US Small Biz/Public Health Coverage Crisis 2026
Key Questions
What priorities is OPM emphasizing for FEHB and PSHB in Plan Year 2027?
The US Office of Personnel Management (OPM) is prioritizing prevention, wellness, digital therapeutics, and non-pharmaceutical options in its PY2027 Carrier Call Letter for FEHB and PSHB programs. This focus comes amid surges in GLP-1 medication use, which affects 18% of users at over $11,000 per user.
What is PwC's projection for healthcare spending growth by 2025?
PwC's Health Research Institute projects healthcare spending to grow at a 7% annual rate by 2025. This trend is driven by factors like rising costs in various sectors.
Why are New Jersey public workers facing health benefit rate hikes?
New Jersey's SHBP and SEHBP programs are hiking rates due to $333 million in losses. These increases impact over 1 million residents, including more than 800,000 retirees, workers, and dependents.
How is South Dakota's public employee retirement system performing against inflation?
South Dakota's retirement system is expected to trail inflation for the sixth straight year. Officials predict a 1.56% cost-of-living adjustment, lagging behind inflation.
What does the Payscale study say about the U.S. gender pay gap?
The Payscale study notes a widening U.S. gender pay gap, reversing previous gains. This strain affects employee benefits and compensation equity.
What trends exist in GLP-1 medication use among US employees with obesity?
A retrospective analysis shows increasing use of glucagon-like peptide-1 (GLP-1) medications among employees with obesity. Usage has reached 18%, with costs exceeding $11,000 per user.
What opportunities exist for small businesses amid health coverage gaps?
Opportunities include ICHRA plans and platforms like Betterfly to address coverage gaps. Bypasses via GoodRx, Lilly, and MedImpact also help manage costs.
How are cost-sharing trends evolving in employment-based coverage?
Cost sharing in employment-based coverage is evolving, impacting affordability. Trends from 2013–2023 reveal shifts that affect employees' out-of-pocket expenses.
OPM PY2027 FEHB/PSHB emphasizes prevention/wellness/digital therapeutics/non-pharma amid GLP-1 surges (18% use, $11k+/user); PwC 7% spend growth; NJ hikes SHBP/SEHBP ($333M losses); NV/MN/USU/SD COLA trails + SS quirks; GoodRx/Lilly/MedImpact bypasses, ICHRA/Betterfly opps/Google death benefits amid gaps/Canada cliffs; Payscale gender gap strain.