Healthcare in the U.S. remains a hot-button issue, and recent decisions under the Trump administration continue to spark debates, particularly regarding their impact on employer-based health plans. While the administration emphasized flexibility and cost-savings in healthcare, many of its policies raised concerns about long-term stability and access to affordable coverage.

Here’s a breakdown of key developments and their potential impact on employer-based health plans and the broader healthcare landscape:

24 Million Americans Face Medicaid Jeopardy

One of the most significant challenges looming over the healthcare system is the potential loss of Medicaid coverage for millions of Americans. Temporary Medicaid expansions during the pandemic helped many low-income families access critical care. However, with the expiration of pandemic-era protections, 24 million Americans could lose their Medicaid coverage, potentially leading to an increase in uninsured individuals and shifting healthcare costs to employers and hospitals.

For businesses, this could mean more employees seeking coverage through workplace-sponsored plans, potentially straining budgets and increasing premiums. Employers will need to evaluate how these shifts may affect their benefits offerings and their role in supporting employees.

Short-Term and Limited Benefit Health Plans: Help or Harm?

The Trump administration expanded the availability of short-term health plans, which are cheaper and exempt from ACA requirements. While this provides a low-cost alternative for individuals between jobs or ineligible for employer plans, it also comes with significant downsides:

• Limited Coverage: These plans do not cover essential benefits like mental health, maternity care, or pre-existing conditions.
• Risk to the ACA Marketplace: By attracting healthier individuals, short-term plans can destabilize ACA-compliant marketplaces, driving up premiums for those who remain.

For employers, these plans may tempt some employees to opt out of comprehensive group coverage, potentially weakening risk pools and increasing costs for those who remain in employer-sponsored plans.

Impact on Public Health Infrastructure

Withdrawal from the WHO

The Trump administration’s decision to withdraw from the World Health Organization (WHO) raised concerns about America’s role in global health. This move could undermine international efforts to address pandemics and public health crises, indirectly affecting the U.S. workforce if future global health challenges are not properly managed.

CDC Policy Changes

Policy shifts and potential closures of certain CDC programs may also weaken the country’s public health infrastructure. Reduced federal support for pandemic preparedness or chronic disease prevention could lead to higher healthcare costs for employers and employees alike.

For businesses, this underscores the importance of offering robust wellness programs and health coverage to mitigate the long-term risks of an overburdened healthcare system.

The Bottom Line for Employers

The Trump administration’s healthcare policies have introduced both opportunities and challenges for employer-based health plans. While short-term health plans and deregulation aim to reduce costs, the risks of destabilizing ACA markets, shrinking Medicaid coverage, and weakening public health infrastructure could lead to increased financial and operational burdens for employers.

What Can Employers Do?

1. Monitor Medicaid Changes: Be prepared for potential impacts on employee benefits as more individuals may turn to employer plans.
2. Educate Employees: Help employees understand the risks of short-term health plans and the value of employer-sponsored benefits.
3. Focus on Wellness: Strengthen workplace wellness initiatives to help employees manage health proactively amid public health uncertainties.

Navigating these shifts requires a proactive approach. Employers must remain informed and flexible to address changes in the healthcare landscape while continuing to support their workforce.

Need help designing a benefits strategy in this uncertain environment? Let’s talk!

Affected by the SoCal Fires? Here is how CorpStrat can help:

CorpStrat is working with employers and employees to share how health insurance companies are helping those affected by the fires.

Reach us if we can help you in any way. Insurance carriers have staffed hotlines to help.

• Prescription Refills: Members in mandatory evacuation zones may receive immediate refills of their prescriptions, even if they are not yet due for a refill.
• Mental Health Support: Carriers’ mental health service administrators provide free access to resources, materials, and counseling services.
• Vision Plan Assistance: Vision plan members in affected areas who have lost or broken eyewear may be eligible for replacement lenses and/or frames – bypassing any annual limits.
• Member Identification (ID) Card Replacement: If members have lost their ID cards they can be replaced immediately online or by calling client services.
• Virtual Care Options: Members can access various telehealth services offered by carriers.

Additionally, if you or someone you know has been affected by the fires, and is covered by Anthem Blue Cross, please read the below from Anthem:

We hope this message finds you and your loved ones safe and well. Our thoughts are with all those affected by the devastating fires in Southern California.

In these challenging times, the health and safety of our community is our utmost priority. We want to assure you that we are committed to providing the necessary support and resources to help navigate this state of emergency.

Our team is working diligently to ensure that our members receive the assistance they need, and we stand ready to support you in any way we can.

We’re making temporary changes to health plan benefits to provide relief and ensure healthcare access for our members who live in Los Angeles and Ventura counties in California and are impacted by the Palisades wildfire and windstorm conditions.

The changes are in effect January 7^th through February 5^th, 2025.

The changes also apply to emergency responders who have been activated to the impacted area by their state or local agency, but who do not live in the impacted area.

For assistance during this emergency, please call us at 833-285-4030

We are here to help make sure you have access to the healthcare you need. We can help with finding available doctors, refilling prescription drugs, and other health plan questions.

We’re available by phone Monday through Friday, 8 a.m. to 6 p.m. PT.

Receiving care during the emergency

• You can receive care from any doctor or hospital, even if they are not in your plan’s network. We will cover the claims as if they are in your plan’s network.
• If your doctor’s office or healthcare facility is closed because of the emergency, or if you are unable to travel there, call us at 833-285-4030. We can help you find another doctor.
• If you’re in a care management program and need to reach them, the contact number is 833-285-4030.

Prescription drug refills

• If your Anthem plan covers your prescription medicines, you can receive up to a 30-day emergency refill at any pharmacy now, even if it’s not in your plan’s network.
• If you use Anthem’s home delivery pharmacy and your address changed, call us at 833-285-4030 so we can make sure to send your medicine to the right place.

Medical equipment that is lost or damaged

• We can help you replace your equipment (also called durable medical equipment or DME). Call us at 833-285-4030.

Eyeglasses or contact lenses that are lost or damaged

• We can help you replace your eyeglasses or contact lenses.

Call us at 833-285-4030.

Preapprovals or referrals

• You have more time to request them. There won’t be any late fees.

Call 833-285-4030 if you need an extension.

Filing a claim

• You and your doctors have more time to file claims. Call us at 833-285-4030 if you need an extension.

Health plan premiums

• If you receive a bill directly from Anthem for your monthly insurance premium and are experiencing financial difficulties because of the emergency, you have more time to pay your bill. Please call us at 833-285-4030 to discuss options.

Mental health support 

• Anthem’s Employee Assistance Program (EAP) offers mental health support and resources to help with legal and financial concerns, dependent-care needs, and other life challenges. Call the 24/7 EAP crisis line at 877-208-8240.
• Our Anthem website also offers resources for mental health support.
• Crisis support is available if you or someone you know is having suicidal thoughts or behavior, is experiencing emotional distress, or is behaving in a way that could harm others. Call 988 or go to 988lifeline.org to reach the confidential Suicide & Crisis Lifeline. Help is available 24/7.

In addition to the above, we are taking the following steps on behalf of our members:

• Activating business continuity procedures to ensure continued access to care for impacted members.  Please refer to https://www.anthem.com/ca for more information on how we’re working to help our members.
• Identifying members who may be medically impacted by smoke and fire.
• Coordinating with providers (e.g., hospitals and nursing homes) to assist in the event of site closures.

Finally, Anthem is also offering free access to its online health option, LiveHealth Online to anyone living in the impacted area. LiveHealth Online offers video visits with U.S.-based board-certified doctors on a mobile device or computer from anywhere for non-emergency health conditions. The free visit offer will be available through the end of the state of emergency.

Important Notes:

• The timing and locations for these relaxed guidelines may change based on conditions. Please check https://www.anthem.com/ca for updates.
• These changes are for impacted members who reside in Los Angeles and Ventura counties in California and who have Anthem group health plans through their employers, or Anthem individual and family plans. They do not apply to Medicaid, Medicare, Medicare Part D, Medicare Advantage, Federal Employee Health Benefit Plans, or fully insured trust funds. These plans have their own guidelines.

The team at CorpStrat is available to help be your resource – reach out to us.

The tragic killing of United Healthcare’s CEO, Brian Thompson, has reignited discussions about consumer dissatisfaction with the insurance industry. While health insurance often dominates these conversations, many consumers are surprised by how functional the health insurance industry is as compared to other types of insurance. Commercial, homeowners, and auto insurance, in particular, are often riddled with inefficiencies and leave policyholders feeling unsupported and frustrated.

A Broken System Across the Board

Insurance as a safety net has turned from a product that truly protected and reimbursed the policyholder, to a system fraught with complexities, call centers, lack of transparency in nearly every turn, and a real sense that the industry is far from the “love like and follow” culture desired and breaded by consumer-centric companies like Google Apple and Amazon. From individuals to businesses, the entire insurance experience is consistently marred by red tape, opaque policies, and a lack of accountability. For many, the process of filing a claim—whether for a personal auto accident or a business interruption—feels more like an uphill battle than the safety net they were promised.

For homeowners’ policies, there has been a record number of fires floods and natural disasters causing widespread destruction. Navigating insurance after disasters is fraught with delays and denials. Consider a family in California whose home was destroyed by a wildfire. Despite holding a comprehensive policy, insurers traditionally negotiate settlements for over a year, leaving them to juggle temporary housing costs and rebuilding expenses. Stories like this are common and erode trust in the industry.

Commercial business of all types face equally daunting challenges. Commercial insurance policies, which are vital for small and large businesses alike, often come with unclear terms and inadequate coverage. A manufacturing business can significant losses after a storm causes structural damage to their facilities, despite having a business interruption policy negotiating and adjudicating claims can lead to months of delays and force companies to scale back operations. No product delivered to business owners has escaped the challenging and tedious process of securing, renewing or managing business insurance.

Auto insurance is another frequent source of frustration. Drivers often face higher premiums after filing claims, even when they were not at fault. Cancellation after use is likely. Rates are near prohibitive for young drivers. The promulgation of  marketing billboards and “call to action” injury hotlines have fueled an “accident turned lawsuit mentality”. The system is challenged

The Business Impact

For business owners, these insurance inefficiencies can be catastrophic. Small businesses, in particular, struggle to recover when insurance is poorly written or ambiguous. Whether it’s a denied claim for property damage or delays in liability settlements, these roadblocks can disrupt operations and jeopardize livelihoods.

Meanwhile, the insurance companies themselves continue to thrive. Stock prices for major insurers, including those offering commercial products, climb quarter after quarter. This financial success highlights a stark disconnect between corporate profitability and the real-world experiences of their customers.

A Call for Industry Reform

Can insurance companies move the needle – even slightly???

The insurance industry must evolve to meet the needs of its consumers. Businesses and individuals alike deserve products that work when they are most needed. To rebuild trust and ensure long-term success, insurers should:

1. Increase Transparency: Clearer policies and communication will empower consumers and reduce misunderstandings.
2. Streamline Claims Processes: Investing in technology and customer service can significantly reduce delays and frustrations.
3. Focus on Fairness: Insurers must commit to honoring legitimate claims promptly and equitably, regardless of the size of the payout.
4. Adopt a Proactive Approach for Businesses: Commercial clients require tailored solutions that adapt to the unique risks and challenges of their industries. Insurers must work collaboratively with business owners to create coverage that supports long-term resilience.

The Path Forward

Reforming the insurance industry isn’t just a matter of improving customer satisfaction; it’s essential for maintaining the industry’s credibility. By shifting focus from shareholder returns to consumer needs, insurers can restore faith in their role as protectors. This shift is critical not just for individuals but for the businesses that drive our economy. It’s time for insurers to recognize that their success depends on the satisfaction and security of their policyholders. By embracing transparency, efficiency, and fairness, the industry can finally begin to repair its fractured relationship with consumers. The general public has no way of moving the needle on the consumer experience – its entirely on the shoulders of every officer manager, executive and employee at every insurance company to start the process.