IN THIS ISSUE:
? Consumer Driven Conference in Nashville
? Washington Post on Open Enrollment Choices
? “Bowling Alone” Medicine?
? USAToday on Open Enrollment Decisions
? KC Star on Open Enrollment Options
? New Individual Plan from California Blue Cross
? Large Employers Leave Many Uninsured
? “Uninsured Catastrophe”
Consumer Driven Conference in Nashville
We are going to skip an issue next week. I’ll be speaking in Nashville at the CDHCC conference, sponsored by the Emergent Group, from Sunday through Wednesday. This is the same group that organized the conference in Las Vegas last spring. I’ll report on it in the next issue.
Washington Post on Open Enrollment Choices
All of this consumer driven stuff has really taken hold in the mainstream media. The “Washington Post’s” Health Section last week had a pretty big article advising readers on how to cope with their new cost-sharing responsibilities. Francesca Lunzer Kritz explains to readers that they need to look not just at premiums, but all of the potential out-of-pocket costs. She cites Aetna’s standard and high options under FEHBP as an example. The standard option costs $750/year less and only has an office visit copay that is $5 more than the high option, and more cost sharing for the first three days of a hospital stay. Aetna spokesman Tom Bernatavitz says he is puzzled that more people don’t choose the standard option. The article also suggests setting up an FSA, taking more control over Rx purchases, asking doctors for cash discounts, and looking into consumer driven plans. The article says Aetna will join the Postal Workers in making HRAs available to federal workers in 2004, and cites Benemax’s David Cowles as predicting 3 million people will be in consumer driven plans by the beginning of 2004.
“Bowling Alone” Medicine?
In the same issue, Abigail Trafford is not so impressed with all the hullabaloo over consumer choice. She says the uninsured don’t have choices, and neither do people working for small employers. Medicare has some choice of plans, but “the once-eager HMO plans – awash in red ink – started to pull out?” She says choice is “rhetorical cover for a major shift in civic values?. This is ‘Bowling Alone’ medicine, and erosion of the social contract that binds the individual to the larger community.” My goodness. We wouldn’t want individuals to be unbound, would we?
USAToday on Open Enrollment Decisions
Writing in “USAToday,” Sandra Block is also concerned about open enrollment season this year. She describes consumer driven plans in some detail, and quotes Aetna’s Ron Williams as saying, “The power of these products is that it gets members thinking as a consumer?” But she also notes that “critics counter that some workers will forgo medical care if they can’t afford the higher out-of-pocket costs.” She suggests people compare the premium savings to the added OOP responsibility and says some workers in Humana’s plan have saved 50% of their premium cost. She also says consumers should look at the coverage of preventive care and chronic conditions. She wraps up by quoting Kaiser Family Foundation’s Gary Claxton as saying, “The expectation is that you will actually ask questions and make cost-effective choices and that takes time.”
SOURCE (there is a fee to access this article): http://pqasb.pqarchiver.com/USAToday/435081361.html?did=435081361&FMT=ABS&FMTS=FT&desc=Health+costs+scare+up+a+new+option+
KC Star on Open Enrollment Options
The “Kansas City Star” also has advice for people during open enrollment season. Rising costs “add up to more expenses, paperwork, worry – and anger,” according to reporter Julius Karash. He recommends that people take advantage of flexible spending accounts when they can, and look at consumer driven plans, although “this option is not widely available yet at many Kansas City area companies.” FSA administrator Miles Ross is quoted as saying, “We’ve seen a huge growth in the number of employers offering FSA plans.” He adds “employees can save $25 to $40 in ? taxes for every $100 they contribute to the accounts.” The article says Blue Cross Blue Shield of Kansas City will be offering a consumer driven plan beginning January 1, 2004. But Trudy Lieberman of Consumers Union says, “We are not in favor of these consumer-driven health plans.”
New Individual Plan from California Blue Cross
The “Sacramento Bee” reports on a new individual product from Blue Cross of California. Called RightPlan, it has monthly premiums as low as $70, but requires a $40 physician copay and 40% coinsurance for hospital stays. Tom Morrison of the Segal Company says, “Consumers will learn they have to pay one way or another. They can pay on the front end to save money when they see a doctor, or they can delay expenses by paying low premiums and accepting that high co-payments and deductibles go with the territory.” But Anthony Wright of Health Access says they “keep diluting the value of insurance. The point of insurance is to not worry about your bank account when you go to the doctor?.”
Large Employers Leave Many Uninsured
In “AMNews”, Joel Finkelstein writes that things are not cheery for large employers either. He cites a Commonwealth Fund study that notes 9.6 million of the uninsured work for companies with 500 or more employees. These tend to be low-wage or part time employees. Commonwealth’s Cathy Shoen says, “Large employers have been the bedrock of insurance for the under-65 population?” But the AFL-CIO’s Gary Shea says, “This study documents what working families have known for some time, which is that working at a large firm doesn’t at all guarantee that you will have affordable health coverage.” And Dr. James Rohack, AMA Chairman-elect, says that is one of the reasons the AMA prefers individual tax credits, “The AMA has long advocated for a system of individually selected and owned health insurance where employers could contribute to their employees’ health plan of choice.”
An article by Don Reichardt in the “Atlanta Business Chronicle” calls it an “Uninsured catastrophe.” He notes how the numbers of uninsured have risen in the past year as costs have increased, but he cites EBRI’s Paul Fronstin as saying the real culprit is job loss. He says, “People are losing jobs and access to employer-based health insurance. I think this is more economy-driven than cost-driven.” The article mentions that some laid-off workers, including as many as 125,000 in Georgia, will be getting help through the TAA tax credit, which will pay 65% of the cost of coverage for “displaced” workers. The article goes on to cite some state actions, including Oregon’s initiative (that lost four to one) and California’s new employer mandate. But most interesting to the writer is a program in Muskegon County, Minnesota that shares costs between employers, employees, and “the community.” Mr. Fronstin says EBRI will be studying this program carefully. Most of the article focuses on problems in Medicaid and SCHIP, including the programs in Georgia. Georgia managed to avoid cutting PeachCare for Kids, but the program is facing shortfalls of $18 million in state and $63 million in federal funds. The governor is promising a 10% cut in physician payments under Medicaid for 2004. Mercer Human Resources has been working on a proposal that includes all stakeholders, according to spokesman Lew Yeouze. He says, “Nothing short of new ways of looking at health care will work.”
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