Oct 4, 2018

Axios Vitals

Good morning ... I'll give you one guess which state is home to a beer made with Dunkin' Donuts coffee.

The brewery, Harpoon, is actually a Massachusetts company, but I'll bet you didn't even need that information. Because you could be standing on the street in Boston, doing your worst attempt at a Southie accent, with Dropkick Murphys playing in the background, and still not be as purely Massachusetts as Dunkin' beer.

1 big thing: Deductibles just keep rising
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Reproduced from Kaiser Family Foundation 2018 Employer Health Benefits Survey; Note: Average general annual deductibles are for single coverage; Chart: Axios Visuals

Every year, health care takes a little bigger bite out of workers' bottom lines. Slowly but surely, it has eaten up all of the average workers' wage increases — and then some.

The big picture: Overall, the cost of employer-based health benefits — the backbone of the U.S. health care system — is growing pretty modestly from year to year, according to the Kaiser Family Foundation's annual review of those plans.

  • But, over the past 10 years, employees have ended up covering more and more of their own health care bills out of pocket. Those costs are rising faster than inflation and faster than wages.

By the numbers: For single coverage — a plan that just covers you, no family members — employees are paying an average of about $1,200 per year in premiums. That’s 65% more than what they paid in 2008.

  • The bigger story is deductibles, which are growing in every way.
  • The number of employees who have a deductible is up. The size of the average deductible is up — 212% since 2008, to be precise. And the number of employees with above-average deductibles is also up.
  • The increases in premiums and deductibles both outstrip increases in wages.

Between the lines: As deductibles and other out-of-pocket costs rise, more patients are more attuned to the high costs of care.

  • The underlying cost of health care services is growing relatively slowly right now, compared to historical trends.
  • But there’s a sense, at least among some liberal-leaning health care experts, that employers have just about maxed out their ability to shift more costs onto employees — meaning that once price increases start to pick up steam again, businesses and workers will both feel the pain quickly.
2. The lasting health effects of sexual assault

Sexual assault and harassment continue to take a toll on victims’ physical and mental health well after the experience itself is over, according to a new study in JAMA Internal Medicine.

Why it matters: The direct health effects of sexual assault and harassment, including an increased risk of depression and anxiety, haven't gotten as much attention as their emotional and professional damage. But all of those consequences can feed and compound each other.

The details: In a study of 304 women, 19% said they had been sexually harassed at work, and 22% reported being a victim of sexual assault.

  • Women who had been the victims of sexual assault were three times more likely to show signs of clinical depression, compared to women who hadn’t been assaulted. They were twice as likely to have elevated anxiety.
  • Harassment, meanwhile, was tied to higher blood pressure.
  • Both groups of women reported much poorer sleep — which, like depression and high blood pressure, often contributes to other health problems.
3. Fentanyl test could reduce overdoses

A $1 strip that tests drugs for the presence of fentanyl could help users avoid overdosing, The Atlantic reports.

The details, per Axios’ Caitlin Owens:

  • Drug users often don't know when a drug is laced with fentanyl, which can be 50 times as potent as heroin. That leads to accidental overdoses. Making it easier to test drugs for fentanyl could reduce those overdoses.
  • When the test strips were distributed to a sample of 125 heroin users through a needle-exchange center in Greensboro, N.C., 81% of them reported using the strips.
  • Roughly 63% got a positive result for fentanyl, and they were five times more likely to modify how they used the drug — for example, using less or snorting instead of injecting it.

Situational awareness: Congress' opioids bill is on its way to President Trump's desk; the Senate passed it yesterday 98-1. (Sen. Mike Lee was the lone "no" vote.)

4. Employers embrace health apps

One more interesting nugget from Kaiser's report on employer-based insurance: 21% of large employers collect health information from employees' mobile apps or wearable devices, as part of their wellness programs.

  • That's up from 14% last year.
  • Small businesses still aren't on this bandwagon — only 5% of them collect workers' health information.

Wellness programs are voluntary, and so is contributing your health information to them. But among companies that offer a wellness program, just 9% of employers (including 35% of large employers) offer workers an incentive to participate.

5. 1 litigious thing: Big Pharma

My colleague Bob Herman flagged some real talk yesterday from James Stansel, a top lobbyist at PhRMA, who was speaking at an industry conference in Chicago.

“PhRMA is not reluctant to sue when necessary.”
— James Stansel

Reality check: PhRMA, the leading trade group for the highly profitable drug industry, indeed has no qualms about going to court.

  • It refiled a lawsuit in California last week challenging the state's drug price transparency law.
  • Stansel was responding to the idea of states being able to exclude certain medications from their Medicaid programs, which PhRMA opposes.
  • Massachusetts proposed such a plan last year, but was turned down by the federal government.