System meltdown: employer-sponsored health insurance

A small business health crisis

0:00I want to tell you about Burden of Proof, Luigi Mangione. It's a podcast from ABC Audio and 2020. In December 2024, UnitedHealthcare CEO Brian Thompson was shot dead. Luigi Mangione has pled guilty to federal charges, but there is so much more to this story. ABC News legal analyst Brian Buckmeyer goes deep into this case and what it means. He'll unpack the murder and how this case has affected the conversation about health care in America. You can follow Burden of Proof, Luigi Mangione, wherever you get your podcasts, or listen ad-free on Apple Podcasts by subscribing

0:34to 2020 True Crime Plus. Again, that's Burden of Proof, Luigi Mangione.

0:42On the next episode of Pocket Science, stars aren't supposed to just disappear, you know? And yet that's exactly what Seattle researchers seem to see when they comb through old telescope data. So they dug into the mystery, and that search would lead them to the story of an apocalyptic event. And maybe a glimpse into Earth's own violent origin story. When worlds collide on the next Pocket Science, on the KUOW app, or wherever you get podcasts.

CFO faces rising insurance costs

1:10Hey there. Rachel Bernier-Green runs Thrivo Financial Advisory on Chicago's South Side. She describes herself as a fractional CFO for small businesses, offering strategic financial advice, along with accounting services. And she says employee health insurance was part of her business plan from the beginning. Before she even had employees, she built extra money into her prices. And at first, she put that extra money into a rainy day fund. But by late 2024, she thought the time had come. I'd been in business for a while. I had a few team members, and things were moving along.

1:45She wanted to keep those team members around, and she knew health insurance would help do that. And so that's when I actually started to think, how do we actually get this in place? She says she moved quickly. By January 2025, she says her six-person team had health insurance. And then, things got wobbly.

2:07Early in the year, a major client left. Income took a hit. And by spring, she could see big trouble coming toward her. Insurance for 2026 was going to be way more expensive. And she could tell because some of her clients were already seeing rate hikes from their health insurance companies. They had policies that renewed early in the year, and these were much steeper increases than they'd been expecting. So they came to Rachel, their fractional CFO, to help them figure out how to adjust. And Rachel knew she would have to do the same.

2:41It was almost like standing on a train tracks, and you're just kind of staring down the impending doom because you know you're going to be in the exact same situation in a couple of months. She says she shared the bad tidings with her team as data came in, right from the start. And she said she makes a practice of sharing the company's finances, details and all, with her colleagues. She calls it open-book accounting. We have regular team meetings where we're discussing these things, and we could all look at the numbers, and the writing was on the wall.

3:14So when we kind of got to the end of the road, it wasn't me saying, surprise, here's what's going on with the health insurance. It was more, okay, we've reached the point where we have to make a decision and call it. They made the call at a regular team meeting, which doesn't mean the meeting was routine. My heart was just in my stomach because, like, I knew what we needed to do, and I just didn't want to want to do it. But they'd gotten their renewal notice for 2026.

3:44Health insurance was going to go up by more than 10%. Rachel says everybody agreed the business couldn't afford it. The entire team was on the same page that what was most important was that the business continues to survive so that we could bring back those benefits in the future. The thing I remember the most is that another team member who relied on the insurance reassuring me that that was the right thing to do. Even with that kind of consensus, and even with a plan in place to bring back those benefits for 2027 now,

4:18Rachel describes the whole episode as devastating.

4:23She's gone on a plan from her husband's employer. Some other colleagues have done the same. One has left the firm, and two are uninsured.

4:37Rachel and her colleagues aren't alone. They're a case study. A reporter named Bob Herman featured them recently in a story for Stat. That's a news outlet dedicated to health and medicine. And the headline for Bob's story was America's small businesses are giving up on health insurance.

4:57And the crisis Bob is reporting on goes beyond small employers. That story kicked off an eight-part series called Out of Pocket, Out of Reach, with a subtitle that tells you how big and how deep this crisis goes. It's how America's employer-based health care system continues to crumble in slow motion, which sounds scary and absolutely sucks. But it's the kind of big picture look we really need. And Bob is exactly the person to break it down.

5:29He's the business of health care reporter at Stat. He has done the most comprehensive reporting on the giant United Health Group. And for years, he's published a list of the top paid CEOs in health care. These compensation packages, they go to the hundreds of millions of dollars a year in some cases. It is completely wild. And he knows how to bring a huge story down to earth. He's coming right up.

The crumbling employer insurance market

5:55This is an Arm and a Leg, a show about why health care costs so freaking much and what we can maybe do about it. I'm Dan Weissman. I'm a reporter. I like a challenge. So the job we've chosen here is to take one of the most enraging, terrifying, depressing parts of American life and bring you something entertaining, empowering, and useful.

6:18Bob Herman joined me from a closet. One of his kids had a friend over. It was the quietest place in his house. He was sitting on the floor. I should have been recording the whole time. But we did have the recorder on when I asked him, how did you come to the conclusion that employer health insurance doesn't just suck? It's crumbling. Well, here, maybe it'll help if I explain kind of the origins of why we even started it. So I'd gotten back from parental leave last year around November. My wife and I just had our second kid.

6:49And literally the first thing I have to do, both of us, we both have to do when we get back, is we have to figure out what health insurance plans we're going to enroll for the next year, which, as I'm sure you and every one of your listeners knows, is a miserable experience. And we cover health care, and it's still miserable. Well, it's tedious, but also it is high stakes. And at that time, we had seen all the headlines that employer-sponsored health insurance was experiencing double-digit increases everywhere.

7:21It is one of the primary ways that Americans are covered. And we're all getting slammed in the face with historically high premium increases. And I think it just became very clear that employer-sponsored health insurance is not the robust product that I think a lot of people think it is. And your conclusion here is there's like a structural problem here, starting with how fast the cost of employer-sponsored insurance is going up, right? Like, there's a really big number in your story where you kind of compare how much more health insurance costs now than it did 40 years ago,

7:58like comparing it to the rate of inflation. And basically, health insurance, the price has risen almost four times as fast as inflation in general. Right. And like we're talking over the past several decades, almost 1,000% increase versus wages that were much, much lower than that. So like one takeaway there is this huge increase. It amounts to something like a hidden pay cut for all of us. I think hopefully that's one thing that this series can accomplish is for all workers out there, when you enroll in your health fund every year, how your employer is paying for it,

8:31how much is getting taken out of your own paycheck? These are things that ultimately affect how someone can pay for their day-to-day things, like groceries feel expensive, rent feels expensive. Why? I think part of it is because your employer health plan, it's become such a financial burden for everybody. Yeah. You've said something I think about all the time, which is like, even if your employer covers your health insurance, like every dollar that your employer is putting toward health insurance is a dollar they could be paying you.

9:02It's a dollar that's on the budget line for your position. It's exactly right, Dan. And this is like, it's like an iceberg. I think a lot of people see like what's, what gets taken out of their paycheck every month. That is only like 20 to 25% of what your actual premium is. Your employer's paying most of it. You just don't see it. But like this big block of compensation that you get, a big and growing chunk of it is for your health plan. And it's so hidden. And I think that's what kind of makes the whole thing so difficult for Americans to afford.

9:37Yeah. I mean, the amounts are really striking. So like the average employer plan for a family now, it's like $27,000 a year. I mean, it's a new car, right? These days it's, and not being not a top of the line car, but a Toyota Corolla is, you know, a car. Yeah. Every year. Yeah. It's that new car every year, but the employer's paying the tens of thousands that makes up most of the car. That's the part that is hidden. And that big chunk of money ultimately gets funneled through to the healthcare system.

10:07And it is so beneficial for the healthcare industry to have workers and families not realize that that money is even theirs. Money you never see that hospitals, drug companies, medical groups, everybody else feasts on. That's where they make hay. They could charge whatever they want. And so the prices that we pay are just higher here than they are elsewhere.

Insurance inflation and hidden costs

10:30So that wild inflation and health insurance premium, yeah, it's driven by how much more everything in healthcare costs, how much prices keep going up. And I'm hearing you say the fact that some of these costs are hidden, they're like, you know, bundled into, hidden inside employer health plans, that actually creates these opportunities for price gouging or like what I've heard you call gaming the system. There's all this money that employers are dumping into these, you know, health insurance payments for their workers. And it is, it's like a feeding frenzy.

11:04You know, years ago, I remember going to the JP Morgan conference out in San Francisco. It's just like the confab where all the big healthcare industry players, you know, gush about how much money they're making. Commercial insurance, the employer-based insurance is their golden goose and they know it. And, you know, I went around talking to people and it's not like they were dismissing that idea. They know that the commercial insurance market, that what we all pay for and through our employers, they know that there's that massive pool of money there. It's, it is, just imagine like Scrooge McDuck, right?

11:37Where there's this massive pile of coins and he's kind of swimming through it. That image has come up before on this show. Yeah, it's just, that is, that is the employer market and it's a lot easier to make money when the people who are paying into it don't understand how much they're paying into it. Yeah. So you came into this project because you cover the whole business of healthcare. You were already thinking like, this is a huge story people need to know about. It's a hidden pay cut. It keeps making insurance and healthcare more expensive every year, keeps getting worse.

12:08But it, it sounds like you didn't realize at first the kind of trouble that small businesses were in. You know, as I was doing research and talking with people and reading up, there was a KFF employer health benefits survey and just buried deep within this very detailed report. There was this chart showing for companies with 200 or fewer employees, you know, a little bit less than 60% of these small companies were offering health insurance. Now, historic low, it's the lowest it had ever been. And I was like, oh my God, like that is a shift.

12:41It's this idea that small companies were giving up on this grand American idea of offering health insurance. It's actually unraveling right now. And so you concluded, small businesses are giving up on health insurance. What does that mean they're actually doing? Yeah. I think when we think about employer's pension and health insurance, companies do it because it's a retention tool. It could be a deciding factor for an employee to come work for you, right? Like, oh my gosh, like this health plan looks pretty good. Sign me up. But if small companies, they already kind of live on the bleeding edge, right?

13:15They just, you know, if you're at a fortune 100 company, you have more money than you know what to do with. If you're a small company, it means that the costs of health insurance eat into your expenses so much more. And, you know, if you're just a company of like, for example, 25 people and you have one really big medical claim, your insurance company could come back to you next year and say, we got to raise rates 20% because of that one medical claim. And you know what the crazy thing is? It's like a 20% is a gigantic amount and it's not like that uncommon for a small business to get slapped with that.

13:52Like I spoke with a business in Pennsylvania and they were staring down the barrel of like a 50% increase. It's not uncommon for premiums to like double, which what are you going to do then? You have to look for other options. And what you knew when you started was things are getting bad. Like rates have been going up even faster than we're used to, right? The past two years in particular have been really bad because insurers, like they endured a lot of losses, not a lot of losses,

14:23but like they, this, the losses were more than they had expected over the past couple of years. And so they're making up for it now. They made up for it in 2026 and they're making up for it again in 2027. And that's exactly what you and others are feeling right now. I mean, they're the house. It's a casino. And they've set the odds and the house never loses. Like it's, it's made that way. Like you can't like the bookmaker never loses. Like they employ a lot of actuaries and actuaries are just bookmakers, right? Yeah. The actuaries, they are the, the very smart people that analyze how much care everyone's getting and how much they can predict that that will go up next year.

14:59And they're pretty good at it. And obviously the past couple of years, they were less good at it, but they know if there is a bad year, they can easily adjust the premiums to make up for that bad year. There is no, there's no multiple years of losing money in health insurance. It doesn't happen. Unlike the rest of us. Yeah. Yeah. Yeah. So if you're really big, you're spreading the risk out across a whole bunch of people and you have reserves and you have long-term plans.

15:33And if you're a tiny little business, like you don't have all of the tools to kind of sock money away for something or pull money out of your budget someplace else. Is that, is that basically the, the deal? I think, yeah, I think you have it spot on. If you're a big company, you can weather these things better. The more people you have, the more money you have to pay out when someone does have to file some kind of claim. So what did your reporting show you about what small businesses are doing instead and what workers are doing instead?

Small businesses abandoning health plans

16:02Yeah. I mean, none of it is ideal, right? Because like a lot of small businesses, they, the ones that I spoke with, and I think this is generally true, like they want to offer health insurance. And when they can't do that, some are just saying, you're just going to figure it out yourself, which is like, it's a great way to lose an employee, right? Like, oh my God, I don't have the safety net anymore. Others are doing, you know, maybe giving their employees extra cash that they can say, hey, go buy a health plan on the ACA marketplace.

16:36And, you know, it's not ideal because if you think, if you have a employer plan, usually, you know, there's a pretty big network or there's like lower out of pocket costs. And when you go to the exchanges, it is a world of difference. Like your doctor may or may not be a network out of pocket costs and deductibles are generally much higher. And it's just, it's a completely different product. It's worse that what you find on the exchanges as an individual is worse than what you'd find anyplace else. Yeah. I know this firsthand.

17:06Like the first episode of our podcast, I'm shopping on the exchange. I'm like, this is bad. Yeah. And like, don't get me wrong. The ACA provided some kind of baseline level of protection for people who would otherwise be uninsurable. Like, like it's crazy to think about 20 years ago, if you had some kind of preexisting condition, you just couldn't get insurance. Like, sorry. And, um, but like the ACA plans are, they're rough. Like it, like it's, it almost like if you have a $9,000 deductible, is that even insurance at that point?

17:38I think that's a fair question to ask. And, and just to zoom out from there, like that chart you found, the one that showed smaller employers are down to just like 60% offering health insurance. It also showed that for larger employers, that number hasn't changed much, right? It's like, it's like 97%. Yeah, it's, I think this question is important because it does kind of help explain the economy in terms of haves and have nots, right? Where the biggest companies are always going to be able to offer health insurance if they really want to.

18:11They just, they have the money to do it. Small businesses, like we're living in the shift right now where small businesses are not thriving anymore in terms of offering health insurance. Well, I guess what? Like I don't foresee this reversing course anytime soon. Ask any small business and more of them are going to be like, you know, my time is up. And, you know, is it, does this spur companies to shut down? I don't know. Like it's totally plausible.

18:42It's not good. It's not good for the economy. And there was even a recent survey that shows that it's not good for workers either. Like a lot of people just stick in their jobs, jobs that they hate because they're just doing it for the health insurance. Like what kind of economy is that where you're doing something, you're collecting a paycheck really to just also get health insurance. It's not, does it feel particularly productive? So like these are all problems that are happening right now. I saw that survey and you wrote about 24% of people in that survey said, I would leave my job except for the health insurance.

19:14A quarter of people. Yeah. And what a term, right? Job lock. Like it's, it's this well-known economic term job lock. Like you're, you're locked in your job, not because you want to, because, but because you feel like you need to. And you dug into some of those numbers. You're like, yeah. And job lock does not hit all people equally, right? That people are, who's, who's more vulnerable to job lock. It's oftentimes it's people who have more chronic health conditions, right? It's like, oh my God, I know I'm going to be a user of my health insurance. So like that makes more, it's like, especially women, because, you know, especially if you're planning on having a baby or if you just have any kind of chronic condition, if you know you're going to be using your health plan, you can't afford to leave your job, even if you think it sucks.

19:56You said at the top of our conversation that, you know, this system is collapsing and that, that health insurance isn't, the employer health insurance is not the kind of robust product we thought it was. And not just for small businesses, even though, like you say, it's more obvious for them. But, you know, you did report this spring on this survey, we were like some large number of CFOs for bigger companies were saying like, yeah, we didn't hire people or we raised our prices for customers because of the cost of health insurance, right?

20:33Yeah, this is still affecting larger businesses and it's happening in all the usual ways that we've seen over the past, you know, two decades, it's making deductibles higher for employees, it's making them contribute more from their paychecks, it's changing the health plans. And, you know, I just spoke with someone the other day, they said that they're out of pocket max, it's the term, like, after you reach this amount, you don't have to pay any more for the rest of the year, like it doubled, like that is a health benefit design change, where it actually functions like a wage cut too, right?

21:05So big companies will always be able to do it, but they haven't making changes. And most of the times, it just means that the worker and their dependents are taking it on the chin somehow. Making health insurance worse. So, I mean, you know, there's this big story coming out right now, like, you saw this story, right, where Disney's saying, actually, your spouse can't be on your plan anymore, if they have an offer from another employer? Yes, Disney's basically saying, if your spouse has an offer of insurance through their own employer, they have to take that they can't join the Disney plan, which is just, honestly, it's batshit crazy.

21:40It is for a company that is like, supposed to be very family friendly. This is a very anti family friendly thing that they're doing. The analysis that I saw was like, look, who chooses our insurance when they have an offer from their insurance? It's somebody who thinks our insurance is better and is and thinks they're likely to use it. Right. So we think we're going to be paying out claims. Yeah, right. Yeah. I mean, if you think about it, if you are sick, and you know, you're going to use insurance, you're going to choose the plan that is that offers you more protection.

So I mean, like, actuarially, like, it makes sense, like they're, they have data showing that, like, when people join it, when dependents join the plan, it is costing them more money. And now they're going to actively stop it. Like, if the entire social fabric of employer based insurance is you if you have a job, you can get an offer of insurance, and you and your family can join it. Even that is starting to unravel. Like, what happens if every other employer?

22:37Did this? Yeah, is this the beginning of the end? Like, it kind of sounds like you started with, like, big employers are going to keep offering health insurance, they're not going to walk away. But it sounds like you're like, maybe you're kind of reconsidering it. I am kind of reconsidering and honestly, it's the GLP ones that have really started making me reconsider this, like Patsy just this week said, we're not offering GLP one coverage for weight loss anymore for our employees. Like, it's not to say like, I still think big companies are always going to offer health insurance. But if but something like GLP one coverage, where it is so much money, and so many people are using it, even for that, they're saying, No, we can't do it anymore.

23:12They're still going to offer coverage that will, that will try to attract people that they want to attract. But stuff like this shows that it is very clear the employer sponsored health insurance system is unraveling more than perhaps I've ever seen. And yet, the experts Bob talked to all said, they don't expect the system to change anytime soon. And Bob ended up with some pretty clear ideas about just why that is. That's coming right up.

23:42I want to tell you about Burden of Proof, Luigi Mangione. It's a podcast from ABC Audio and 2020. In December 2024, UnitedHealthcare CEO Brian Thompson was shot dead. Luigi Mangione has pled guilty to federal charges, but there is so much more to this story. ABC News legal analyst Brian Buckmeyer goes deep into this case and what it means. He'll unpack the murder and how this case has affected the conversation about health care in America.

24:17You can follow Burden of Proof, Luigi Mangione, wherever you get your podcasts, or listen ad-free on Apple Podcasts by subscribing to 2020 True Crime Plus. Again, that's Burden of Proof, Luigi Mangione. Are you the one that gets the plans out of the group chat and into an actual restaurant? Let me help you out. I'm Brandi Fullwood, host of Seattle Eats, and I gotta say, this podcast is for you. Every week I talk to chefs, critics, industry people about the best places to eat in Seattle so you always know where to go next.

24:55Listen to Seattle Eats on the KUOW app or wherever you get your podcasts.

25:03This episode of An Arm and a Leg is a co-production of Public Road Productions and KFF Health News. That's a nonprofit newsroom covering health issues in America. It's a newsroom full of superstar reporters. We are honored to work with them. The sense I got, you know, from your reporting is that, like, big employers aren't happy about it.

Why the broken system persists

25:27They're mad. They're unhappy. But this system of employer-sponsored health care, it's not likely to go away. And you had, like, a kind of analysis of, like, the politics where the money is. Can you kind of share that? Like, if everybody's like, this sucks, why doesn't somebody do something? Who's benefiting from the way things are? Who would get hurt if things changed? Getting rid of the employer-sponsored health insurance system is just vehemently opposed by big business.

25:58They know, especially the largest businesses, if they offer an attractive health plan, they could get anybody they want. And then, going back to the job lock, those people could also stay with them for a long time because they know that they have the health plan. And the largest tax break in the entire code is employer-sponsored health insurance. So it's great for middle and upper class people. It's great for the businesses. Nobody pays any taxes on it. I mean, I was really struck by the note that it's the biggest tax break in the entire tax code.

26:32We're talking hundreds of billions of dollars that otherwise would go into the federal kitty that don't. So businesses, they see all of these things that are beneficial to them. And even though it costs them so much money, it is not worth giving that up. We still have way too many advantages from it, even though it costs us an arm and a leg. And you had a specific example that, like, the Affordable Care Act was part of its design was, like, super souped up workplace health plans would incur a tax.

27:04And this did not end up happening. Yes. I don't know if you remember that debate, Dan, but it was called the Cadillac Tax. And it was this idea that, you know, if it's a really, really super generous plan, we're going to start to tax a little bit. Everyone lost their minds about it. And it was across the board. It was businesses. It was unions who obviously fight very hard to, you know, to negotiate for their health plans. It was just universally reviled. But the idea was we need to start taxing these.

27:35It went terribly. It got killed. And that was honestly, it was a pretty modest change. And look, look what happened there. And so I think what that example shows is there are people with something to lose. And then, of course, there's all the people who, you know, make money in health care, right? Not just insurance companies, right? It is like the health care industry is very powerful. If you look at, like, lobbying dollars, like health care companies and their trade groups are always at the top. And, like, yeah, they want inertia, even as they vacuum up another $6 trillion this year and exponentially more next year.

28:14It is a feeding frenzy. And, again, this is money that otherwise would be in your paycheck. Yeah. I mean, it's just one of the things I think about. We become aware of how much things cost a lot of us when, like, we get a giant bill or people we know. And we're like, that's wild. But what you're reporting is showing, like, no, all of this wildness is paid by all of us. A lot of us get insurance from our jobs. That's money that could be our wages. We're paying it there in places where the government pays for health care.

28:46And we are paying that through our taxes. That is a part that I don't think I get to enough on this show is that, like, we're vulnerable individually, but we're also each of us individually paying a collective price. I remember years ago, I was interviewing Don Berwick. He used to be the CMS administrator during President Obama's term for a short while. And he made the good point that was like, workers pay for every dime of health care in this country, either through your wages or through what is owed to through compensation or through taxes.

29:26And I think if your listeners just think of it that way, it's actually pretty simple. Like, we're all paying for this. It just doesn't, it might not seem like it, but that is the reality. This is a little bit risky just for our emotional health. But, like, as a parent, as you report on these things, do you think about your kids as adults navigating an economy that's another 20 and change years along this path?

30:01Oh, yeah. I mean, I don't know. Maybe a lot of parents are worriers. I'm one of them. I think about, like, my kids when they eventually have to go off our health insurance, right, when they have to find their own. And, you know, maybe they have their own health care needs at that point and they have to find something. Like, is it going to be affordable for them? Are they going to be one of those people who gets job locked where they find a job, but they absolutely hate every minute of it because they're just doing it for the health insurance? I mean, 20 years from now is a long time.

30:33Like, costs aren't going down. And how will it affect their, you know, basic standards of living? I have no idea. I mean, it's hard not to think about it, but it is far in the future. And I think that's what also prevents people from changing things. Like, we know it's bad. It's going to get worse. But, like, you know, when it's that far in the future, you can't, like, address it right now. But I think that's the perfect time to address this before it's so bad that our own kids can't even, you know, afford their rent or their groceries or whatever else.

31:06I'm reminded, right, of the saying, like, the best time to plant a tree is 30 years ago. And the second best time to plant a tree is today. Today. Exactly right. I'm a little anxious about what we'll be paying, but it, you know, it's not keeping me up at night.

Facing another year of rate hikes

31:26Back on the south side of Chicago, Rachel Bernier-Green tells me she is on track to bring insurance back for her team in 2027. She says changes they made to their business strategy last year have been paying off. So she's got the money lined up. I mean, we hope that there are not, you know, more sky-high increases because, yes, they do drastically impact our ability to operate the business. But I know that we'll be well positioned to absorb the cost. Do you know what you're going to be paying next year?

31:57I do not. I will share with you that, like, yesterday as I'm preparing for today's reporting, I'm like, oh, yeah, this would be a good time for me to email our insurance broker and be like, hey, Kurt, so what are we looking at for next year? I think it's going to be bad. And he's like, it's going to be bad. He thinks for the plan that we're on, which because of our needs for networks and stuff, we don't have a whole lot of choices. He's like, yeah, you're looking at like 14 to 18 percent, I think, for the next year. Yeah. Yep.

32:28Yeah. Which sounds obscene, but I'm thinking is between 20 and 25 percent that we need to be prepared for jumps of that magnitude. And I hope that that is not the case, but that's what we are building into our models moving forward. And are you advising clients the same way?

32:48Yeah. Yeah. I'm curious about what it was like reading Bob's story, whether it was surprising or not. Like, what was it like seeing all of that kind of put together? Oh, I was just like silently cheering because those are the exact conclusions that I, you know, I can't inform the conclusions that he reaches. But that is exactly where where I am, that the system is fundamentally broken and it is harming people in irreparable ways.

33:23And that we need a significant overhaul. Amen to that, which is a thing about a story like this. On the one hand, it is full of really terrible news. On the other hand, most of us, I mean, maybe all of us are already experiencing the effects of all this terrible news. And I think it's helpful. It's it's good to see it all tied together, to know we're not alone. We're not imagining things. The whole system truly is completely broken.

33:56And as Bob says, continuing to actually crumble. So even if we don't have a solution, it's good to know we're up against to peel back the curtain.

Medicare advantage and upcoming chaos

34:07Next time on an arm and a leg, we take another look at Medicare Advantage and it's more broken than we thought. Many major health care providers are dropping their Medicare Advantage plans. I heard that was just in tears. I don't know any other way to describe it other than total chaos.

34:38I'm hoping that you're right here with me when I say it is so much better to know. We do not want to get taken by surprise. So do not miss this one. Till then, take care of yourself. This episode of an arm and a leg was produced by me, Dan Weissman, with help from Emily P. Secreta and edited by Ellen Weiss.

35:12Adam Raimunda is our audio wizard. Our music is by Dave Weiner and Blue Dot Sessions. Claire Davenport is our engagement producer. Amanda Boyd is our operations manager. Bea Bosco is our consulting director of operations. And arm and a leg is produced in partnership with KFF Health News. That's a national newsroom producing in-depth journalism about health issues in America and a core program at KFF, an independent source of health policy research, polling and journalism. Zach Dyer is senior audio producer at KFF Health News.

35:42He's editorial liaison to this show. And arm and a leg is distributed by KUOW, Seattle's NPR news station. Thank you to the Institute for Nonprofit News for serving as our fiscal sponsor. They allow us to accept tax-exempt donations. You can learn more about INN at INN.org. Finally, thank you to everybody who supports this show financially. You can join in anytime at armandalegshow.com slash support. I want to tell you about Burden of Proof, Luigi Mangione.

36:32It's a podcast from ABC Audio and 2020. In December 2024, UnitedHealthcare CEO Brian Thompson was shot dead. Luigi Mangione has pled guilty to federal charges, but there is so much more to this story. ABC News legal analyst Brian Buckmeyer goes deep into this case and what it means. He'll unpack the murder and how this case has affected the conversation about health care in America. You can follow Burden of Proof, Luigi Mangione, wherever you get your podcasts. Or listen ad-free on Apple Podcasts by subscribing to 2020 True Crime Plus.

37:06Again, that's Burden of Proof, Luigi Mangione. Some of the world's biggest companies have brought jobs and wealth to the Seattle region. That growth has come with some real pains, too. There are these hotspots. Seattle has the potential to be one of those. Tech people are getting replaced by AI and you can't replace us with AI yet. I'm Monica Nicholsberg. And I'm Joshua McNichols. We host Booming, a podcast about the economic forces shaping our lives here in the Pacific Northwest. We get into the stories that hit your wallet and our region.

37:37Listen now on the KUOW app or wherever you listen.