Managed Care - July 2008 - (Page 11) NEWS AND COMMENTARY Insurance Connector Key To Newly Proposed Health Plan he Commonwealth Fund has advanced a plan that it says would insure 44 million of the estimated 48 million uninsured Americans and would offer new health insurance choices to individuals and small businesses for 30 percent less than what employers pay now. Dubbed the “Building Blocks” plan by the Commonwealth Fund, it would preserve employer-sponsored health insurance, Medicaid, and the State Children’s Health Insurance Program (SCHIP), and would offer a Medicare-like option along with a choice of private health plans through a national “health insurance connector” or a purchasing cooperative that is modelled after the Massachusetts plan. The connector would be open to small businesses, the self-employed, and everyone without large employer insurance or Medicare. According to the article “Building Blocks for Reform: Achieving Universal Coverage with Private and Public Group Health Insurance” the plan could save $1.6 trillion over 10 years if it is coupled with efforts to reform how the United States pays for health care. The plan proposes to use a national entity called a connector that could offer individuals and small businesses a choice of private plans or a Medicare Extra plan. Medicare Extra is a proposed new insurance product with benefits similar to those in the Federal Employees Health Benefits plan. About 60 million people would get their health insurance through the connector, most as a result of small businesses deciding to buy into the connector and its plan choices. About 14 million would be previously uninsured and an additional 1.2 million would be individually insured who switch to the connector. In addition, the plan would require that all applicants receive health insurance with premiums that are community rated, i.e., the rates are the same for all enrollees in a given plan regardless of age or health status (insurers would decide what premium to charge); tax credits to help make premiums affordable; and expanded Medicaid and state CHIP coverage for low-income adults and children. The proposal would also require employers to either provide health insurance or pay seven percent of earnings up to $1.25 an hour into a pool to help finance coverage. “If a typical worker made $40,000 a year, the employer would be contributing $2,800 a year,” says Karen Davis, president of the Commonwealth Fund. Details of the plan and its framework are published in the May/June issue of Health Affairs. T such as atorvastatin (Lipitor), fluvastatin (Lescol), pravastatin (Pravachol), and simvastatin (Zocor). Further, the average annual personal expenditure for statins increased about 37 percent ($484 and $661, respectively) during that time period. The number of prescriptions purchased for statins nearly doubled from 2000 to 2005, rising from 89.7 million to 173.7 million. The number of persons purchasing a statin increased 88 percent from 2000 to 2005, rising from 15.8 million to 29.7. Workplace Wellness Programs Proliferate Despite a lack of evidence to show a return on investment, health and wellness programs in the workplace are now common, according to the Center for Studying Health System Change. For more details about how employers are encouraging employees to sign up or continue with their wellness program, see our Outlook column on page 56. The driving force for these initiatives has come from large employers looking for long-term strategies to address rising costs and to give employees more responsibility for health care decisions and costs, according to “Health and Wellness Initiatives: The Shift From Managing Illness to Promoting Health.” “We heard from employers and health plans that health and wellness activities are the right thing to do,” says HSC senior fellow Debra A. Draper, PhD, coauthor of the study. The investment payoff for these programs has been difficult to demonstrate. Several health plan respondents said in the report that “it takes at least three to five years to have Statin Spending Up 156 Percent Spending on statins increased 156 percent between 2000 and 2005, according to “Trends in Statins Utilization and Expenditures for the U.S. Civilian Noninstitutionalized Population, 2000 and 2005,” issued by the Agency for Healthcare Research and Quality. In 2000, outpatient prescription expenditures for statins amounted to $7.7 billion. That rose to $19.7 billion in 2005. Statins include drugs JULY 2008 / MANAGED CARE 11
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