SCIA workshop offers employers insight

It was one year since Congress passed a massive health-care reform bill to socialize medicine in the United States. The measure sparked a firestorm of debate, prompted rumor and added confusion to what was already at times a mysterious world of health-care coverage.

To mark the anniversary on Thursday, the South Central Industrial Association hosted a Healthcare Reform Workshop for members and other business leaders concerned about how new federal regulations might impact coverage for themselves and their employees.

“There is a lot more uncertainty about what’s going to take place in the future,” SCIA President Tony Alford said prior to the morning session at the Marriot Courtyard in Houma.

“Some politics have changed up in Washington, so there is some speculation. I think these folks are going to go over what we know and maybe a little bit about what they think might happen,” Alford said.

The primary speaker of the day was Michael Bertaut, a healthcare economist with Blue Cross Blue Shield of Louisiana.

Bertaut told those in attendance that the goals set forth by President Obama in his health-care package involved expanding coverage for an estimated 50 million Americans that do not have health insurance. It is intended to regulate insurance carriers on a federal level as well as already established state levels. And the health-care package was designed to reduce the cost of health care.

“We do evaluations and we are convinced that [the federal government] will have various degrees of success on these three things,” Bertaut said. “In all likelihood the bill will do a great job at expanding coverage. That’s pretty easy. All you have to do is spend money.

“It will also do a good job at regulating insurance carriers. We have an enormous amount of new regulations that we are trying to build into the industry that are being handed down from above. More than we’ve seen in the last 20 years all at once. So, it is a bit confusing for people,” he said.

When it comes to the actual cost of health care, Bertaut said that new federal regulations do little more than shuffle money.

Bertaut addressed some of the rumors before the session began. In particular he spoke to one concern that federal health care allotments would be offered per individual but when the designated amount ran out it would be up to the patient to pick up the rest of the tab.

“There has been a lot of talk about does the bill ration health care,” Bertaut said. “There is nothing in the bill specifically. There are some states [like] Washington and Oregon that have panels that run their Medicaid programs [and] make decisions about what treatments they cover and what treatments they shouldn’t. The Medicare plan for seniors already has a panel that does that. What they do is look at seniors and say, ‘That’s a good treatment for seniors, but this one is not.’ So, in a way there is high-level rationing going on already at the government and the insurance companies as well. As far as someone assigning a dollar value to healthcare for you, there is nothing like that.”

Bertaut told participants that as of 2014 many of the underwriting rules that are in place today will become illegal. This means that establishing rates by demographic such as age groups or people living in high risk situations will no longer be practiced.

“We will have to change the way we price insurance. It will be good for some and bad for others,” Bertaut said. “You have to price it without regard to health status. You may not even have health questions on an insurance application by 2014. Every policy has to have a neutral price based on gender.”

As a health-care economist, he gave the example of women between the ages of 19 and 50 typically having double the medical cost as men in the same age range. Historically, insurance has been priced accordingly, because the claims for females are much higher. Yet, as of 2014 gender pricing will be illegal. The same would apply for people with preexisting conditions.

“It’s really good for sick people, because people who wouldn’t be able to get coverage before because they were sick will be able to get coverage and it will be less expensive than it would be otherwise,” Bertaut said. “It is bad for healthy people because healthy people’s rates will go up to compensate for the money we are not going to get from the very sick.”

Bertaut confirmed that while preventive medicine has been a popular effort made on the part of medical professionals and insurance companies. The new health-care plan would increase the cost of being healthy with higher premiums.

Bertaut voiced concern that if the cost of health-care coverage makes people hesitant to build relationships with health-care providers, or if doctors are not making enough money to offer the kind of treatment a person needs, “Then populations get sicker, not healthier,” he said.

“Obamacare has already resulted in harmful impacts on Americans,” said Rep. Jeff Landry, R-New Iberia, separately from the SCIA meeting, “including raising health-care premiums and uncertainty for businesses.”

Landry charged that the health-care reform bill is really an added tax on Americans. Particularly those that will lose Medicare advantage plans and workers that could have benefits through their employers cut.

“We want to keep our membership up with everything and keep them informed so they know what to expect in the future,” Alford said. “I’d like to make sure [SCIA members] know the changes that have been made and are prepared not to be penalized in the future if they are not up to that, and also be aware and prepared for what possibly could come.”

Blue Cross Blue Shield Health Care Economist Michael Bertaut addresses participants at the South Central Industrial Association Health-Care Reform Workshop and clues them in on what they need to know while dispelling myths regarding federal health-care plans. MIKE NIXON