Current Health Care Strategies Target Access, Affordability–Yet Again

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A review of recent health care funding developments suggests most are addressing two issues: access to care and lower costs.

These are not new issues. Given that an estimated 41 million Americans have no health insurance coverage and that private health care insurance premium increases are in the double-digit range, public discussion over accessibility and affordability has been ongoing.

What is new, in 2003, are the strategies players are using to address the issues.

On the governmental level, both houses of Congress have recently passed legislation–S. 1 and H.R. 2596–that would put prescription drug coverage into Medicare for the first time ever.

These proposed plans are not without problems (see NU, July 14, 2003, page 19). But if the two chambers resolve the problems and if President Bush signs the legislation, 40 million seniors now in Medicare will gain increased access to prescription drug coverage, making the drugs themselves more affordable for many.

The House bill also targets cost savings in another area. It calls for tax deductibility of money contributed to health savings security accounts and health savings accounts.

States are making accessibility and affordability moves, too. For example, Illinois has expanded eligibility for its KidCare and FamilyCare programs. These programs provide comprehensive health care coverage to low income families and children, with funding shared with the federal government. Other states have similar programs.

As for the private sector, some initiatives there target ways to minimize the sting of double-digit cost increases in group medical plans.

Many carriers, for example, have debuted so-called consumer-driven health plans (CDHPs). These typically combine high-deductible medical insurance with reimbursement accounts (that employees can use to pay noninsured medical expense). The high-deductible component makes them controversial in the eyes of some critics, but the developers say employers are interested in seeing the designs due to the lower costs they entail.

These products “help employers hold down health benefit costs, while also offering consumers more choice and control,” contends Brad Utoft, vice president and product manager at Mutual of Omaha, which recently added a CDHP to its portfolio of medical plans.

The Mutual of Omaha offering includes informational services to help employees make medical decisions, Utoft points out. These include online access to medical claims status, balances in reimbursement accounts and prescription drug information.

Although the plan has a high deductible, its prescription benefit has a separate smaller deductible, Utoft points out. This should help ensure that the chronically ill can afford to continue buying their prescriptions, he says. Other features include nurse support services, debit card payment and an employee assistance program.

Even though cost control is an important aspect of CDHPs, Utoft cautions against viewing the product as the “silver bullet” for cost concerns.

These products approach health care in a different way than traditional health plans, he says. Therefore, consumers need to be more engaged with the cost of the medical services they seek than in traditional plans. In HMOs and PPOs, most people do not know the cost of an office visit or a prescription drug, Utoft explains. People just go to the doctor or hospital, show the medical card, make the co-payment and then forget about it, he says.

But that is not the way it works with CDHPs. These products have a large deductible and no co-pays, Utoft says. Insureds do have a health care reimbursement account from which they can draw to pay for noncovered expenses, he says, but people will choose carefully about when to use that account and for what. In short, they will be paying more attention to the costs of their choices, he predicts.

Another cost-conscious strategy is a multi-discount card from Fortis Benefits Insurance Company, Kansas City, Mo. Called HealthySolutions, it is actually a noninsured product, says the company. Available to employees at companies offering Fortis Benefits voluntary life or disability insurance plans, it provides discounts for various services–vision, nurse hotline, counseling, pharmacy, chiropractic, travel assistance and legal advice.

Insureds in Fortis voluntary plans get one of those eight discount programs free, says Neal Lucchi, vice president-worksite marketing. They can buy any or all of the other programs, too, for a nominal monthly cost (roughly $2 per program per employee). Even employees who do not own the Fortis voluntary products can buy the discount options, he adds.

This way, Lucchi says, employees can have the discounts they want “without paying for programs they dont need.”

This is not insurance, and it is not tied to a medical insurance offering, he says. But it does help employees deal with the benefit cutbacks many are seeing in their medical insurance plans.

“And it does this by giving employees choice, with no cost to the employer,” adds John Suddeth, project manager.

Meanwhile, the Blue Cross and Blue Shield Association of Chicago, says Blues plans countrywide are working with hospitals and physicians to design contracts that reward better quality care.

It made that statement in reacting to a new report showing that health care costs rose 9.6% in 2002. The report was released by the Center for Studying Health System Change, a policy research group in Washington, D.C.

Rewards for quality care lead to better health for consumers, with greater efficiency and affordability, contends the Blues association. To keep health care affordable, “we must have a clear understanding of what is driving health care costs,” adds the association.


Reproduced from National Underwriter Life & Health/Financial Services Edition, August 4, 2003. Copyright 2003 by The National Underwriter Company in the serial publication. All rights reserved.Copyright in this article as an independent work may be held by the author.