What do riding a horse and the individual health insurance marketplaces have to do with one another? 

For one thing, if both are pointed in the wrong direction, you could end up a long, long way from your intended destination. When spooked, they can take you on a hell of a ride. Alright… on to the show. First off, thank you very much for stopping by and listening. As the Altitude Sessions series grows in content, our purpose is to use this format to help key executives in the health economy #ElevateYourHealthcareThinking.

This first podcast examines the latest results from the ACA marketplaces now that 2019’s significant enrollment period is closed. We examine the impact of healthcare on politics in these coming months (because who isn’t talking about politics these days). There is a concept called competitive federalism that we love, so that’s discussed with some thinking about how we might create closer state-based partnerships to solve for forthcoming healthcare issues. There’s also this massive expansion in how we view distribution underway. The real distribution models undergoing change have nothing to do with enrollment and eligibility for insurance products. This activity may (key phrase: “may”) actually pull both the pre- and post-purchasing sides of healthcare together. We begin to explain why during the show. And, of course, how could a Wyoming-based company leave out a reference to a horse in our first podcast. We couldn’t, but there’s a lesson in there that sets up to be good career advice for all of you health economy trailblazers. Sit back & get elevated. It’s Altitude Sessions time!

Research Links & Show Notes:

(1:25) – NBC News exit polls show that 41% of midterm voters said healthcare is their top issue. 23% said it was immigration. Makes you wonder why we are still in the middle of a government shutdown over immigration as this post is being written, doesn’t it? 

(2:15) – NPR has an entire area where they are focused on surprise medical bills (or, we could just say this is symptomatic of high costs that might be reaching a tipping point)

(2:45) – Kaiser Family Foundation shows in their 2018 Employer Benefits study that employees pay on average $5,547 per year for insurance. The employer picks up the remaining $14,069. The system only works today because the “Cadillac” is still heavily-funded by either employers or via government subsidies in the individual market. This creates little incentive for price changes due to a multi-tiered system. If employers will keep paying these costs, why worry about cost control as a system? As the market further bi-furcates between large & small employer benefits, when does the employer’s role in all of this crack? Never? Soon?

(3:10) – Oh, when you want to take a trip back to 1993, here is one of the early press stories on HillaryCare. Back then, we “were choking on a healthcare system that is not working,” according to President Clinton. If we were choking then, we must be euphoric from the lack of oxygen now. Flash forward to 2019, and are we about to engage in this debate, again? The think tank that did a lot of work on the initial questions regarding healthcare in the 90’s wrote this paper? They also inspired our company to put our business in Jackson Hole to facilitate the debate that’s coming. 

(3:45) – The debate has already begun given the proposed plan that Sen. Bernie Sanders put forth in 2018. The question becomes, how reliable are the cost estimates? Will it really cost $33 trillion over a decade? How will this impact the economy?

(5:10) – The middle class still swings elections, as the last presidential election showed. They are also the segment getting crushed the most by healthcare costs. Cue why politics and healthcare are best buddies.

(5:20) – 8.5 million folks enrolled in the ACA marketplaces in 2019 – down 4%

(5:45) – And, Medicaid is also tightening its grip by adding new work requirements. As budgets at the state/federal level get more eaten up by healthcare costs, this will only get more interesting over time.

(7:00) – Let’s introduce the idea of competitive federalism. The big question is for healthcare… would this be a more effective compromise that preserves the integrity of the Constitution while also providing an alternative to a centrally-planned solution?

(9:25) – Is the industry really out of ideas? Or, is risk such a big elephant that it can’t be turned without something bigger forcing it to turn? It’s been a good run, but is a crazier pace of innovation about to redefine this industry? That’s why we’re here for you guys… to help debate and plan for just that.

(9:55) – Gov. Newsom in California proposes raising subsidies to 600% of FPL (along with other nuggets to expand coverage in the state). That would certainly help with the “cliff” that many middle class folks face today, but it will definitely come at a cost.

(11:35) – Look, the politics around healthcare are weaponized right now. Repeal & Replace to Just Repeal It to Preserve Obamacare to Universal Coverage For All! Pick your cause and donate today! As executives in this industry, this is the key issue to sort through in the coming years.

(13:35) – Americans are risking it & just going without insurance… and this segment of the population might not be who you think they are. Check around the soccer field at the next local match.

(14:15) – Yes, I have had discussions with some of the architects of the system that we are in today that are even afraid to get sick in it. Look, there are a LOT of really good, philanthropic people in healthcare. Not everyone is the boogeyman. But, the system is still set up to take advantage of the sick. That may not be any one person’s doing, but it is a systemic flaw. Costs are growing at the edges with every new breakthrough that comes to the market. Here’s looking at you, pharma. Who is going to step up and help us find more balance there… and in all of the other areas where countless studies have shown that American citizens don’t utilize in an outlier pattern compared to our peer nations; we just pay more for what we get.

(16:25) – Sen. Cassidy released a surprise medical bill proposal in September. Employers agree that something needs to be done.

(17:15) – The ACA has always struggled to get the right pool balance between sick & healthy. As policies get more expensive, this issue will only get worse. There is an alternatives market growing to take advantage of this – keeping with the American tradition of further bi-furcating pools between the sick and the healthy.

(18:55) – 13 states grew their marketplaces in the ACA this year… one of the big keys is what Colorado has done, to get more subsidized folks into coverage (77% of all ACA purchasers).

(19:20) – The penalty is still necessary, it can be argued, to change uninsured behaviors by finding the right tipping point in how much to penalize (& it’s a revenue generator for the states that implement this). But, that’s never going to be as important as access to subsidies.

(21:30) – Yes, Health Care Sharing Ministries are considered to have around 1 million folks enrolled in them. This shows that alternatives to traditional insurance continue to find a way to syphon off folks. What is more interesting than this is considering if the drag on affordability will drive a bigger debate around “unbundling in healthcare.” That is already getting a healthy helping here 

(22:30) – Millennials would rather have the money in lieu of what is paid on their behalf to purchase benefits… this lends more credence to our proprietary survey annuities findings. Or, do they still not grasp what all they are getting in the form of some security against bankruptcy in illness?

(23:30) – So, are you still thinking about this healthcare bundled vs. unbundled thing, still? We are, too. There have been a lot of conversations around what “Amazon” is going to do. Our early guess… become the extended, trusted distribution platform with direct to consumer healthcare services (that extended distribution thing, again). We often talk about the key is solving for the lowest common denominator in healthcare. Why not think about Medicaid? Amazon is.  

(26:45) – What do you do when you have raised a total of $91.1 million to sell viagra & smoking cessation as a specialized, digital, direct-to-consumer pharmacy solution… well, if you are Roman, you advertise a lot during the World Series (& give dads an opportunity to have life-changing conversations with their sons)

(28:55) – It’s time to ride your horse – this was pretty insightful advice given by Jerry Seinfeld while interviewing David Letterman for a Netflix special. Are you riding your talent to your fullest potential? Are you pointed in the right direction? Do you need a tug to get going to meet your destiny? Are you the lead cowgirl/cowboy hearding your company to new heights (we couldn’t resist)? If so, how is the journey going?

(32:10) – This is one of the joys of live studio recording – I received a text message & my phone was not on silent (whoops & sorry).

(33:00) – How do we help executives in our most exclusive ranks at m4? Here are a few seconds to help paint that picture.

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