National Alliance Releases Purchaser Survey Aug 2021


New Survey Finds Many Employers had Reached Same Conclusion as Biden Administration for COVID-19 Mitigation in the Workplace

  Employers shifting return-to-work plans due to Delta variant, considering health strategy changes connected to affordability, and changing attitudes related to health reforms


WASHINGTON – SEPTEMBER 13, 2021 – While most employers anticipated a stabilized business environment by the end of the year, the Delta variant surge has caused this confidence to decrease from 65% to 57% over the past six months. Many organizations have also had to rethink their return-to-work timing with 55% indicating a change in plans. These are among the findings of a survey of employer views on COVID-19, health strategy and policy conducted by the National Alliance of Healthcare Purchaser Coalitions (National Alliance) and its members.

“The Delta variant has changed the game on employer efforts to return to normal and created even more uncertainty about the safety and sustainability of their COVID-19 strategies,” said Michael Thompson, National Alliance president and CEO. “Based on the survey responses, almost all have taken actions to educate, encourage and support vaccination but there is now a strong trend to differentiate the treatment of the vaccinated from the unvaccinated. The Biden administration’s new mandate will clearly accelerate a trend that was already underway and push others who were reticent to take a stronger stance with their workforce.”

Additional survey findings:

  • Almost three in 10 employers are now unsure of when the environment will stabilize
  • The openness to considering the COVID-19 vaccine mandates has grown substantially in the past six months since the Pulse of the Purchaser survey was last conducted
    • Require vaccination for all employees (37% in August 2021 vs 8% in March 2021)
    • Require for higher exposure employees (29% in August 2021 vs 10% in March 2021
    • Require for business-related travel (40% in August 2021 vs 26% in March 2021)
  • Almost all employers are continuing COVID-19 safety procedures in the workplace, and most are requiring stricter standards for those who have not been vaccinated such as mandatory masking at workplace (90%), restrictions on meeting attendance (52%) and business travel (47%), requiring working remote (if possible, 46%), routine COVID-19 testing at employer‘s (44%) or employee’s (14%) expense, and few are considering termination of employment (16%) or benefits surcharges (13%)
  • Employers continue to have significant concerns about the affordability of employer-provided health coverage for employees and their families, with 80% citing drug prices and 73% citing hospital prices as a significant threats
  • When asked about areas of focus for health benefit plans over the next one to two years, the top strategies included:
    • Mental health and substance use access and quality (92%)
    • Centers of excellence (92%)
    • Hospital price and quality transparency (91%)
    • High-cost claims (88%)
    • Total person health (87%)
    • Value-based benefits (86%)
  • Emerging health benefit strategies where employers stated they require more information are health equity (72%) and advanced primary care (68%)
  • Most employers view potential health reforms favorably overall and considered the following very or somewhat helpful (with few considering them even somewhat harmful): 
    • Drug price regulation (95%)
    • Hospital rate regulation (80%)
    • Hospital price transparency (90%)
    • Surprise billing regulation (84%)
    • The percentage rating reform “very helpful” has increased significantly in the past 12 months for both drug price regulation (70% vs 65%) and hospital rate regulation (50% vs 46%)
  • A Medicare public option is viewed favorably by almost half (47%) of employers and harmful by 16%
  • Employers viewed a public option most favorably if pricing is available to all plan sponsors (60% found very or somewhat helpful) and available to all employees regardless of plan sponsor (55% found very or somewhat helpful)

            “While mitigating COVID-19 remains the number one priority, employers are also rethinking their broader health and wellbeing strategies,” added Thompson. “The days of delegating and shifting responsibility to employees are yielding to greater employer advocacy and guidance for employees to improve health, equity and value.”

            The online poll of 142 employers that are members of coalitions affiliated with the National Alliance was conducted in August 2021. Organizations represented included manufacturers, educational services, public administration, finance and insurance, and healthcare and social assistance institutions. Purchasers ranged in size from very large (24%, 10,000+), large (12%, 5,000-9,999) to mid (27%, 1,000-4,999).

            The full Pulse of the Purchaser results can be found here.

            About National Alliance of Healthcare Purchaser Coalitions

            The National Alliance of Healthcare Purchaser Coalitions (National Alliance) is the only nonprofit, purchaser-led organization with a national and regional structure dedicated to driving health and healthcare value across the country. Its members represent private and public sector, nonprofit, and Taft-Hartley organizations, and more than 45 million Americans, spending over $300 billion annually on healthcare. To learn more, visit and connect with us on Twitter and LinkedIn.

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            Media contact:
            Cary Conway