Changing the Conversation: Health vs. Healthcare

The statistics are foreboding: since 1980, growth in healthcare spending has outpaced all other consumer spending by a factor of nearly three, while increasing from 5% to 18% of GDP. Looking just 3 years ahead, this figure is projected to reach at least 22%.  Despite so much of the national conversation focused on managing “healthcare”, employers remain confronted with:

  • Healthcare renewal costs that are unsustainable
  • Plan design changes that have reduced benefits
  • Employee dissatisfaction with reduced benefits and increased costs

To understand why a shift in the national conversation from healthcare to health is necessary, one needs only to consider the implications of the data provided by our medical professionals:

  • Nearly 75% of Americans are overweight, and 33%  qualify as obese
  • Cardiovascular disease and stroke are now the leading cause of death
  • 17.5 million Americans will be afflicted with diabetes, and 25.1 million with cardiovascular disease
  • 1 in 3 children born after 2000 will develop diabetes by age 50
  • 29% of adults with high blood pressure are undiagnosed
  • 70% of all claim costs are the direct results of behavior
  • 74% of all claims are confined to four chronic conditions: cardiovascular disease, diabetes, cancer and obesity

For those business owners seeking real solutions to rising healthcare costs, we propose the need to change the conversation on how to improve the health of those who are employed.

Understanding that the cost of improving health is far lower than the healthcare costs associated with combating increased disease, companies must learn how to build a culture of health improvement and engage employees and families in order to achieve sustainability in healthcare costs. To do so, employers can take a “measures-based approach” to identify risk within the employee population, develop strategies to facilitate positive change among high risk individuals, and strategies to keep the healthy population healthy.

By learning and adopting new strategies that emphasize and reward employees and their families to embrace healthy lifestyle choices, employers can help employees and their families become far more efficient healthcare consumers, and move towards a zero trend health plan (for our next discussion).

Thomson Reuters Health Care Spending Index: Insurance Costs Climb 4.0% for Q3 2011 

Is Obesity an Infectious Disease?

Changing the Conversation: Health vs. Healthcare, is an editorial series designed to advance the health improvement model as a business strategy, supported by medical research, academic and corporate case studies. Scott Bradley is a Sr. Vice President with Cook, Hall & Hyde, Inc., a health and welfare advocate supporting middle market employers to design, implement and manage employee health improvement and insurance programs.     

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A Site Helping Consumers Understand Health Care Reform

This new site was established to help comsumers understand what the reform means for them.  This isn’t a goverment website!

The Health Care and You Coalition is made up of some of our country’s leading organizations that represent consumers, patients, physicians, nurses, hospitals and pharmacists. The goal is to provide the public with easy-to-understand information about the health care law. HealthCareandYou.org is a place where individuals, families, small business owners and health care professionals can turn for help in understanding the specific law and how it impacts them.

A New York Times article by Anahad O’Connor states, One poll released by the Kaiser Family Foundation last week found that about 20 percent of people believe — wrongly — that the law was killed when House Republicans voted to repeal it earlier this year, and 26 percent said they didn’t know enough to say whether it was still the law or not. While a bill to repeal the act was approved by House Republicans in January, it was seen as largely symbolic since a similar measure would be unlikely to clear the Democratic-controlled Senate. President Obama has also said he would veto the bill if it reached his desk.

This is a valuable resource for every American.  Please share with someone you love.

New York and New Jersey Establish “High Risk Health Insurance Pools”

The federal Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act, which together comprise the new federal health care reform law, were signed into law by President Obama on March 23, 2010, and March 30, 2010, respectively. The health care reform law contains a provision for the establishment of a temporary statewide insurance pool for high risk individuals.  Coverage through this program will be available until January 2014 when more health insurance coverage options become available through a Health Insurance Exchange.

New York

This new program is called the Pre-Existing Condition Insurance Plan (PCIP) and will be available throughout the country. In New York State, the PCIP plan is called the NY Bridge Plan, and is administered by Group Health Incorporated (GHI), an EmblemHealth company.

The NY Bridge Plan provides health coverage to individuals who have a pre-existing medical condition, have not had insurance for six months, and who are legal residents.

The NY Bridge Plan covers a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs.  Eligibility is not based on income and the Plan does not charge a higher premium because of a pre-existing condition.  Coverage for a pre-existing condition begins right away, with no waiting period.

Applications are available now with coverage effective October 1, 2010. for more information go to NY Bridge Plan

New Jersey

NJ Protect is a new health insurance option for uninsured New Jerseyans with pre-existing medical conditions. Coverage through NJ Protect will generally cost less than comparable individual health insurance and offer superior benefits. Because the program is federally subsidized, treatment for pre-existing medical conditions will be covered as of the day a policy goes into effect, and preventive care will be covered at no out-of-pocket cost to the policyholder.

Applications for NJ Protect are now available.  Contact Horizon Blue Cross and Blue Shield of NJ to request the application.  Please be sure to explain you are asking about NJ Protect so the customer service representative can quickly provide information for the NJ Protect options.  More more information go to www.HorizonBlue.com/NJProtect

Health Care Bill Update

On October 13, 2009, the Senate Finance Committee approved Senator Max Baucus’s (D-Montana) health care bill, the America’s Healthy Future Act, by a vote of 14 to 9. Senator Olympia Snowe (R-Maine) was the only Republican to vote with the committee’s 13 Democrats in favor of the bill. The Congressional Budget Office (CBO) estimated the cost of the bill at $829 billion over 10 years.

The bill will now be fully merged with Sen. Kennedy’s HELP bill with hands-on participation from Senate Majority Leader Harry Reid and key Administration officials. Some of the most contentious issues to be resolved in the merger include the fate of the HELP bill’s government option, the Finance Committee’s weak individual mandate penalties and new taxes and fees on the insurance industry.  

The stated aims of the legislation are to lower costs, provide quality, affordable health care coverage, make purchasing health insurance easier, prohibit discrimination due to health factors and improve the way the health care system delivers care. However, many in Congress are divided on whether the bill can meet these objectives. Opponents of the bill have argued that it will increase costs for many Americans, rather than making health care more affordable.  

Stayed tuned for MANY updates as this bill is vollyed about  the Senate and House.

BREAKING NEWS: AP Story on Increased Costs Caused by Senate Finance Proposal

The Associated Press is out with another story on the new PricewaterhouseCoopers’ report highlighting the increased costs for individuals and families as a result of proposals from the Senate Finance Committee.  Here are some key excerpts:

  • “…a new accounting firm study that projects the legislation would add $1,700 a year to the cost of family coverage in 2013, when most of the major provisions in the bill would be in effect.  Premiums for a single person would go up by $600 more than would be the case without the legislation, the PriceWaterhouseCoopers analysis concluded.”
  • The study projected that in 2019, family premiums could be $4,000 higher and individual premiums could be $1,500 higher.”
  • It concluded that a combination of factors in the bill — and decisions by lawmakers as they amended it — would raise costs.”
  • “Other factors leading to higher costs include a new tax on high-cost health insurance plans, cuts in Medicare payments to hospitals and doctors, and a series of new taxes on insurers and other health care industries, the report said.”
  • ‘Health reform could have a significant impact on the cost of private health insurance coverage,’ it concluded.”
  • the industry stopped short of signaling all-out opposition.  ‘We will continue to work with policymakers in support of workable bipartisan reform,’ Ignagni said in her memo.”

Full AP Article

Three New Federal Healthcare Mandates Will Impact Healthcare Costs

American’s with Disabilities Act (ADA) Amendments

    • Effective October 3, 2009 for all large and small groups.
    • Hearing Aids:
      • Coverage of hearing aids will be standard.
      • Dollar limits mirror Durable Medical Equipment (DME) and Prosthetics and vary by state and plan
      • Limited to one device as follows:
        • Connecticut every 12 months
        • New Jersey every 24 months
        • New York every 3 years 

 Mental Health/Substance Use Parity

    • Effective October 3, 2009 for large (51+ lives) groups.
    • The new law does not allow more restrictive financial requirements for mental health and substance use disorder coverage than for any other medical expense.
    • It specifically states that deductibles, copayments, coinsurance, and out-of-pocket expenses must be in parity.
    • A plan may still have an aggregate lifetime limit and an aggregate annual limit that is applied to both medical and mental health/substance use disorder benefits.
    • The law also prohibits treatment limits on mental health and substance use disorder benefits that are more restrictive than those of medical/surgical benefits. The law specifically requires the following limitations to be in parity:
      • Limits on frequency of treatment
      • Limits on number of visits
      • Limits on number of days of coverage
      • Other similar limits on the scope or duration of coverage.

 Michelle’s Law

    • Effective October 9, 2009 for individual plans, large, and small groups.
    • Prevents dependent children covered under a group health plan from losing coverage if they are forced to take a medically necessary leave of absence from school

Obama No Single Payor Health Care System

On September 15, 2008 Staten Island University Hospital agreed to return $88.9 million that prosecutors say it fraudulently obtained from government health insurance programs, one of the largest settlements of such a claim ever paid by a single hospital.  This is the fraud that will continue under a single payor health care delivery system. 

 

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