IN THIS ISSUE:
IN THIS ISSUE:
? Join Health Benefits Reform Discussion List
? Keeping Government Out of Benefits Mandates
? Tax Credits Debated in Florida
? Losing the War on Health Costs
? Unions to Resist Cost-Sharing
? Taxpayers to Subsidize Big Business Benefits?
? Urban Institute Examines SCHIP
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Keeping Government Out of Benefits Mandates
?Managed Healthcare Executive? includes a very interesting interview with Mike Cascone, the CEO of Blue Cross Blue Shield of Florida. The article quotes him as saying the most important issue in health care is, ?Keeping the government out of benefits definition, and allowing people to shape the marketplace according to the benefits they want.? He adds that mandated benefits have ?forced (people) into buying the Cadillac package of benefits.? The author of the article manages to equate consumer choice with ?Darwinism? and ?survival of the fittest,? but Mr. Cascone?s commitment to empowering consumers comes through. ?We have to find a way to give consumers greater choice and control over their own health care decisions,? he says. ?No matter how wonderful a product you create, if you force people into it, they?ll be unhappy.?
Tax Credits Debated in Florida
While we?re in Florida, John Dorschner of the “Miami Herald” writes about local reaction to tax credit proposals. He points out that, while Democrats are all over the board with reform proposals, ?most Republicans are united behind a simple alternative: Give consumers tax breaks that would allow them more control over their medical spending.? He quotes Cato?s Tom Miller as saying that putting ?buying power into the hands of the consumers ? can change a lot.? But the article also cites one local resident who says ?it?s not going to solve my problem.? He got a quote from Humana for a family premium of $1,180/mo, with a $1,000 deductible. [Is it just me, or is there something odd about rebutting a reform proposal by finding one person who will not be helped? Nowhere in the article does it mention the numbers of uninsured who would be helped ? estimated by Mark Pauly as up to 80 percent of all the uninsured.] The rest of the article is pretty good, including mentions of the AMA, CAHI, and Heritage supporting tax credits, balanced with criticisms from Mike Hash, Karen Pollitz, and Brian Klepper. Ms. Pollitz is quoted as saying, ?the individual market is never going to be any good.?
Losing the War on Health Costs
John Torinus, the CEO of Serigraph, Inc., reflects on the ?health care quandary? in the ?Milwaukee Journal Sentinel.? He wonders if we are ?winning or losing the war? on health care costs. He says there is plenty of evidence that we are losing, including a 20% premium bump for his own company this year, state budget deficits due largely to medical costs, rising ?labor strife over the sharing of medical costs,? and small businesses dropping coverage due to rate increases. He cites one estimate of medical expenses reaching 83% of total pay by 2020. On the other hand, he sees ?consumer-driven models,? and medical quality improvements as potential victories. He?s especially impressed by some local companies that are working on automating medical records that should save money and reduce errors.
Unions to Resist Cost-Sharing
Speaking of labor strife, Maria Perotin writes in the “Ft. Worth Star Telegram” that, ?This year, unions across the country are battling for cheap prescriptions and frequent doctors visits.? She says Machinists at Lockheed?s Ft. Worth division walked out for two weeks in April to protest an increase in Rx copays. They came back only when the company relented. She cites Hewitt in saying that national per-employee costs have soared to $6,295, up from $3,692 in 1998, and companies are ?trying to pass along more of the expense to workers.? Rick Bank, an AFL-CIO spokesman, says health care is ?the number one issue in most negotiations.? Marianne Fazen of the DFW Business Group on Health says some union workers have only a $3 copay for drugs, while non-union workers are paying three times that much. The article goes on to say that 75 percent of union workers have health coverage, while only 49 percent of non-union workers do, and 46 percent have the entire premium paid by the employer, compared to just 14 percent of non-union workers. Ms. Fazen says, ?Because (union workers) have been shielded for so long from (the cost of) their very, very rich benefits, they are going through absolute sticker shock when their costs are increased even the slightest amount.? Mr. Bank said that workers who ?have a strong union that?s capable of paralyzing an employer with a strike? will probably maintain their benefits, ?but there are also likely to be tradeoffs in terms of lower wages.?
SOURCE: The article ran on May 11, 2003. There is a fee for accessing it at:
Taxpayers to Subsidize Big Business Benefits?
Writing in “Business Week,” Howard Gleckman says there are three approaches to health reform ? a ?government-run system? favored by many Democrats, an ?individual-based? system which is ?a darling of the conservatives,? and ?a third way? which is ?built around employer-based insurance.? He adds, ?there?s a consensus emerging among Democrats that the problem of the uninsured should be fixed by requiring employers to cover all their workers while easing the costs with subsidies.? He says, ?Large corporations such as General Motors? would love some help from Uncle Sam. And many big companies would benefit from an employer mandate that forced rivals to provide full coverage, too.? [So, we taxpayers will end up subsidizing General Motors because the company has been ineffective in resisting union demands for expanded Cadillac benefits. Sounds about right].
SOURCE: The article is in the May 19, 2003 edition. There is a fee for accessing it at: http://www.businessweek.com/
Urban Institute Examines SCHIP
The Urban Institute has released a number of updates on the State CHIP programs. Written by Amy Westpfahl Lutzky and Ian Hill under a grant from HHS, the papers delve into some interesting, if technical, areas of the program. Number 65 looks at Premium Assistance Programs under SCHIP in Massachusetts, Mississippi, and Wisconsin and finds that the federal requirements aimed at avoiding ?crowd-out? made the programs extremely difficult to implement. The states studied discovered that premium assistance reduces the problem of crowd-out compared to direct coverage public programs, because premium assistance encourages enrollees to stay with their employer?s coverage.
Number 66 looks at enrollment issues in eight states, and finds that most of them have simplified enrollment for SCHIP, but not for Medicaid. ?Less than 50 percent of applicants were approved for SCHIP eligibility,? say the authors, though many of these were kicked over to Medicaid. There is a downside to some of the simplified enrollment processes, according to the findings. For instance, many of the applicants who mail-in the applications are turned down because they don?t fill out the applications correctly or did not supply supporting documentation.
Paper Number 67 is called ?Is There a Hole in The Bucket?? and looks at problems of retention in the program. It finds that fewer than half of enrolled children stay on the program at renewal time. There are many reasons, including loss of income that makes them eligible for Medicaid, increases in income that make them ineligible for the program, parents failing to send in the paperwork for a variety of reasons, and parents failing to pay whatever premium is required, again for a variety of reasons. Once again, we are finding that the uninsured, and the American people generally, are a whole lot more mobile and dynamic than Washington policy-makers seem to think.
Paper Number 65: http://www.urban.org/urlprint.cfm?ID=8394
Paper Number 66: http://www.urban.org/urlprint.cfm?ID=8395
Paper Number 67: http://www.urban.org/urlprint.cfm?ID=8396
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