16
  - The organizations that figure out how to collaborate
• 0:19
  - genuinely, not just contractually,
• 0:21
  - are the ones that will set the terms
• 0:23
  - for what comes next.
• 0:24
  - Becker's fifth annual fall payer issues roundtable brings
• 0:27
  - together more than 500 executive level attendees
• 0:30
  - and 70 plus speakers for two days of
• 0:32
  - focused senior level conversation on benefit design, network
• 0:36
  - strategy, transparency,
• 0:38
  - and the financial
• 0:46
  - Hotel Chicago. For the agenda and event details,
• 0:49
  - visit beckerspayer.com
• 0:50
  - and click on the events tab in the
• 0:52
  - upper right.
• 0:54
  - This is Scott Becker with the Beckers HealthCare
• 0:57
  - podcast. We're talking to Jacob Emerson, the guru
• 1:00
  - of the payer industry.
• 1:02
  - Jacob, tell us what stories you're watching currently.
• 1:05
  - What are the big stories going on currently?
• 1:08
  - Sure. Good morning, Scott. Good to talk with
• 1:10
  - you. So
• 1:11
  - some some news that,
• 1:13
  - I put up just late yesterday that I
• 1:16
  - don't see anywhere else yet. I was able
• 1:18
  - to get it confirmed with Centene that they're
• 1:20
  - gonna be exiting
• 1:22
  - the commercial group markets in California and Oregon.
• 1:25
  - So that's, you know, health insurance for employers.
• 1:28
  - Centene's gonna be pulling out of those markets.
• 1:30
  - Obviously, California being the biggest one, so pretty
• 1:34
  - big news there. And then then we could
• 1:36
  - also talk about the broader trend we're seeing
• 1:38
  - as we go into talking about employer health
• 1:40
  - insurance. And as we go into renewal season
• 1:43
  - for employers
• 1:45
  - all over the country, we're seeing some of
• 1:47
  - the biggest employers, so companies like Starbucks, Disney,
• 1:52
  - companies like that,
• 1:53
  - really pouring down the the benefits
• 1:56
  - that they offer,
• 1:57
  - their employees. So things like cutting weight loss
• 2:00
  - drug coverage, cutting dependent coverage, things like that.
• 2:03
  - You know, I think anybody who's in the
• 2:06
  - employer health benefit space knows what's coming heading
• 2:09
  - into next year, double digit rate increases most
• 2:12
  - likely, and there's a few different reasons or
• 2:13
  - a lot of different reasons for that. But
• 2:15
  - it's just it's it's the same trend as
• 2:17
  - as always. It's got a health insurance cost
• 2:19
  - going up, but it's getting worse.
• 2:22
  - And and now we're starting to see even
• 2:23
  - the most, let's say, sophisticated
• 2:26
  - health benefits programs that these private companies really
• 2:28
  - be affected by that. And and and let
• 2:30
  - me ask you a question.
• 2:32
  - And I know on its face, it sounds
• 2:34
  - bad. Like, Cigna cuts coverage for the GLP
• 2:37
  - wines.
• 2:37
  - Starbucks cuts tariffs to cut their benefits.
• 2:41
  - With the GLP ones, I find it fascinating
• 2:43
  - because I could almost immediately see the net
• 2:46
  - positive
• 2:48
  - in reduction of the cost of GLP ones
• 2:51
  - when people are buying them directly, particularly the
• 2:53
  - semi compounded
• 2:54
  - versus the name brands.
• 2:57
  - Is this the kind of thing that this
• 2:58
  - movement away from employer health coverage? I saw
• 3:02
  - the latest stats from Milliman were employer coverage,
• 3:05
  - family of four, thirty five thousand a year,
• 3:07
  - meaning income in our country, 84,000 or 85,000
• 3:10
  - a year. Yeah. Those numbers obviously just don't
• 3:12
  - work.
• 3:13
  - Is this are there possible benefits here till
• 3:15
  - we till we get out of insurance
• 3:18
  - and everything in health care being paid for
• 3:20
  - with other people's money?
• 3:22
  - The stark reduction in cost for GLP ones
• 3:25
  - as they want to consumers
• 3:27
  - is, to me, fascinating and striking how the
• 3:29
  - companies have had to come to be much
• 3:31
  - more competitive price wise.
• 3:34
  - Are there benefits to some of this? Has
• 3:36
  - the insurance thing gotten to be so big
• 3:39
  - and so costly and everybody trying to pay
• 3:41
  - things through other people's money
• 3:43
  - that it's not working for our triple aim?
• 3:46
  - Is there is there a spot where there's
• 3:47
  - some some of this is actually really good?
• 3:50
  - Yeah. I mean, I think that's a great
• 3:51
  - question, and I think it's depending on what
• 3:53
  - you're talking about. If we're you know, with
• 3:54
  - GLP ones, I think there's a there's a
• 3:56
  - good point to be made there that it's
• 3:59
  - might might be probably as cheaper for
• 4:02
  - employees or some employees to move towards a
• 4:05
  - a cash pay direction, especially for what you
• 4:08
  - were talking about with, like, compounded semaglutides
• 4:10
  - or semaglutides,
• 4:12
  - you know, compared to trying to cover have
• 4:14
  - the employer cover these branded medications that we
• 4:16
  - know are extremely expensive still.
• 4:18
  - But,
• 4:19
  - I mean, I think if you're just talking
• 4:21
  - about this from a health benefits perspective overall,
• 4:23
  - I mean, I don't think that works necessarily
• 4:26
  - if we're talking about, let's say,
• 4:28
  - some kind of cardiac
• 4:30
  - surgery or oncology.
• 4:31
  - So I mean, the the the the old
• 4:33
  - idea of insurance was that it is for
• 4:34
  - the catastrophic things. It is for the big
• 4:36
  - things. Yeah. So you're gonna need insurance for,
• 4:38
  - you know, if you have cardiac oncology, hospital
• 4:40
  - bills, all kinds of things. Absolutely.
• 4:42
  - But is there a spot where, you know,
• 4:45
  - like, for example, if people were buying their
• 4:46
  - primary care,
• 4:48
  - you know, shopping for it in in trying
• 4:51
  - to find it, we're already seeing so much
• 4:52
  - of that, quite frankly, with more and more
• 4:54
  - of it going to concierge and urgent care
• 4:56
  - and other kinds of way that people are
• 4:57
  - accessing it by what's the best place for
• 4:59
  - them to access because so much of what's
• 5:00
  - coming out of their own HSA or their
• 5:01
  - own deductibles.
• 5:03
  - Mhmm. Is there a spot where
• 5:05
  - insurance was back a little bit to what
• 5:07
  - the original intention was back in the day,
• 5:09
  - which is, you know, higher cost catastrophic
• 5:12
  - type of problems
• 5:13
  - and not for every daily thing. And is
• 5:15
  - that part of what's driven insurance up through
• 5:17
  - the roof or at least does it allow
• 5:18
  - us to focus on a different part of
• 5:20
  - it where costs are still extremely high for
• 5:22
  - these big, big diseases and big problems? Yeah.
• 5:24
  - No. A 100%. I would argue I mean,
• 5:26
  - maybe that's that is what you're describing as
• 5:28
  - a high deductible health plan where, you know,
• 5:31
  - you've gotta pay $8,000
• 5:32
  - out of pocket before
• 5:34
  - your your health benefits kick in, and that's
• 5:37
  - more moving moving the the cost
• 5:40
  - toward the the employee versus the employer.
• 5:43
  - So for things like, you know, primary care,
• 5:45
  - like what you just said, the more of
• 5:48
  - the the cost is on the employee before
• 5:50
  - the the health insurance costs kick in. But
• 5:52
  - I think it's, you know, I think it's
• 5:53
  - complicated. It's hard to it's hard to talk
• 5:56
  - about this industry in absolutes from the employer
• 5:59
  - perspective because it's it's completely different at every
• 6:01
  - company. Right? I mean, every self insured company
• 6:04
  - is essentially designing their own plans
• 6:06
  - and just using the big insurers as as
• 6:10
  - administrators of those plans.
• 6:12
  - So, you know, I think overall, it's it's
• 6:14
  - it's hard to say, but I think what
• 6:16
  - you're describing is what I've heard a lot
• 6:17
  - of people in the industry say is, you
• 6:19
  - know, health insurance was originally meant for catastrophic
• 6:22
  - coverage, and it's moved into a
• 6:25
  - more cover everything or try to make things
• 6:28
  - cheaper at the at the at the payment,
• 6:31
  - counter cheaper for for the employee.
• 6:34
  - But I think when I've talked to, you
• 6:35
  - know, health plan CFOs, especially over the last
• 6:37
  - couple of years, They've also really talked about
• 6:40
  - the fact that,
• 6:42
  - with specialty drugs, specifically, that that category of
• 6:45
  - spend, that that's really what is,
• 6:48
  - driven cost up so extreme over these last
• 6:51
  - few years. And it's not just GLP ones.
• 6:53
  - I mean, it's it's,
• 6:55
  - specialty medications around,
• 6:57
  - oncology,
• 6:59
  - oncology especially,
• 7:00
  - skin medications,
• 7:02
  - so eczema medications, but just these these specialty
• 7:04
  - medications that I would argue that the employee
• 7:07
  - can't pay for out of cost because they
• 7:10
  - are so expensive. And there are no generics,
• 7:11
  - and there are no compounded alternatives for that
• 7:14
  - kind of thing.
• 7:15
  - No. A 100%. And you're absolutely right on
• 7:17
  - so many levels that it's on the mono.
• 7:19
  - With a mono with Employer coverage is all
• 7:21
  - different depending on, you know, a five person
• 7:23
  - company versus a 5,000 person company or a
• 7:25
  - bigger company, smaller company, and where they're located
• 7:27
  - and all kinds of things. You're you're absolutely
• 7:29
  - right. And, certainly, there are so many things
• 7:31
  - that right. You divide health care into big
• 7:34
  - differences,
• 7:35
  - the five to ten thousand a year that
• 7:37
  - an employer or the family might be able
• 7:39
  - to cover and actually do better off with
• 7:42
  - some consumerism around it. And then the bigger
• 7:45
  - incidences, the bigger drug cost that no family
• 7:48
  - can really cover unless
• 7:50
  - they're ludicrously
• 7:51
  - rich, but but nobody really wants to handle
• 7:53
  - those costs. If you got a cardiac incident
• 7:55
  - and oncology incident, a million different types of
• 7:57
  - incidences where, you know, where the cost are
• 7:59
  - you can't you could just list them by
• 8:01
  - expensive versus versus day to day or annualized,
• 8:05
  - and so
• 8:06
  - it's it's it's that movement. But you're absolutely
• 8:08
  - right. That's on a monolith. So okay. So
• 8:11
  - one set of issues is there,
• 8:14
  - you know, more and more employers trying to,
• 8:17
  - you know, drop some of coverage.
• 8:18
  - And it's a really fascinating issue because there
• 8:20
  - are a lot of politicians on the left
• 8:22
  - and right that think we should get to
• 8:24
  - the spot where we're divorcing insurance from the
• 8:26
  - employers as well.
• 8:28
  - Yeah. And that's a whole different subject. But
• 8:30
  - what else are you watching closely? Because there's
• 8:32
  - a lot of discussion of that on the
• 8:33
  - left and right, and we've combined
• 8:36
  - you know, and one of the things that
• 8:37
  - was loved about the Obamacare act was the
• 8:39
  - concept that you had portability of your coverage,
• 8:42
  - that you weren't sort of cut off. And
• 8:43
  - because, you know, in in my generation, so
• 8:45
  - many friends had to stay at companies.
• 8:47
  - They had oncology problems, they had other issues,
• 8:50
  - and they couldn't leave the company because they
• 8:52
  - would lose their insurance with it. So the
• 8:53
  - portability things in the Obamacare act were just
• 8:56
  - loved by a lot of us. I mean,
• 8:57
  - overwhelmingly, 90% of people, right or left, were
• 9:00
  - big fans of some of those provisions, not
• 9:01
  - even a question. Tell us what else you're
• 9:03
  - watching closely. I mean, just to follow-up there
• 9:06
  - quickly on your last point though, Scott, I'm
• 9:08
  - I'm finding, especially recently, the the politics of
• 9:11
  - health insurance is is fascinating
• 9:14
  - in terms of it it doesn't necessarily neatly
• 9:17
  - follow anymore the the left and right divide
• 9:20
  - that we're seeing, you know, happen across almost
• 9:22
  - everything else. And I say that because
• 9:25
  - to your point, you know, Obamacare, the ACA,
• 9:28
  - in theory, might not be popular among Republicans,
• 9:32
  - among Republican voters,
• 9:34
  - but the portability
• 9:35
  - idea is. And the the idea of,
• 9:39
  - of of small businesses being able to
• 9:43
  - to offer their employees health insurance in some
• 9:45
  - kind of way to incentivize
• 9:47
  - the the creation of small businesses
• 9:49
  - is a popular Republican idea. And and in
• 9:52
  - that vein, you know, there's we we've talked
• 9:54
  - about it on on this podcast about ICRA's,
• 9:56
  - and that was created by the first Trump
• 9:58
  - administration where the employer gives a tax free
• 10:02
  - stipend to the employee to then go purchase,
• 10:04
  - coverage on their state exchange
• 10:06
  - and and that stipend covers the premium or
• 10:09
  - or maybe just a piece of it. And
• 10:11
  - and like I said, that was created under
• 10:13
  - under the first Trump administration and that's that
• 10:15
  - is the the the infrastructure that is Obamacare,
• 10:18
  - but that's but ICRA is, I think,
• 10:21
  - in the in the discourse maybe something more
• 10:23
  - of a a small business
• 10:25
  - oriented, republican oriented
• 10:27
  - idea. So I think that's interesting, but then
• 10:30
  - one one last point here is that, you
• 10:32
  - know, I I saw some saw some,
• 10:34
  - reporters
• 10:35
  - in national outlets talking about,
• 10:38
  - some polling that Republican strategists have been getting
• 10:41
  - going into the midterms, and they're they're finding
• 10:44
  - that hitting hard or doubling down on attacking
• 10:47
  - insurance private insurance companies right now is very
• 10:49
  - popular
• 10:50
  - among all voters and among the Republican voters
• 10:53
  - because everybody is affected by these high costs.
• 10:56
  - And yet, how do you then as a
• 10:57
  - Republican attack the insurance companies but then not
• 11:00
  - embrace an alternative to the insurance companies, which
• 11:03
  - of course would be government more government backed
• 11:05
  - health care. And on on the far left,
• 11:07
  - you're seeing in a lot of these silent
• 11:09
  - races, for example,
• 11:10
  - a a big embrace of Medicare for all.
• 11:13
  - So and I I believe I saw, El
• 11:15
  - Sayed in in Michigan responding to one of
• 11:18
  - those polls
• 11:19
  - saying, does that mean you're gonna be embracing
• 11:21
  - Medicare for all if if you Republicans are
• 11:23
  - gonna be doubling down on attacking the insurance
• 11:25
  - companies? And so it's I just I think
• 11:27
  - it's an interesting predicament that all of the
• 11:29
  - both parties have are getting themselves in around
• 11:31
  - this topic. Well, yeah. Yeah. 100%. And and
• 11:34
  - both parties are sort of in the spot
• 11:36
  - where
• 11:37
  - I mean, the reality visit with your Republican
• 11:40
  - or Democratic voter,
• 11:42
  - your health care costs are outrageously
• 11:44
  - high. Yeah. And one of the things I
• 11:46
  - find so disturbing about DC, when you talk
• 11:49
  - about the al Said comments, when you talk
• 11:50
  - about the Republican comments, what really
• 11:54
  - it seems like there's little focus on
• 11:56
  - actually how do we take care of all
• 11:58
  - of our people. Mhmm. And what what I
• 12:00
  - mean by that is
• 12:02
  - Medicare for all is a slogan,
• 12:04
  - and it's a payment system,
• 12:06
  - but it doesn't actually mean taking care of
• 12:08
  - everybody. It means we have coverage everybody,
• 12:11
  - but we still don't have enough doctors, nurses
• 12:14
  - to take care of everybody, and the costs
• 12:16
  - are still really high.
• 12:17
  - You know, how do you actually and and
• 12:19
  - and what and what positive about DC is
• 12:21
  - there's no discussion of how do we actually,
• 12:23
  - you know,
• 12:24
  - take care of more people.
• 12:26
  - So we'll see
• 12:28
  - we'll see if there's any way to,
• 12:30
  - to move forward on it. But you're right.
• 12:32
  - Republican voters, Democratic voters, no matter who you
• 12:35
  - are,
• 12:36
  - you know, the cost are I mean, the
• 12:37
  - 35,000 for a family of four versus 85,000
• 12:40
  - median income, to me, says it all. Those
• 12:41
  - numbers just don't work. They just don't work.
• 12:43
  - You know? Yeah. If we have the country,
• 12:45
  - we can sell them 85,000.
• 12:46
  - When this crazy situation, we have to subsidize
• 12:48
  - the insurance companies or put someone's money through
• 12:50
  - the insurance companies. This drives cost up so
• 12:53
  - much, and then we have to give people
• 12:55
  - subsidies
• 12:56
  - to to them. And I guess the only
• 12:58
  - you know, what you're seeing now is with
• 12:59
  - health systems, and you cover this a lot,
• 13:02
  - is health systems are talking about
• 13:05
  - our
• 13:06
  - consumers are losing coverage, but they're still coming.
• 13:08
  - So we're still providing the care. Mhmm. We
• 13:10
  - just we just aren't getting paid for it.
• 13:13
  - You know, and and, obviously,
• 13:15
  - that's no good,
• 13:17
  - but it is part of forcing people to
• 13:18
  - actually solve the real problem, which is just
• 13:20
  - not coverage, but it's actually making sure there's
• 13:23
  - enough providers to take care of everybody and
• 13:25
  - technologies and providers. It's fascinating.
• 13:27
  - Yeah. And honestly, Scott, this is a topic
• 13:29
  - we could go on about for hours, and
• 13:30
  - I say that because with some of the
• 13:32
  - the estimates coming out for next year for
• 13:34
  - '27 around what is ultimately driving these costs
• 13:37
  - up,
• 13:38
  - you know, it's it's none of it some
• 13:39
  - of it's not really that new. A lot
• 13:41
  - of it's, you know, consolidation
• 13:42
  - by the health systems, the the pharmacy spending
• 13:45
  - like what we just talked about,
• 13:47
  - behavioral health utilization, all all that stuff. It's
• 13:49
  - not too new, but I think one factor
• 13:51
  - that we're seeing cited for the first time
• 13:53
  - on some of these actuarial reports is the
• 13:55
  - AI documentation and the coding tools.
• 13:58
  - So the the the AI that's listening to
• 14:00
  - you in the doctor's room capturing everything you
• 14:03
  - say and then, you know and I'm oversimplifying
• 14:06
  - it, but then, you know, that going down
• 14:08
  - into some kind of,
• 14:10
  - the insurers call it,
• 14:11
  - overcoding
• 14:12
  - or or, you know, basically,
• 14:16
  - submitting claims for more care than what was
• 14:18
  - delivered, and then the insurers using AI to
• 14:20
  - parse through that data and and deny more
• 14:22
  - or make, you know, providers jump through more
• 14:24
  - hoops to get paid. So all all to
• 14:26
  - say, the administrative issues that have been, you
• 14:29
  - know, a function of the health care system
• 14:31
  - for decades, they're getting worse because of AI.
• 14:33
  - It's causing all these these costs to go
• 14:35
  - up, and that's now starting to come out
• 14:37
  - in these reports as well. To your point,
• 14:39
  - I don't know how Washington would would attack
• 14:41
  - that because that is a direct result of
• 14:43
  - private industry. So all to say, I like
• 14:45
  - I said, I know I could talk about
• 14:47
  - this for a while, but I did wanna
• 14:48
  - mention the story about,
• 14:51
  - Centene pulling out of the commercial group market
• 14:53
  - in California
• 14:55
  - based in Oregon and basically saying, you know,
• 14:57
  - we're not gonna we're no longer gonna be
• 14:58
  - selling health insurance plans to,
• 15:01
  - small and large employers in those two states.
• 15:04
  - And I I it it's a relatively small
• 15:06
  - book of business for Centene overall. It's through
• 15:08
  - their a subsidiary called Health Net, over on
• 15:11
  - the West Coast, because Centene, of course, is
• 15:13
  - a managed care giant. Their main book of
• 15:16
  - business is managed Medicaid, contracting with the states,
• 15:19
  - and and ACA, and a little bit of
• 15:21
  - Medicare Advantage as well. But what it it's
• 15:24
  - significant because it's showing that even the big
• 15:27
  - players are they're reorienting
• 15:30
  - around what they know best. They're they're pruning
• 15:33
  - away those those smaller books of business that,
• 15:36
  - is not their core operations
• 15:38
  - even if,
• 15:40
  - it's in theory one of the more or
• 15:42
  - in the past is one of the more,
• 15:44
  - revenue generating areas.
• 15:46
  - Now, you know, this company like Centene publicly
• 15:48
  - traded is saying, we're gonna focus entirely on
• 15:51
  - Medicaid, Medicare,
• 15:52
  - and ACA.
• 15:54
  - We're not making any biz enough money, essentially
• 15:57
  - to stay open,
• 15:58
  - in in this area. And I don't think
• 16:00
  - it's that surprising. California
• 16:02
  - probably, if not the if not one of
• 16:04
  - them, the most competitive
• 16:06
  - health insurance market in the country between Kaiser,
• 16:09
  - Blue Shield of California, Anthem, United, all having
• 16:12
  - huge books of business there. And then I
• 16:14
  - also think it's it's just interesting to them
• 16:16
  - pulling out of Oregon.
• 16:18
  - Oregon is I would I would argue going
• 16:19
  - into next year seeing one of the biggest
• 16:21
  - health insurance shakeups of all the states because
• 16:23
  - you've got Providence Health Plan completely shutting down.
• 16:26
  - You've got, Legacy Health, which is in Portland,
• 16:28
  - their their health plan, Pacific Source pulling out
• 16:31
  - the ACA market, and now you've got Centene
• 16:33
  - pulling out of the employer market. So Oregon
• 16:35
  - keeps losing all these health insurance carriers,
• 16:38
  - and and that's gonna cause you know, it's
• 16:39
  - just gonna cause a lot of disruption as
• 16:41
  - we go into next year. And and what
• 16:43
  - do you see in terms of, right I
• 16:45
  - mean,
• 16:46
  - you you you see these people getting out
• 16:47
  - of small midsize group markets that leaves those
• 16:49
  - small and midsize employees really in bad shape.
• 16:51
  - It leaves them less and less options, more
• 16:53
  - and more expensive options. Mhmm. The big insurers
• 16:56
  - really worry about their big employers, the big
• 16:58
  - book of business, and then I guess
• 17:00
  - individual consumers where they could they've got them
• 17:03
  - by the the the the the they've got
• 17:06
  - a the don't have a lot of choices.
• 17:07
  - The the individual consumers that don't have a
• 17:10
  - that aren't getting their insurance through a job.
• 17:12
  - So you end up really in this really
• 17:13
  - difficult spot
• 17:15
  - for small businesses, mid sized businesses, and individuals
• 17:18
  - looking for coverage. I mean, it seems to
• 17:19
  - put a big hole in the market there.
• 17:21
  - Yeah. I mean, it it literally does. And
• 17:23
  - I talked to the the Blues plan in
• 17:27
  - I believe it was it was either Oregon
• 17:29
  - or Washington. I I I'm I'm pretty it
• 17:31
  - was Oregon. And they were talking about how,
• 17:35
  - it was the the woman who oversees their
• 17:37
  - their sales, and she's been there for almost
• 17:38
  - thirty years. And she's talking about how this
• 17:41
  - this past year so for coverage this year,
• 17:43
  - it was the most competitive,
• 17:45
  - and they're just the most intense and the
• 17:47
  - most disruptive,
• 17:49
  - renewal period she'd ever seen in her almost
• 17:51
  - thirty year career.
• 17:52
  - And now is you know, I'm sure the
• 17:54
  - the pressures that cause that are not changing.
• 17:56
  - And as we go into next year, she
• 17:58
  - said as Providence especially shuts down, because they
• 18:00
  - had almost,
• 18:02
  - over 400,000
• 18:03
  - members, not all entirely in commercial, but that's
• 18:05
  - that's business for them to take. For for
• 18:07
  - just the Blues plan alone, they they want
• 18:09
  - that business. And so, you know, it it
• 18:11
  - definitely is it's tough for employers. You're losing
• 18:14
  - you're losing options. You're losing competition,
• 18:16
  - in terms of affecting price. But but for
• 18:19
  - the insurance companies that are still there, now
• 18:21
  - it's kind of like knives are out. Let's
• 18:22
  - let's go get those those big employers. 100%.
• 18:25
  - Now now there's another book of business to
• 18:27
  - get, and those insurers have more control in
• 18:29
  - those markets. I mean, it's what we've seen
• 18:30
  - over the last twenty, thirty years. Used to
• 18:32
  - be five big payers in the market. Now
• 18:34
  - there's one dominant one, one secondary one. The
• 18:36
  - others have all pulled out because they can't
• 18:37
  - compete
• 18:38
  - or make money off it, and it leaves
• 18:40
  - the general community
• 18:42
  - more at the mercy of the one to
• 18:43
  - two that are left, the big commercial insurers.
• 18:46
  - And and it it does drive towards people
• 18:48
  - towards this natural attraction to Medicare for all,
• 18:51
  - a public option, all these kinds of things.
• 18:53
  - None of which seem to be fully working,
• 18:55
  - but it certainly drives the natural instinct to
• 18:57
  - say, god. If I can't get coverage from
• 18:58
  - an insurance company, I'd surely like the option
• 19:00
  - to get Medicare, to get some other way
• 19:02
  - of buying my coverage a 100%.
• 19:04
  - It's it's not surprising in terms of what's
• 19:05
  - happening politically,
• 19:07
  - based off of all these pressures that we're
• 19:08
  - talking about. And I I saw a really
• 19:10
  - interesting
• 19:11
  - piece that doctor Sachin Jain published in I
• 19:13
  - believe it was it was in in Forbes,
• 19:15
  - and he, of course, runs a a large
• 19:16
  - nonprofit
• 19:17
  - Medicare Advantage company. And he was talking about
• 19:20
  - the this rise of Medicare for all movement
• 19:22
  - we're seeing around the country. And he said,
• 19:24
  - you know, I understand what's causing this, but
• 19:27
  - I would caution and say and I don't
• 19:28
  - wanna quote him exactly, but basically saying, like,
• 19:30
  - Medicare is not perfect. It actually has a
• 19:32
  - lot of flaws,
• 19:34
  - on both sides, Medicare Advantage and just traditional
• 19:36
  - Medicare.
• 19:37
  - And so we should be really thinking about
• 19:40
  - if we if this was ever something expanded
• 19:42
  - to the broader population,
• 19:43
  - well, it probably just it wouldn't work as
• 19:45
  - as the current Medicare system is
• 19:49
  - exists because, you know, just as an example,
• 19:51
  - Scott, it doesn't cover vent vision, dental, hearing,
• 19:54
  - and and people would definitely want that. So,
• 19:57
  - you know, I think that's I for anybody
• 19:59
  - listening, I would encourage them to read that
• 20:01
  - article. It's it's, you know, it's coming from
• 20:03
  - an expert in this industry, and it's, I
• 20:04
  - think, really interesting poking some holes in,
• 20:07
  - some of the aspirational
• 20:09
  - pieces of of this Medicare for all movement
• 20:11
  - we're seeing.
• 20:13
  - Yeah. Yeah. 100%.
• 20:14
  - No. Fascinating to hear and listen to. Jacob,
• 20:17
  - as always, I wanna thank you for joining
• 20:18
  - us on the Becker's HealthCare podcast. Always fantastic.
• 20:21
  - Thank you so much for joining us. Good
• 20:23
  - to chat with you, Scott.