While U.S. mortality spike is normalizing, 5 troubling trends continue

The alarming spike in U.S. mortality rates post-COVID, which vexed scientists and affected life insurance earnings, appears to be normalizing, according to the latest health statistics. Yet, the public health data hold other surprising numbers that may foretell trouble ahead for both Americans' health and their insurers.

Overall, a significant decline in U.S. life expectancy during the COVID era has bounced back a bit but still lags other developed nations. Moreover, troubling increases in certain ailments and diseases, along with rising health care costs, have worried some insurers and led to major losses in stop-loss coverage for several companies. Self-funded employers rely on stop-loss insurance to mitigate the financial risk of large claims, but as medical expenses grow, insurers may face higher payouts, affecting their profitability.

Earnings impacted

Cigna, a major stop-loss insurer, reported lower-than-expected earnings last month and attributed the drop in higher health care expenses to its stop-loss business. The company said it would aggressively raise the prices of those plans to make back lost profits.

Executives from Voya Financial told securities analysts this month that the company is getting tougher with employers that use stop-loss insurance to protect their self-insured health plans. Its ratio of benefits payments to premium revenue soared to 115% in the fourth quarter of 2024, from 76% in the fourth quarter of 2023. The company had expected to report a loss ratio of 86%.

Sun Life Financial’s US operations reported a surge in extremely expensive claims that caused stop-loss insurance benefits costs to spike in the fourth quarter. Sun Life’s president, Dan Fishbein, blamed the surge in big claims on three factors: a rise in the number of more advanced cancer cases and the high cost of cancer drugs; a lack of normal preventive screening during the COVID-19 pandemic years, a surprising rise in the overall US birth rate – with more parents relying on in vitro fertilization and other expensive fertility tools; and increases in hospital care prices.

Fishbein said the company would increase renewal prices by 14%. Once clients receive their renewal rates, they will have the option to renew or explore alternative options. 

Analysts say those insurance company stumbles reflect an industry-wide trend in which insurers increasingly are paying for a lot more unexpected, big-ticket health care procedures.

And the trend may continue. The Insurance Collaboration to Save Lives, a nonprofit organization that analyzes life insurance claims and encourages insurers to screen, test, and triage members to reduce excess mortality and morbidity, has identified what it said were five troubling trends affecting the nation’s health.

'Life expectancy has really flatlined'

“Life expectancy has really flatlined and is worse now than it was a decade ago,” said Josh Stirling, the Collaboration’s founder. “We were going in the wrong direction while other countries generally have had improving trends. There's a lot of contributing factors to that.”

Those five trends, Stirling said, are:

1. Cardiac and circulatory. Rates for many cardiac & circulatory linked causes up 8-36%+
2. Neurological and nervous system. Rates for many key neuro/nervous causes up 16-39%+ (Includes a shift younger for dementia e.g. +22% for 65-74 year-olds.)
3. Metabolic and digestive. Rates for many key metabolic & digestive causes up 10-137%+
4. Cancer. Rates for many key cancers have risen by 10-50%+ (Nearly all cancers rising except for lung, breast, and colon.)
5. External Causes. Rate of accidents, assaults, and overdoses up 11-30%+.

The lingering effects of COVID, so-called Long Covid, could be behind some of the increases. But the causes are long, complicated, and varied.

“Arguably we should be back to something close to normal,” Stirling said. “But if you look at it by age group what you see is that it's really quite substantially elevated for younger ages. That’s what jumped out at me.”

High blood pressure is a major cause of death, according to the statistics, and its increase is linked to factors like obesity, heart problems, and possibly post-COVID conditions.
Insurers, Stirling said, are recognizing the need for proactive steps to address health deterioration, particularly in cardiac, circulatory, and cancer-related issues. He said insurers should focus on proactive health measures, such as promoting blood pressure checks, to address the silent epidemic of high blood pressure.

“Proactive health measures, like regular blood pressure checks, can help manage underlying health issues contributing to increased mortality,” Stirling said.

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Doug Bailey is a journalist and freelance writer who lives outside of Boston. He can be reached at [email protected].