Why Taft-Hartley funds can’t rely on one health plan design to serve every generation
How multigenerational health patterns are reshaping benefits strategies for labor and trust funds.
For trustees and administrators of multiemployer health and welfare funds, benefit design has always been an exercise in balancing competing pressures: protecting reserves, honoring collectively bargained commitments and delivering meaningful care to a membership that spans decades of working life.
What is becoming increasingly clear is that the membership itself cannot be bucketed into a single audience. It is 4 distinct cohorts, each bringing different clinical profiles, different utilization patterns and different sets of cost drivers.
Findings from UMR’s 2025 book of business data make the point in concrete terms: Health care costs rose 14 to 16% for the younger generations from 2024 to 2025, while Baby Boomer costs fell 6.5%.1 For a fund whose contribution rates are set at the bargaining table and often lag actual cost movement, that kind of divergence across the membership can be a structural planning issue.
A multigenerational membership
The generational mix inside a typical labor and trust fund is pretty balanced among Gen X, Millennials and Gen Z. Baby Boomers, however, now make up less than 10% of the workforce.1 Women represent 21.3% of the workforce but 88.2% of covered spouses — a reminder that dependent utilization is where much of the plan's female-driven clinical spend actually shows up.1
It’s critical to understand the distribution matters because utilization is not evenly spread across it. For instance, according to labor data, medical benefit utilization runs at 94% among women versus 81% among men. Pharmacy use climbs steadily with age, from roughly 493 patients per 1,000 among Gen Z to 737 per 1,000 among Baby Boomers.1
Office visits show an even sharper age gradient: Baby Boomers visit the office at 2.5 times the rate of Gen Z and post the highest emergency room utilization of any cohort. Millennials, by contrast, lead every generation in virtual care use at nearly 680 visits per 1,000 members.2
For a plan that must forecast claims activity against a fixed contribution schedule, these are lifestyle preferences and cost signals. Where care is delivered — ER versus office versus virtual — and how frequently it is used are among the most direct inputs into total cost of care, which in turn drives the reserve position that trustees are responsible for defending.1
Each generation carries a distinct clinical signature
The condition data is where the multigenerational picture becomes actionable. Chronic disease prevalence climbs sharply with age, but the shape of the climb — and the conditions that dominate at each stage — differs enough that a single utilization management or care coordination strategy cannot reasonably address all 4 cohorts.
Baby Boomers
Baby Boomers carry peak chronic load: 1 in 3 has hypertension and diabetes prevalence approaches 187 per 1,000. Baby Boomers also represent the highest rates in 7 of 8 tracked chronic conditions and drive the most intensive ongoing care needs in the plan.
Cancer follows the same age gradient but even more steeply. The Baby Boomer top-cancer rate is roughly 54 times the Gen Z rate, and their rates of skin cancer lead every other adult generation. Breast and prostate cancers climb sharply with age, which has direct implications for how screening benefits should be positioned and communicated across the membership.
Generation X
Gen X shows the cardiometabolic surge, with some of the highest rates of hypertension, diabetes and obesity. This generation has 3 times the diagnoses of hypertension and diabetes of its counterparts in the Millennial generation. It also has the most members with obesity across any generation. For a fund preparing its next actuarial evaluation, Gen X is the highest-leverage population for managed care intervention before members transition into Boomer-level utilization patterns.
Even though Gen X trails Millennials and Gen Z when it comes to behavioral health utilization, this generation experiences anxiety and depressive disorders at levels much higher than its Baby Boomer counterparts.2
Millennials
Millennials mark the inflection point. Not only do Millennials have more than 7 times the hypertension diagnoses when compared to Gen Z, Millennials also take the lead when it comes to musculoskeletal strain. Obesity takes hold a full decade earlier than the traditional risk curve would predict. This is the cohort where chronic disease management programs earn their return — before Gen X-level acuity sets in.
Behavioral health prevalence is also notably highest among Millennials at 232 per 1,000, with Gen Z falling close behind — nearly double the Baby Boomer rate, especially when it comes to anxiety.2
Generation Z
Among Gen Z members, pain and behavioral health lead the profile rather than chronic disease. Migraine and headache prevalence sits at 34.8 per 1,000 while hypertension registers at just 8.9 per 1,0002 — the lowest chronic burden of any adult cohort in the plan. This is the prevention window: the cohort where early engagement is most cost-effective because the downstream conditions have not yet taken hold.
When it comes to behavioral health, Gen Z comes in second to Millennials for utilization.2 This generation also stands apart for neurodevelopmental conditions and early self-harm signals, with suicide ideation reaching 5.4 per 1,000 in that cohort.2
Why this matters for reserves and bargaining
Multiemployer funds cannot easily adjust contributions in response to rising costs. Contribution rates are negotiated periodically and often lag any cost changes in collectively bargained plans, which means reserves must absorb cost fluctuations between bargaining cycles. That means that when one generation's costs are rising upwards of 14%, while another's are falling, the composition of the membership becomes a leading indicator of where reserves will be pressured next.1
A benefits strategy that treats the plan as a single risk pool — the traditional approach — obscures that signal. A multigenerational strategy surfaces it. Trustees who understand which cohort is driving pharmacy trend, which is driving behavioral health utilization and which is driving cardiometabolic claims can distinguish structural cost drivers from temporary fluctuations and manage proactively rather than reactively.
That distinction matters most at the bargaining table. When contribution rate discussions begin, the ability to point to a specific cohort-driven cost trajectory — rather than a plan-wide average — gives trustees and consultants a substantially clearer case for the funding levels required to protect reserves across the next cycle.
What a multigenerational benefit design looks like in practice
For multiemployer funds, a multigenerational design does not mean 4 separate benefit packages. It means calibrating the programs already in the plan to the cohorts that will actually use them:2
- Cancer screening should emphasize skin cancer prevention across all adult generations, breast screening for Millennials and Gen X, and prostate screening for Gen X and Baby Boomers — the cohorts where the underlying prevalence is concentrated
- Mental health programs should be built for Millennials and Gen Z first, addressing anxiety, depression and trauma at the prevalence rates those cohorts actually carry
- Suicide prevention requires targeted outreach for Gen Z, where ideation reaches 5.4 per 1,000
- Substance use programs should be positioned toward Baby Boomers and Gen X, where prevalence is highest, while ADHD and autism resources should be built out for Gen Z
- Chronic disease management delivers its highest return in the Gen X decade, before Baby Boomer-level acuity sets in
- Virtual care access should be preserved and expanded for Millennials, who use it at rates no other cohort approaches
A whole-person approach — addressing physical, mental, financial and overall well-being — supports this calibration by ensuring the plan is not measuring success on medical claims alone. Care may also be better coordinated when benefits and programs are integrated under a single carrier rather than fragmented across different vendors, which reduces the administrative complexity trustees face when reconciling utilization data across cohorts.
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