Main

2021

year in review

Health industry leaders’ protests are not enough to prevent the Price Transparency Rule from going into effect on January 1, requiring health systems to disclose negotiated rates for common patient procedures on their websites in a machine-readable format. While many believe it’s a step in the right direction for consumer-driven health care, compliance and awareness are both slow to catch on. The January 6 Capitol insurrection sets the stage for another year of political turmoil, as demonstrators protesting the presidential election outcome swarm the Capitol. Both chambers of Congress are placed on lockdown as rioters loot the Senate chamber and invade Congress members’ offices. More than 600 people will ultimately be arrested and charged for their involvement as part of an investigation that will last through the year. On January 14 President-elect Biden announces the “American Rescue Plan,” which is the new administration’s first emergency coronavirus and stimulus proposal. If passed, the plan will greatly expand the availability of paid leave and unemployment benefits to U.S. workers. After just three years, Haven, the acclaimed health care venture started by Amazon, J.P. Morgan Chase and Berkshire Hathaway, calls it quits. “We were fighting a tapeworm in the American economy, and the tapeworm won,” says Berkshire Hathaway CEO Warren Buffett. Joe Biden is sworn in as the 46th president of the United States. Among his key agenda items are administering 100 million COVID vaccines within his first 100 days, as well as large-scale economic and environmental reform. His administration also puts a regulatory freeze on any recent federal rules sent to the Office of the Federal Register, requiring all rules to be postponed and further reviewed. The end of the month marks a sober milestone in the COVID pandemic: 450,000 U.S. deaths.

01 02 03 04 05 06 07 08 09 10 11 12

January

Nearly a year into the pandemic, remote work continues to experience ups and downs. A Texas lawyer brings a little levity to the nation when a video of his Zoom mishap, in which he appears virtually before a judge with a cat filter, goes viral. During the work-from-home era, many consumers pick up new hobbies, from breadmaking to stock market investing. Retail investors, driven by a series of posts and communications on Reddit, thumb their nose at institutional investors, driving prices of GameStop stock to comically record highs as part of a short squeeze. The ACA marketplaces open for enrollment… again. The CMS under the Biden administration announces a new special enrollment period starting February 15, as well as $50 million in funding for outreach support. The numbers are in: For the first time in six decades, total health spending in the United States was lower in 2020 than in the previous year. According to estimates, national health spending in 2020 was 2% lower than in 2019, a decline of about $75.8 billion. As February ends, the U.S. COVID death toll surpasses 500,000.

February

March

April

May

June

July

August

September

October

November

December

California Attorney General Xavier Becerra is confirmed as secretary for the Department of Health and Human Services. Hospitals are finding creative ways to skirt the Price Transparency Rule that went into effect this year. According to the Wall Street Journal, hospitals are using special coding embedded on their websites to block the information from appearing in search results. Amazon Care, which offers virtual and in-home health care services for Amazon employees, announces it will open its virtual care offering to employers in all 50 states. In-person health care services will also be rolled out to major cities, including Washington, D.C. and Baltimore, in the coming months, via a partnership with Crossover Health. March 11 marks the one-year anniversary of COVID-19 being declared a pandemic by the World Health Organization.

The Biden administration surpasses its goal of hitting 100 million vaccine doses in 100 days, instead hitting 200 million. There’s still a long way to go, and the administration offers tax credits for employers to encourage workers to get the shot. The Biden administration also unveils the details of its American Families Plan, calling for an expansion of child care, paid leave and other family-focused benefits. A federal subsidy program to help keep laid-off workers enrolled in their employer-sponsored health insurance goes into effect in April. The program, which will cover the full cost of COBRA benefits continuation through the end of September, was enacted as part of the American Rescue Plan Act of 2021. After months of gains, more than 165,000 women leave the workforce during the month of April. The exodus of women from the workforce will be a key theme throughout the year, as more turn their focus to caregiving.

Haven may be gone, but the short-lived venture continues to spark real change. JP Morgan announces the launch of Morgan Health, which aims to improve the quality, efficiency and equity of employer-sponsored health care. Amazon is also still hard at work reforming its own health care programs, launching its Working Well health and safety program. On the consumer side, the retail giant also announces new capabilities of its online pharmacy that will allow consumers to know the price of their insurance copay and shop for the best price among all participating pharmacies. The virtual health care market gets even more competitive with Walmart’s acquisition of telehealth provider MeMD. This comes on the heels of partnerships with Doctor on Demand as well as telehealth app Ro, strengthening the retail giant’s suite of digital health care offerings. Americans are looking forward to a return to normal and a summer of fun as states begin rolling back their mask mandates and reopening businesses. Unfortunately, the Delta variant, first detected in India in late 2020, is spreading rapidly and will lead to many states and businesses reverting back to mask mandates and other precautions over the summer. The latest Trump-era policy to be reversed by the Biden administration: health care protections for LGBTQ individuals.

The retail pharma wars heat up, with both Amazon and Walmart rolling out new offerings. Amazon announces it will offer six-month prescriptions starting at just $6, as well as incentives for consumers paying without insurance. Walmart, meanwhile, will offer free shipping and steep discounts for members of its Walmart+ membership service. Speaking of Walmart, the retailer-turned-health-care-disruptor announces it will begin selling its own line of analog insulin at a fraction of the price of brand-name products. The growing flight of employees from the workforce will go by several names in the coming months, including the “Great Resignation,” “Resignation Wave” and “Talent Tsunami.” Whatever you call it, by June analysts are already noting a higher-than-usual rate of resignations. Burnout is driving many to leave the workforce altogether, while others seek higher pay, better work/life balance, advancement opportunities or simply a new career path. Some financial pundits warn that the summer months could see the “biggest crash ever” of the stock market. But despite these ominous predictions, the market closes out the first half of the year at record highs. Life expectancy in the United States falls to 76.87 years in 2020 as a result of the pandemic. The drop is even more pronounced for Black men, who can expect to live to just 67.73 on average, the lowest since 1998. June 15 sees the U.S. surpass 600,000 COVID deaths.

Unable to sell their merger to the Department of Justice, Aon and Willis Towers Watson agree to scrap the proposed deal. WTW will net a $1 billion termination fee on the deal, which would have been valued at $30 billion. So much for getting back to normal. By July, Delta has become the dominant COVID variant and a third wave of the pandemic throws a wrench in reopening plans across the country. Many employers and businesses reinstate mask mandates, while Twitter again closes its office and sends its workers back home. Other companies, such as Lyft, opt to postpone a return to the office. Dollar General becomes the latest retailer to set its sights on the health care space. The discount retailer announces plans to expand access to health care products and services in its 17,000 stores, many of which are located in rural areas and underserved “health deserts.”

UnitedHealthcare agrees to pay out $14.3 million in a “landmark” settlement over the insurer’s mental health and substance abuse coverage practices after it is determined that the company’s policies denied care or limited coverage for certain behavioral health treatment services for thousands. The Department of Justice continues its heightened antitrust scrutiny of the health care sector, starting with a careful look at the proposed $8 billion acquisition of Change Healthcare by UnitedHealthcare. The DOJ signals it may consider a lawsuit following concerns raised by several state attorneys general that it would significantly reduce competition and give UnitedHealth an unfair advantage. Meanwhile, the DOJ also has its eyes on health care operator HCA Healthcare, which is accused of using its monopoly power to increase prices, insurance rates and deductibles throughout its area. Delta Air Lines makes headlines after announcing the company will begin charging unvaccinated employees an extra $200 per month in health insurance premiums, or $2,400 per year. In comparison, the Peterson-KFF Health System Tracker pegs the average cost of a preventable COVID hospitalization at $20,000 per person, and finds that unvaccinated consumers have cost $5.7 billion since June. August 15 marks the end of the special ACA enrollment period enacted by the Biden administration. An estimated 2.1 million Americans purchased coverage through the federal exchanges during the period, with an additional 738,000 picking up coverage on their state-based exchange.

The Biden administration announces a nationwide vaccine mandate for employers with more than 100 workers. The announcement instructs OSHA to create a set of standards and guidelines for enforcement. Details from the latest U.S. Census show that the overall uninsured rate is holding steady, accounting for just 8.6% of Americans in 2020. Sources of coverage, however, are shifting, with private insurance decreasing 0.8%, public coverage rising 0.4% and Medicare increasing 0.5%, as more Americans become eligible. More than 10 years after Theranos promised to revolutionize health care with a simple blood test, the trial for founder Elizabeth Holmes kicks off. Holmes is accused of defrauding investors of more than $700 million and could face 20 years in prison, if convicted. While members of Congress butt heads over details of the Biden administration’s $3.5 trillion Build Back Better spending bill, the Senate and House agree to a short-term bill that will keep the government running through December 3 and avoid a partial shutdown.

The Social Security administration announces its largest cost-of-living adjustment in 40 years. After rising just an average of 1.4% a year over the past decade, benefits will increase by 5.9%, or approximately $92 per month, in 2022. Walmart takes another big step forward in the health care space, partnering with consumer-directed health platform Transcarent to offer its services to self-insured employers. As companies across the country struggle to fill open positions, fast-food chain Raising Cane’s calls on its corporate employees to step in and man the cash registers and fryers. The 750 extra hands will be welcome as the company looks to hire more than 10,000 by the end of November. As if companies’ talent shortages weren’t bad enough, more than 100,000 workers strike or threaten to strike in what some are dubbing “Striketober.” Overworked and burned-out health care workers, including more than 24,000 Kaiser Permanente employees, picket for better pay and working conditions. They’re joined by 10,000 John Deere employees and 60,000 TV and film crew members. UnitedHealthcare becomes the latest insurer to hop on the “virtual-first” health plan craze with its NavigateNOW option. Such plans offer lower premiums and/or waived copays on plans that utilize virtual provider networks in place of the traditional in-person provider visit, where appropriate. Other major insurers jumping into the virtual-first market this year include Cigna with its MDLive services; CVS Health and its Teledoc partnership; and Centene subsidiary Ambetter. COVID deaths may be slowing, but the U.S. surpasses the 700,000 mark on October 1.

Open enrollment for the federal health insurance marketplace kicks off on November 1 and will run until January 15. Premiums are not expected to increase significantly, though regional factors could cause some variation. The House passes a significantly scaled-back $1.2 trillion infrastructure deal, including $165 billion to reduce ACA premiums and a proposal to allow Medicare to negotiate drug prices. Oral arguments kick off in the Supreme Court’s expedited hearing of Texas’s controversial law banning abortions after six weeks. The law, SB8, went into effect in September, and the justices declined the DOJ’s request to put the law on hold while legal challenges were resolved. In a sign that the third wave of the pandemic is abating, Walmart brings its corporate workers back to the office. Exact plans will vary by office location and employees’ roles, with tech teams expected to continue to work virtually. OSHA announces key deadlines and details of the Biden administration’s vaccine mandate. Within days, dozens of states file lawsuits challenging the government’s authority to enforce the rule. Private insurance companies are expected to pay more than $2 billion in rebates to consumers this fall as part of the Medical Loss Ratio rebate requirement included in the ACA—a decline from last year’s record-setting $2.5 billion.

Heading into the new year, health care is once again on employers’ minds. Costs are expected to rise by about 5%, and a shortage of health care services looms, with some 6.5 million low-wage workers expected to leave the health care industry. In addition, 21% of primary care physicians are expected to retire within the next five years. Benefits brokers and insurance agents prepare for new compensation disclosure rules from the CMS. Starting as early as December 27, the rules will require producers to provide customers with compensation descriptions and commission schedules.

What surprises lay ahead for the employee benefits industry in 2022? The specifics are anyone’s guess, but there are some wheels in motion that will not easily be slowed. We can expect to see the latest wave of innovation continue to gain momentum, particularly as new entrants and established players vie for their place in the new order. We’ll also have a clearer picture of the long-term impacts of the pandemic on employees and their families, including the emotional and mental health toll, the long-lasting health impacts of COVID, and growing political rifts.