Reform by Any Other Name
Healthcare Reform Panel
Prescription for Change
Not a Bitter Pill
Cut Out the Middle Man
As the Affordable Care Act inches closer toward reality, many questions persist regarding how the changes will impact employers and individuals. Hear from industry leaders as they discuss the many challenges and issues associated with reform.
Participants (pictured left to right):
Chet Loftis, PEHP
Lieutenant Gov. Greg Bell, State of Utah
Patty Conner, Avenue H
Rachel Reimann, SelectHealth
Patricia Berridge, Stealth Partner Group
Jason Williams, Stealth Partner Group
Ana Sabatino, Cigna Healthcare
Dr. Sean Mulvihill, University of Utah Health Care
Mark Selman, Tall Tree Administrators
Susan Grassli, GBS Benefits
We’d like to thank Chet Loftis, executive director at PEHP, for moderating the discussion.
MODERATOR: Lieutenant Governor Greg Bell, could you talk about the state’s position on reform-related issues?
BELL: Well, we were one of the plaintiff states that joined in the suit to hopefully overturn the Affordable Care Act, and as you know, we were not successful. Politically, ACA is not what we would have designed.
Obviously, there are two huge issues relative to health insurance: access and cost. We feel like the ACA concentrated almost entirely on access and did very little for cost except to increase it significantly. But still, this is the context where we live, and so creatively and positively we are trying to move forward with that.
It brings a host of issues for us to resolve, as well as issues for you to address. Some of the important ones are what do we do with our exchange? Second, what do we do with Medicaid? Third, as a very large insurer with 22,000 lives, we are very interested in the cost of health insurance, the quality of benefit, the cost to our employees as well as ways of saving money—HSAs, et cetera.
We all know that the way we fund medical care has lost the incentive for people to try to save their own money because it is often not their own money. So hopefully as we redesign the health system, we can put the consumer in touch with the cost and certainly HSAs and other mediums will do that.
The Massachusetts exchange and the Utah exchange have been the bookends—the Blue state and the Red state. In the laboratories of democracy, the 50 states, we are completely opposite of what Massachusetts has done. The guiding principles we have adopted are, number one, that this be economically driven. And number two, we want to facilitate defined contribution, we want to facilitate individual choice, we want to be a facilitator of lesser costs and more control with the consumer; and particularly, we want to assist small business in helping them address the needs of their employees by providing health insurance in a way that will still allow an employer to afford a good policy but not price them out of business.
Our experience in the market has been that as health insurance got more and more expensive, employers reached a point like a plane in stall. In other words, you’d think a plane in a linear fashion would reach its power point, and when it loses that then it would start to level off until it reaches power equilibrium. Well, that doesn’t happen. It reaches stall, and all of the sudden the plane falls out of control. And that’s what we have seen with small employers—they hit $492—and $491 was OK, but $492 was just the sign that “we’re done.”
So we found that people were jumping out of the market and it was hard on the employers, especially hard on our consumers, and really tough on our providers and our state. So we were hoping that the exchange, through defined contribution, will really allow small employers to stay in the market and provide benefits.
Our relationship with HHS has been somewhat rocky. As we talked to the nonpolitical people, as we talk wonk to wonk, they have been very open about saying, “We want to facilitate what you need to do. We want to help Utah do what it wants to do and do what it does best.” You saw the report on the cost of our healthcare relative to the rest of the nation. We do so many things right here; other states, and particularly the federal government, if they are not willing to learn from us, at least they ought to say, “Well, you can govern yourselves.”
But every time we push an issue to the political level to actually get something in writing, then we are referred back to the laws and the regs. And we have not been highly successful so far in obtaining waivers.
Now, the story with the exchange was one encouraging thing. We interfaced with the Secretary and her people, and the governor had said, “We would like to continue our exchange. However, we are unwilling to create an exchange that departs from our essential fundamental principles on which the exchange was founded.” Our exchange predates Obamacare. We were doing this before anybody thought about it. So he said, “We were here first and we have to have these, these are non-negotiables.”