Health Care Surveys Show Employers What to Expect in 2020

By Andie Burjek

Oct. 24, 2019

Recent surveys show that employers are increasingly addressing outside financial and environmental factors in their benefits offerings.

While the Kaiser Family Foundation’s annual survey gives insight into cost trends in employer-sponsored health care, the National Business Group on Health’s new study focuses on what large employers are doing to address these trends.

One noteworthy trend is rethinking impact of cost-shifting and consumer-driven health plans, also referred to as high-deductible health plans.

Employers are bringing back choice, according to the National Business Group on Health’s “2020 Large Employers’ Health Care Strategy and Plan Design Survey,” which was conducted in May and June 2019 among 147 large employers. Collectively, respondents represent a wide range of industry sectors and offer coverage to more than 15.6 million employees and their dependents.

According to the NBGH survey, 11 percent of employers offering an optional HDHP for 2020 previously offered HDHP-only. Employers cited several reasons for this shift, including the desire to be more sensitive to employees with chronic health care conditions and their health care expenses.

The Kaiser Family Foundation also stressed the adverse impact of HDHPs on many employees in its 2019 “Employer Health Benefits” report released in September. Forty percent of non-elderly adults who have employer-based coverage said that either they or a dependent have had difficulties affording health care.

Further, people with HDHPs were worse off. Among all employees surveyed with chronic conditions, 60 percent said they felt confident enough to afford the cost of the major illness. This percentage halved for chronically ill employees with HDHPs. Only 1 in 3 said they feel confident affording this major medical cost.

Taking employees’ health into account goes beyond health insurance. The NBGH survey found that 60 percent of employers are considering strategies to address food quality/access in the next few years.

“One of the primary things that employers can do is offer nutritious food in on-site cafes and vending machines — and importantly — reduce the cost of these items to make them more desirable than less nutritious ones,” said Steve Wojcik, vice president, public policy at NBGH.

Other ways to address employees’ food quality and access challenges include partnering with local grocery stores to offer employees discounts on healthy foods and offering healthy, prepared take-home meals for purchase, he added.

Macro trends that impact people’s physical or financial health go beyond food deserts. The NBGH report also cited other notable macro trends like stagnant wages, poor public transportation systems and high housing prices.

Bringing an end to the most pressing social and environmental challenges will likely require action and partnership from both public and private sectors, Wojcik said. Companies are increasingly understanding that business performance, employee well-being and community health are intrinsically linked.

“Large employers are uniquely positioned to use their voice to draw attention to issues, advocate for public solutions (potentially in partnership with other employers or nonprofit organizations) or invest corporate social responsibility funds into initiatives that will positively impact their employees, customers and the communities where they work,” he said.

Also read: 4 Myths of Health Care Cost Reduction

Wojcik also suggested that if employers claim a position on some external issue, their internal benefits should be aligned with that. If a company has a corporate social responsibility program or external initiative on affordable housing, for example, it should also make sure that it supports financial well-being program such as employer-sponsored housing programs or homebuyer workshops.

The Kaiser report also stressed the need to keep employees’ financial situations in mind,  comparing the needs of low-wage versus high-wage employees.

“When people talk about the 153 million people with employer-based coverage, they often gloss over the very real cost differences for different groups of workers across the marketplace,” according to the report, which compared companies that have a large share of low-wage workers with companies that have a small share of low-wage workers.

Covered employees in organizations with large shares of lower­ wage workers on average face higher deductibles for single coverage and must contribute a greater share of the premium for family coverage than workers in firms with a smaller share of lower­ wage workers, the study found.

Being eligible for employer-sponsored coverage also is impacted by wages. In companies where at least 35 percent of employees earn $25,000 a year, 66 percent of employees are eligible for the coverage compared to 81 percent of employees in companies with a smaller share of low-wage workers.

The national debate around expanding Medicare was also a major theme in these reports. Most employers have major concerns about Medicare for All, NBGH noted. Fifty-seven percent of those surveyed believe that Medicare for All would increase the country’s health care costs, 69 percent believe it would decrease health care innovation and 56 percent believe it would decrease quality.

While the Kaiser report did not go into attitudes people have about Medicare, it did explore attitudes people have toward employer-sponsored plans. The debates over Medicare and the future of U.S. health care have raised concerns about the performance of employer-based coverage, the report noted. Many employees with chronic conditions, especially people with HDHPs, have issues affording health care, and low-wage workers may very well face higher premiums for health care than employees who earn more.

“Regardless of its outcome, the national debate around expanding Medicare or creating public program options provides an opportunity to step back and evaluate how well employer-based coverage is doing in achieving national goals relating to costs and affordability,” the report stated.

Andie Burjek is an associate editor at

Schedule, engage, and pay your staff in one system with