Managed Healthcare Executive - January 2009 - (Page 15)

upfront investments in healthcare will save money over the long run. Republicans and conservative Democrats are leery about creating permanent health programs that will ratchet up the federal de cit beyond the $1 trillion level already anticipated, however. New entitlements, they say, could require new taxes, which could have an adverse e ect on the economy. Widespread public enthusiasm for health reform has prompted a change in tune among insurers and MCOs that want a seat at the table. Now health plans are proposing market reforms in response to intense public complaints about costly premiums and coverage denials related to pre-existing health conditions. “Emotion aside, it has to come down to the facts and the data,” says Martin Hauser, president of SummaCare in Ohio. “The insurance industry has that. The problem the industry has faced for years is lack of credibility. Moving forward, the proposals are a positive sign in attempting to gain credibility.” America’s Health Insurance Plans (AHIP) and the Blue Cross and Blue Shield Assn. (BCBSA) announced in November support for guaranteed issue for all individuals—provided it comes with an enforceable mandate for individual coverage. BCBSA President Scott Serota says requiring insurers to accept everyone regardless of health status has to be linked to required individual coverage in order to spread the risk over a broad and representative population. Otherwise, the unintended consequences are higher premiums for everyone. An individual coverage mandate goes further than Obama’s reform plan promoted during the election campaign. In an e ort to di erentiate his policy, Obama called for mandated coverage for children only, leaving open the potential for a broader mandate later. Who are healthcare’s new political leaders? President-elect Barack Obama signaled his serious push for reform by nominating former Senate Majority Leader Tom Daschle to head a new White House Of ce of Health Reform, while also overseeing HHS. Daschle will strive to avoid yet another case of reform promises “derailed by Washington politics and in uence peddling.” Daschle was an early backer of Obama’s campaign and will use his legislative experience to move health reform legislation through Congress. Since the former senator from South Dakota lost his seat in 2004, he has been a partner with a Washington law rm that serves healthcare clients. Daschle also served on the board of the Mayo Clinic and has been a fellow of the Center for American Progress. His appointment drew criticism, but most recognize that his consummate political skill will be needed to enact reform legislation. Jeanne Lambrew will be deputy director of the White House reform of ce. Lambrew, a well-known health policy expert, was an aide to the Clinton administration and recently co-authored a book with Daschle, “Critical: What We Can Do about the Health-Care Crisis.” The reform effort also will gain support from the Of ce of Management and Budget, which will be led by Peter Orszag, former director of the Congressional Budget Of ce. Orszag has emphasized that the rising cost of health services and products—not an aging population—is the main factor for the steady climb in healthcare spending. “Obama is talking about the right thing, but my fear is that the insurance paradigm is going to be replicated,” says Hudson Health Plan’s Chapin. “Not the managed care part—I love managed care—but what we need is a care paradigm, not an insurance paradigm.” She believes that covering children has historically been a low-cost proposition, but cautions that a broad mandate could lead to a program of watered-down bene ts. The government and other sponsors would simply be throwing their money away to give everyone an insurance card that entitles them to few bene ts and little actual care, she says. ESSENTIAL BENEFIT PLANS A coverage mandate that continues current ine ciencies will not lead to a sustainable system, according to Mark McClellan, former CMS administrator, former FDA commissioner, now with the Brookings Institution. Insurers must “come up with plans that are affordable enough that people will want to sign up.” Insurers, however, don’t support the employer mandate that Obama and Democrats o er under the pay-orplay approach. Health plans prefer to use carrots instead of sticks in the form of low-cost policies, appropriate subsidies and tax breaks. AHIP proposes establishing “essential bene t” plans that would be available on a national basis to small companies and individuals. That approach would require an exemption from varying state bene t mandates and a shift away from disease state requirements. Basic plans would cover primary and preventive care, chronic conditions, and emergency room and hospital services, and would be at least actuarially equivalent to the minimum federal standard for a highdeductible health plan. An important plus is that these plans would be portable and provide coverage for individuals changing or losing jobs. JANUARY 2009 15

Table of Contents Feed for the Digital Edition of Managed Healthcare Executive - January 2009

Managed Healthcare Executive - January 2009 Contents Editorial Advisors For Your Benefit News Analysis Politics & Policy Letter of the Law Managed Care Outlook New Day 5 New Realities of Disease Management Pharmacy Best Practices Health Management Technology State Report: Hawaii MHE Resource Ad/Edit Index

Managed Healthcare Executive - January 2009

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