 |
 |
 |
|
Benefits Business Universal health coverage Presidential candidates’ plans primarily call for better access to the private system By Len Strazewski “Access.” Learn the word, because your clients will be hearing it a lot in the coming months as each presidential hopeful introduces his or her own plan for universal health insurance coverage. Even though the plans require some federal funding and oversight, they all still lean on the private health insurance system and demand participation from employers. So far, Democratic frontrunners Senators Hillary Clinton (D-N.Y.) and Barack Obama (D-Ill.) have released a few details of their own plans to reduce the estimated 46 million uninsured. Though the plans differ in the details of how they would provide access to the existing health care system, both would require employers either to provide coverage to all employees or pay higher taxes for access to a publicly funded health plan. It may be several years before the national plans shake out through the legislative system but, in the meantime, more than 30 states are also debating proposals that would either require employers to provide coverage or demand that residents purchase individual coverage from traditional insurance markets. Though all of these proposals may be confusing and expensive for employers, they may also mean opportunity for agents and brokers. With all of these mandates brewing, now may be the time to suggest to your employer clients that they anticipate legislative change by modifying their own health benefits to provide broader health care access to employees—including workers who may not already be covered. There are several potential approaches. Consumer-directed health plans have received a lot of attention in the past several years but not a lot of participation yet; however, they have the potential to provide access at relatively low cost to employers. Employers can pay for a portion of the cost of the high-deductible health plan that provides catastrophic coverage for plan participants while employees fund their own HSAs through payroll deduction. Industry surveys estimate about 4 million active health savings accounts (HSAs) in 2006, up from about 1 million in 2005. However, Mintel, a consumer research firm with U.S. headquarters in Chicago, predicts the number of HSAs to jump to 30 million by 2009. The upside of the consumer-directed plans is the cost savings for employers and the tax benefits for employees. The downside is that lower-paid employees may find funding the accounts burdensome, even at the tax-incented rates. Some critics also fear that the ill-informed consumers may skip regular primary care or preventive care to avoid tapping their funded accounts. Another option for employers is more traditional health insurance plans that have been redesigned to attract more employees and their dependents—even those who are not presently eligible for benefits. A large health insurer and a third-party administrator recently announced plans for more flexible benefits packages that would emphasize preventive care for all employees and offer limited benefits to hourly, part-time or seasonal workers at managed care network prices. Great-West Healthcare, head-quartered in Greenwood Village, Colorado, recently launched the Universal Health Care Options plan that could be used to provide relatively traditional group benefits to full-time employees, but restructured to emphasize primary and preventive care with no deductibles and low office co-pays and high-limit protection against catastrophic claims. The new plan is designed to encourage higher levels of employee participation—which have been dropping as employee premium contributions have been rising. Affordability is the key issue for uncovered workers, says Great-West Healthcare Executive Vice President Rick Rivers. He cites a recent study conducted by the Washington-based Urban Institute, a non-partisan research organization, which says 30% of the working uninsured in this country have access to coverage but decline to participate due to affordability. The study indicates that over the past five years, employer health plan costs have increased more than four times the rate of annual salary and wage increases. And as portions of this cost increase are shared with employees, the percentage of Americans who participate in their employer’s health insurance program has dropped. Rivers says the new health plan design reduces overall costs 25% to 30% by building in higher deductibles and co-pays in the middle tier of health care claims—elective surgeries and advanced diagnostics—that are expensive but not acute or critical. “We are recommending that employers who choose this new plan use the savings to actually increase their contribution to employee premiums as an incentive to encourage employees to enroll in the coverage,” he explains. “Employers can also use the cost savings to contribute to the cost of supplemental coverage which employees can purchase to fill in the gap for the elective procedures or offer limited benefits to workers who are not now offered benefits.” Rivers says there is a growing interest among many employers to provide some form of basic health insurance to part-time, seasonal or hourly workers who do not generally receive group benefits. The plan design can be structured to offer limited benefits with lower maximums to these employees. “There are more than 46 million Americans without health insurance today, and there is little debate that these individuals need improved access to more affordable health plans,” says Rivers. “Our objective with this plan is to provide employers with some creative solutions to reduce the number of working uninsured in their companies and to implement programs to improve the overall health status of their workforce.” Susan Nicolai, director of marketing administration for Planned Administrators, Inc. (PAI), a third-party administration subsidiary of BlueCross BlueShield of South Carolina in Greenville, agrees. “I would argue that employers have a responsibility to make benefits available to all their employees—full-time, part-time, hourly and salaried,” she says. “A vast majority of human resource directors say that offering health care and other employee benefits is a critical factor in recruitment and retention, yet most of these executives say they do not offer a plan for part-time and hourly employees.” PAI recently introduced Essential Care, a limited benefit package or “min-mid” that provides many of the primary care features of more traditional plans. These features include out-patient coverage for doctor office visits with a small co-pay; hospital in-patient coverage, including the costs of minor surgery; prescription drug benefits; and preventive and wellness benefits. Though the plan has relative low maximum benefits ranging from $2,500 up to $10,000 for in-patient care and does not offer coverage for catastrophic claims, Nicolai says the plan introduces previously uninsured workers into networked health care and provides access to the less expensive world of primary care. PAI says the plan costs about $100 per employee per month and can be offered to employees with a small employer contribution or completely employee-paid through payroll deduction. Life insurance, short-term disability insurance and vision care can also be offered through the same program. * The author |
|
|||||||||||||
| ||||||||||||||
