Managed Care - June 2008 - (Page 19)

LEGISLATION & REGULATION Plans Don’t Applaud Healthy Americans Act Sen. Ron Wyden’s bill promises to provide universal coverage without draining the federal treasury. Too good to be true? By John Carroll A A CBO report that his bill is fiscally practical was good news for Sen. Ron Wyden. universal coverage plan that has been gradually gaining the support of senators cleared a major obstacle recently, winning an opinion from the Congressional Budget Office that it could actually generate budget surpluses after it becomes fully operational. However, in analyzing the bill’s effect on the government budget, the CBO may have helped inspire some key modifications that raise lightning-rod issues for the managed care industry. The bill is Oregon Sen. Ron Wyden’s Healthy Americans Act. Wyden, an Oregon Democrat, teamed with Republican Sen. Robert Bennett to offer an ambitious plan to engineer coverage for all Americans by shifting from an employerbased insurance system to a federally subsidized individual approach that pools consumers into regional health plans with mandated benefits on par with what lawmakers receive. The news that it could be enacted without going billions into the red triggered a round of cheers from its many supporters on Capitol Hill. “If he’s really come up with a bill that’s fully funded, that’s significant,” says John Sheils, senior vice president of the Lewin Group and a key analyst who helped design the legislation. That was also the general tone of the news stories that greeted the analysis. Responded Wyden: “This is the first independent evidence that the health care system can be fixed without massive tax increases and boatloads of new federal spending.” Observers note that before the CBO analysts tackled the bill, the legislation was modified in a way that is likely to draw fierce opposition from anyone in managed care. In particular, critics point to an assumption that the governJohn Carroll, a freelance writer, has been a contributing editor of MANAGED CARE for six years. ment will collect insurance premiums through the tax system and a provision that the value of the least expensive plans’ benefits could not grow faster than gross domestic product, a rate that has traditionally lagged well behind health care inflation. To some in the insurance industry, that all adds up to a back-door approach to government run health care — a move that managed care companies have fiercely resisted for the past 15 years. Respect The outlines of the Wyden bill have been circulating in Congress for almost a year. Essentially, the bill mandates a minimum level of coverage based on the Blue Cross & Blue Shield plan offered to federal workers. Health plans would compete for members under regional exchanges called Health Help Agencies. The premiums for basic plans would be community-rated, eliminating the price spikes for highrisk patients but allowed to fluctuate by geography and smoking status. The government would contribute a sliding range of subsidies for people with incomes up to 400 percent of the poverty level. People could buy more extensive benefits, but they would have to pay for that out of their own pocket. Under the Wyden plan, employers would be allowed to back out of their traditional role as the key provider of workers’ health insurance, shifting the money they now spend on subsidizing insurance to workers’ payrolls. Companies would face a new tax, but pay far less than they do now for benefits. Medicaid and SCHIP would be essentially mainstreamed in the new system, with states expected to help cover the cost of the new program. The tax exclusion companies now enjoy for insurance would be replaced by a standard individual deduction. JUNE 2008 / MANAGED CARE 19

Table of Contents Feed for the Digital Edition of Managed Care - June 2008

Managed Care - June 2008 Editor’s Memo Contents Viewpoint Letters News and Commentary Legislation & Regulation Medication Management Compensation Monitor Plans Chart Course in Rough Waters A Conversation With Barbara Starfield, MD Smoke Signals from Payers Slow Going for Clinical Decision Support Back Pain and Physical Therapy Formulary Files PlanWatch Outlook

Managed Care - June 2008

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