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Health Spending Moderates, But Employers Still Waiting to See Benefits

Posted by Katie Holahan on Feb 13, 2019 2:35:28 PM

Health-care spending in Massachusetts grew less than a key state benchmark and less than the national average during 2017, but employers and workers are not yet seeing the benefits.

health_careThe annual Health-Care Cost Trends Report issued today by the state Health Policy Commission (HPC) indicates that total per-capita health-care expenditures in Massachusetts rose 1.6 percent during 2016, significantly less than the 3.6 percent benchmark set by the commission. The Massachusetts growth rate also fell below the national rate - 3.1 percent – for the eighth consecutive year.

But the health-insurance premiums paid by Massachusetts employers and employees increased 5.8 percent in 2017, leaving the average total premium for employer-based coverage among the highest in the country at $21,000 per year for a family plan and $7,000 for a single employee. These figures do not include out-of-pocket spending such as co-payments and deductible spending, which grew 5.9 percent in 2017 for commercially-insured enrollees.

Premiums for smaller employers increased 6.9 percent and are now the second highest in the country, according to the HPC. Fifty-seven percent of small-firm (1-50 employees) employees are enrolled in high-deductible health plans.

“AIM-member employers told us in a recent survey that the rising cost of providing health insurance to employees is their biggest concern,” said Richard C. Lord, President and Chief Executive Officer of Associated Industries of Massachusetts and a member of the Health Policy Commission.

“The HPC report contains good news about health-care expenditures, but also underscores the need to look at issues such as price variations among doctors and hospitals that are driving up insurance premiums.”

Part of the reason that employers are not seeing more benefit from moderating health spending may be the fact that commercial insurers in Massachusetts pay higher prices to providers than Medicare pays for the same services. For hospital inpatient care, average prices among the three largest Massachusetts insurers were 57 percent higher than Medicare prices for similar patients ($15,913 versus $10,117, respectively).

Commercial insurers also paid considerably more for typical outpatient services, including brain MRIs, emergency department visits, and physician office visits.

The HPC attributed much of the overall increase health-care expenditures to spending on prescription drugs (4.1 percent) and hospital outpatient services (4.9 percent). The commission also found that medical bills can vary as much as 30 percent from one hospital or medical group to another with no measurable different in quality of care.

The HPC makes 11 policy recommendations to continue health spending moderation. Highlights include:

Unnecessary utilization: The Commonwealth should focus on reducing unnecessary utilization and increasing the provision of coordinated care in high-value, low-cost settings. Payers and providers should reduce the use of avoidable high-cost care such as emer­gency department (ED) visits, behavioral health-related ED visits, readmissions, use of teaching hospitals and academic medical centers for community-appropri­ate inpatient care, and institutional post-acute care by ensuring access to high-value, low cost settings, and for shifting care, as appropriate, to these settings.

Provider price variation: Policymakers should advance specific, data-driven interventions to address the press­ing issue of continued provider price variation in the coming year.

Alternative payment methods: The Commonwealth should continue to promote the increased adoption of alternative payment methods (APMs). Also, as part of a strategy to reduce spending, payers should develop plans to lessen the unwarranted disparities in global budgets paid to different providers by establishing stricter targets for spending growth for highly paid providers, by moving away from historical spending as the basis of global budgets, and by using bundled payments for certain care episodes where evidence has shown effectiveness.

Pharmaceutical spending: The Commonwealth should act to reduce drug spending growth. Specific areas of focus should include authorizing the Executive Office of Health and Human Services to establish a process that allows for a rigorous review of certain high-cost drugs, increasing the ability of MassHealth to negotiate directly with drug manufacturers for additional supplemental rebates and outcomes-based contracts, and increasing public transparency and public oversight for pharmaceutical manufacturers, medical device companies, and pharmacy benefit managers.

As a leader of the Massachusetts Employer Health Coalition, AIM is working with employers, employees, doctors, hospitals, and health insurers to reduce inappropriate use of emergency departments by 20 percent in two years. State officials estimate that a significant number of ED visits are potentially avoidable, a pattern that costs $300-$350 million annually for commercially insured members. Please check out our website for resources and information.

Topics: Health Care Costs, Health Insurance, Health Care

Business Confidence Slides Again in January

Posted by Christopher Geehern on Feb 12, 2019 8:30:00 AM

Stabilizing financial markets and continued strong employment were not enough to brighten the outlook of Massachusetts employers during January as business confidence fell for the fifth time in seven months.

BCI.January.2019The Associated Industries of Massachusetts Business Confidence Index (BCI) lost 0.9 points to 57.7, its lowest level since October 2016. Confidence has dropped 6.4 points during the past 12 months.

The retreat was led by a 7.3-point drop in employer views of the Massachusetts economy, and a 2.4-point drop in opinions about the national economy.

Overall confidence remains within optimistic territory, but every element of the AIM Index is now lower than it was a year ago.

A separate survey within the January Business Confidence Index found that while 71 percent of Massachusetts employers have seen some effect from the US government’s imposition of tariffs on goods form China and other nations, only 10 percent of companies characterize the effect as “significant” or a threat to the existence of their business.

The most common consequence of the tariffs has been an increase in raw-material prices, followed by changes to the supply chain, supply interruptions, products affected by retaliatory tariffs and loss of overseas customers.

“The Massachusetts economy grew at 2.1 percent during the fourth quarter of 2018 and continues to operate at near full capacity,” said Raymond G. Torto, Chair of AIM's Board of Economic Advisors (BEA) and Lecturer, Harvard Graduate School of Design.

“At the same time, employers continue to confront uncertainty surrounding trade policy, demographic constraints on the labor market and the implementation of a sweeping paid family and medical leave program in Massachusetts.”

The AIM Index, based on a survey of Massachusetts employers, has appeared monthly since July 1991. It is calculated on a 100-point scale, with 50 as neutral; a reading above 50 is positive, while below 50 is negative. The Index reached its historic high of 68.5 on two occasions in 1997-98, and its all-time low of 33.3 in February 2009.

The Index has remained above 50 since October 2013.

Constituent Indicators  

The constituent indicators that make up the overall Business Confidence Index were mixed during January.

The 7.3-point drop in the Massachusetts Index assessing business conditions within the commonwealth left that indicator at 57.4. Confidence in the Massachusetts economy has declined 11.5 points since January 2018.

The U.S. Index measuring employer sentiment about the national economy dropped 2.4 points to 52.7, a decline of 12.1 points year-over-year. It marked the lowest reading for the U.S. Index since November 2016.

The Current Index, which assesses overall business conditions at the time of the survey, fell 1.8 points to 58.2. The Future Index, measuring expectations for six months out, remained flat at 57.3 but has declined 9.3 points over 12 months.

Manufacturers (57.8) and non-manufacturers (57.7) were equally confident. There was also little difference in the confidence readings reported by large companies (57.9), medium-sized companies (57.7) and small companies (57.6). Companies in Eastern Massachusetts (59.4) were more bullish than those in the west (55.3).

Economist Barry Bluestone, retired Professor of Public Policy and Urban Affairs at Northeastern University and a member of the BEA, suggested that employers face two parallel sets of challenges - uncertainty about political issues such as tariffs and a more fundamental uncertainty about the limits of a full-employment state economy. He noted that wage and salary income growth was strong in the fourth quarter, rising 7.2 percent in Massachusetts on an annualized basis.

“A 3.3 percent unemployment rate, combined with an aging population and slow labor force growth will challenge the ability of Massachusetts employers to expand during 2019 and beyond,” Bluestone said.

Piling On Costs

AIM President and CEO Richard C. Lord, also BEA member, said the significant weakening of confidence in the Massachusetts economy also reflects frustration among employers with a cascade of expensive new state mandates, including a two-year MassHealth assessment, an increase in the minimum wage and the impending start of paid family and medical leave.

“We hear frequently from Massachusetts employers who feel under siege from both the sheer expense of these programs and the administrative burden they place on companies, particularly smaller companies,” Lord said.

Topics: AIM Business Confidence Index, Massachusetts employers, Massachusetts economy

Video Blog | Economic Outlook 2019

Posted by Christopher Geehern on Feb 1, 2019 9:11:06 AM

The AIM Economic Outlook Forum on January 25 looked at creative solutions to the persistent shortage of skilled workers in Massachusetts. Watch as WBZ radio morning news anchor Jeff Brown moderates a discussion with Robin LeClaire, President of Lampin Corporation in Uxbridge; Massachusetts Secretary of Labor and Workforce Development Rosalin Acosta and UMass Amherst Chancellor Kumble Subbaswamy.

Topics: Skills Gap, Massachusetts economy, AIM Executive Forum

AIM's John Regan Talks Issues on Comcast Newsmakers

Posted by Christopher Geehern on Jan 31, 2019 12:38:52 PM

John Regan, AIM's Executive Vice President of Government Affairs, recently joined Comcast Newsmakers and host Jenny Johnson for a look at the issues facing employers as the Massachusetts Legislature begins a new, two-year session.

Regan.Comcast.2019

 

 

 

Topics: Associated Industries of Massachusetts, Massachusetts Legislature, Charlie Baker

10 Things Employers Need to Know about Paid Family/Medical Leave

Posted by Brad MacDougall on Jan 31, 2019 10:42:45 AM

The Baker Administration last week published draft regulations for implementation of paid family and medical leave in Massachusetts.

Pregnant2-1Paid family and medical leave were approved by the Legislature and signed by Governor Charlie Baker last year as part of the so-called Grand Bargain between the advocacy group Raise Up Massachusetts and the business community. The newly published regulations represent the “rules of the road” that employers and workers will follow as the law takes effect beginning in July.

AIM has been working for months with the Executive Office of Workforce Development to address employer concerns about what will be a major new benefit program. More than 700 AIM members with an interest in paid family and medical leave are currently reviewing the draft regulations and formulating comments.

The state is conducting seven listening sessions though February 19 to provide employers and others an opportunity to comment on the draft regulations.

In the meantime, here are 10 facts that employers need to know about paid family and medical leave as outlined in the draft regulations:

  1. When it begins

    On July 1, employers and/or their workers must begin to pay 0.63 percent of all wages or other qualifying earnings or payments into the Family and Employment Security Trust Fund. Employees may take family or medical leave beginning January 1, 2021.

  2. Who pays?

    The employer is required to pay at least 60 percent of the medical leave contribution required for each employee. The employer is required to pay none of the contribution for family leave. Employers may, of course, pay a higher percentage for each category of leave or elect to pay the entire contribution for each employee. The employer may deduct the medical leave and family leave contributions directly from wages or other qualifying payments made to the employee or individual. Companies employing an average of fewer than 25 employees in Massachusetts will not be required to pay the employer portion of premiums for either family or medical leave.

  3. Surprise contribution for employees?

    Employers who elect to pay less than the entire family and medical leave contribution will need to communicate to employees the news that an additional several hundred dollars will be deducted from their paychecks each year. Few employees realize they may be required to pay into the family and medical leave system.

  4. How much leave?

    Beginning January 1, 2021, covered individuals are eligible for up to 26 total weeks, in the aggregate, of family and medical leave in a benefit year.

    Beginning January 1, 2021, covered individuals are eligible for up to 12 weeks of family leave in a benefit year for the birth, adoption, or foster care placement of a child, or because of a qualifying exigency arising out of the fact that a family member is on active duty or has been notified of an impending call to active duty in the Armed Forces.

    Beginning January 1, 2021, covered individuals are eligible for up to 26 weeks of family leave in a benefit year to care for a family member who is a covered service member.

    Beginning January 1, 2021, covered individuals are eligible for up to 20 weeks of medical leave in a benefit year if they have a serious health condition that incapacitates them from work.

    Beginning July 1, 2021, covered individuals are eligible for up to 12 weeks of family leave to care for a family member with a serious health condition.
  1. The pay in paid leave

    An individual’s paid family or medical leave weekly benefit amount is calculated as follows: (a) The portion of an individual’s average weekly wage that is equal to, or less than, 50 percent of the state average weekly wage is replaced at a rate of 80 percent; the portion of an individual’s average weekly wage that is more than 50 percent of the state average weekly wage is replaced at a rate of 50 per cent. The initial maximum weekly benefit amount is $850. Thereafter, the maximum weekly benefit amount for any individual will be 64 percent of the state average weekly wage.

  2. We are family

    The regulations define a family member as a spouse, domestic partner, child, parent or parent of a spouse or domestic partner of the covered individual; a person who stood in loco parentis to the covered individual when the covered individual was a minor child; or a grandchild, grandparent or sibling of the covered individual.

  3. Intermittent leave

    An employee may take family or medical leave on an intermittent basis for family leave to bond with a child during the first 12 months after the child’s birth, adoption, or foster care placement, but only if the employer and employee agree to it. Employees may also take intermittent family leave if medically necessary to care for a family member’s serious health condition; to care for a family member who is a covered service member, or for or the employee’s own serious health condition.

  4. Contractors

    An employer with a work force that is more than 50 percent self-employed individuals whose compensation is recorded on Internal Revenue Service form 1099-MISC shall treat those self-employed individuals as employees for the purposes of determining a company’s number of employees under the paid family and medical leave law.
  1. Exemptions

    An employer with an existing, private benefit plan that confers the same rights, protections and benefits provided under the state program make apply for an exemption from the public plan. An employer may apply for exemptions from medical leave coverage, family leave coverage, or both.

  2. Self-employed people

    A self-employed individual may elect coverage and become a covered individual for an initial period of not less than three years. A self-employed individual who elects coverage is responsible for the full contribution amount, based on that individual’s income from self-employment. If a self-employed individual elects coverage and fails to remit contributions owed for at least three years, the self-employed individual will be disqualified from electing coverage thereafter.

Want regular updates on paid family and medical leave in Massachusetts? Please contact Brad MacDougall at bmacdougall@aimnet.org

Topics: Paid Family Leave, Employment Law, Massachusetts employers

Few Employers Change Drug Tests with Legal Marijuana

Posted by Tom Jones on Jan 30, 2019 8:30:00 AM

Drugtest1.2019Only 10 percent of employers plan to change their drug-testing policies now that recreational marijuana is legal in Massachusetts, a new Associated Industries of Massachusetts survey shows.

The member survey, conducted by AIM HR Solutions, found that two-thirds of the 52 Massachusetts employers who participated say they drug-test employees or job candidates. Three quarters of the companies that conduct drug tests do so for marijuana (THC).

Kyle Pardo, Vice President of Consulting Services for AIM HR Solutions, said the limited number of companies planning to change their marijuana testing policies reflects widespread uncertainty among employers as legal cannabis impinges on the idea of a drug-free workplace.

“Testing detects the presence of marijuana long after an employee may have used the drug during non-work hours. But there is no clear test to determine whether or not that employee is impaired and may represent a danger to co-workers or customers,” Pardo said.

Drugtest2.2019“It has created a confusing situation for employers.”

Recreational marijuana became legal in Massachusetts in 2016 and retail pot dispensaries began to open throughout the state at the end of last year.

Massachusetts law does not require any accommodation of on-site medical or recreational use of marijuana in any workplace or permit employees to come to work under any controlled substance. A recent Massachusetts Supreme Judicial decision requires employers to address an employee with a medical marijuana card in the same manner as those using any other lawfully prescribed medication.

Adding to the confusion is that employers in some federally regulated industries such as trucking and transportation, as well as many federal contractors are required to drug-test employees. Marijuana remains illegal under federal law.

Pardo recommends that employers make sure their hiring process and progressive discipline policy contain information on the drug testing policy and that applicants and employees sign for and acknowledge their understanding of such processes and policies.

Topics: Employment Law, Marijuana, Massachusetts employers

The State of Massachusetts Business 2019

Posted by Christopher Geehern on Jan 29, 2019 10:12:55 AM

Associated Industries of Massachusetts President Richard C. Lord delivered his final State of Massachusetts Business address last Friday before an audience of 300 business leaders in Waltham.

Lord said that at a time when there are more job openings than job seekers in New England and throughout the United States, Massachusetts must summon all its creativity and innovation to solve the structural shortage of qualified workers.

 

Topics: State of Massachusetts Business Address, Richard Lord, Massachusetts economy

Video Blog | Gearing Up to Address the Skills Crisis

Posted by Christopher Geehern on Jan 28, 2019 8:00:00 AM

A key element to addressing the persistent shortage of skilled workers in Massachusetts will be encouraging collaboration among employers, schools, community colleges, universities and training providers to establish a consistent and logical path from learning to employment.

What will those collaborations look like?

They will probably look a lot like one developed last year by AIM member Benjamin Franklin Institute of Technology in Boston and the Prime Motor Group of Westwood, which operates 70 auto dealerships throughout the US.

Prime had for many years hired graduates of Ben Franklin’s automotive technology program, but last year stepped up its involvement with Prime Scholars, a partnership that provides students both financial aid and the opportunity to get real-world training with one of the region’s largest auto groups.

Topics: Workforce Shortage, Workforce Training, Education

Many Job Openings, Few Job Seekers

Posted by Christopher Geehern on Jan 25, 2019 11:41:10 AM

At a time when there are more job openings than job seekers in New England and throughout the United States, Massachusetts must summon all its creativity and innovation to solve the structural shortage of qualified workers, AIM President Rick Lord and a group of experts said today.

SOMB2019“There are 6.9 million job openings throughout the United States this morning. There are 6.2 million unemployed people throughout the United States looking for work. Closer to home, there are 51,000 more jobs available in the six New England states than people to fill them,” Lord told an audience of 300 employers during his final State of Massachusetts Business Address.

“The good news is that we live in a commonwealth known for creative solutions to seemingly intractable problems. A state that has produced everything from the game of basketball to the microwave oven to Facebook should certainly be a leader in ensuring that all its citizens share in the economic possibilities that lie ahead.”

Lord offered several recommendations to help Massachusetts employers find the people they need to fuel economic growth:

  • Overhauling the work-force development system to ensure that people of all ages are being taught the skills that employers demand.
  • Ensuring that the public schools provide the basic skills that allow students to compete for jobs that were not even envisioned 20 years ago.
  • Supporting and expanding vocational education.
  • Resolving the immigration issue that has restricted the availability of skilled foreign workers in Massachusetts and other education and technology driven economies.
  • Expanding opportunity to the full diversity of the Massachusetts population. Lord noted that the unemployment rate among people of color exceeds 6 percent in Massachusetts and among Latinos is 5.6 percent.
  • Encouraging collaboration among employers, schools, community colleges, universities and training providers to establish a consistent and logical path from learning to employment.

Lord highlighted several examples of such collaborations, including an initiative by Prime Motor Group to provide scholarships and employment opportunities to automotive technology students at the Benjamin Franklin School of Technology in Boston.

Robin LeClaire, President of Lampin Corporation in Uxbridge, said the 35-person manufacturing company is working on multiple fronts to attract and train people to replace a workforce heavily tilted toward 40 and 50-somethings. The company speaks frequently to middle- and high-school students to let them know that manufacturing offers a rewarding career path to young people who don’t wish to attend college or who cannot afford to do so in the traditional manner.

“They don’t know that there are jobs other than those that require going to college,” said LeClaire.

“We tell them that when they come to Lampin, we’ll pay for them to go to college.”

Massachusetts Secretary of Labor and Work Force Development Rosalin Acosta said it is “astonishing” that the state economy added 185,000 people during 2018 amid a 3.4 percent unemployment rate. She warned, however, that the future work force – people 19 years of age or under – has virtually flattened.

“Where are we going to get all the people employers need, and how are we going to get the right people with the right skills,” Acosta said.

She told the audience that the Baker Administration is focusing its job-training resources on three key areas - manufacturing, health care and information technology.

University of Massachusetts Amherst Chancellor Kumble Subbaswamy said the commonwealth’s formidable lineup of colleges and universities are using internships and other experiential learning to ensure that students have the ability to meet the evolving needs of employers.

“Employers now look for employees who are more job ready that when we went to college,” Subbaswamy said.

Topics: Workforce Training, Skills Gap, AIM Executive Forum

Employer Confidence Weakens in December

Posted by Christopher Geehern on Jan 14, 2019 8:30:00 AM

Massachusetts employers gave a big “Bah Humbug” to the year-end economy as business confidence withered in the face of a government shutdown and the largest one-month stock market decline since the Great Depression.

The Associated Industries of Massachusetts Business Confidence Index (BCI) lost three points to 58.6 during December, its lowest level since December 2016. Confidence readings have dropped five points during the past 12 months.

BCI.December.2018The retreat was led by an 8.6-point drop in employer views of the national economy, and a 4.7-point drop among manufacturing companies.

Overall confidence remains within optimistic territory, but less comfortably so than earlier in 2018.

“The Massachusetts economy remains strong, with a 3.3 percent growth rate and an unemployment rate of 3.4 percent, but employers are increasingly concerned about factors such as financial-market volatility, a dysfunctional national political debate and challenges such as the cost of providing health insurance to employees,” said Raymond G. Torto, Chair of AIM's Board of Economic Advisors (BEA) and Lecturer, Harvard Graduate School of Design.

One employer who participated in the survey summarized the uncertainty: “A tremendous amount of unknowns are ahead.”

The AIM Index, based on a survey of Massachusetts employers, has appeared monthly since July 1991. It is calculated on a 100-point scale, with 50 as neutral; a reading above 50 is positive, while below 50 is negative. The Index reached its historic high of 68.5 on two occasions in 1997-98, and its all-time low of 33.3 in February 2009.

The Index has remained above 50 since October 2013.

Constituent Indicators Lower

The constituent indicators that make up the overall Business Confidence Index were mostly lower during December.

The Massachusetts Index assessing business conditions within the commonwealth lost 2.4 points to 64.7, leaving it 2.9 points lower than in December 2017.

The 8.6-point decline in the U.S. Index to 55.1 left employer sentiment about the national economy 9.1 points lower than a year earlier. It marked the lowest reading for the U.S. Index since May 2017.

The Company Index measuring employer assessments of their own operations dropped 1.4 points to 57.8, down 4.3 points year-to-year. The Employment Index gained 1.2 points to 54.4 during the month, leaving it down a modest 2.3 points for the year, while the Sales Index declined 1.6 points in December.

Employers don’t expect to change their outlook anytime soon.

The Current Index, which assesses overall business conditions at the time of the survey, fell 2.6 points last month to 60.0. But the Future Index, measuring expectations for six months out, dropped 3.4 points for the month and 7.2 points for the year.

Non-Manufacturers (59.4) were slightly more optimistic than manufacturing companies (57.7), re-establishing a trend that existed for most of 2018. Large companies (60.5) registered higher confidence readings than medium-sized companies (57.3) and small companies (57.7). Companies in Eastern Massachusetts (59.8) were more bullish than those in the west (57.0).

Paul Bolger, President of Massachusetts Capital Resource Company and a member of the BEA, suggested that uncertainty about economic factors such as slowing corporate profits, rising interest rates, and trade are overshadowing employer confidence in what remains a fundamentally strong growth pattern.

“Employers are cautiously watching earnings warnings from Apple and other major brands, while hoping that negotiations between the US and China are able to ratchet down the trade war,” Bolger said.

Eye on Health Costs

AIM President and CEO Richard C. Lord, also BEA member, said moderating the cost of providing health insurance to employees remains the biggest concern for employers who participated in AIM’s biennial Issues Survey in the fall.

That’s one reason, Lord said, that AIM has called upon the Legislature and Governor Charlie Baker to end immediately the two-year assessment imposed on employers last year to close a financial gap at the state’s MassHealth insurance program for low-income residents.

“The assessment is no longer necessary because employers last year paid tens of millions of dollars more than anticipated under the levy. Businesses are on track to contribute some $519 million by the time the assessment sunsets at the end of this year instead of the $400 million envisioned under the 2017 legislation,” Lord said.

Topics: AIM Business Confidence Index, Massachusetts economy, Massachusetts employers

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