Health industry changes: ‘Whatever you thought you knew, you don’t know anymore’

ELGIN — How fast are changes coming in America’s complex system of providing and paying for medical care?

When it comes to insurance and paying for care, “whatever you thought you knew, you don’t know anymore,” Craig Rodrigue of the Association of Mature American Citizens said during an all-day Health Care Leadership Forum that drew about 50 people to Elgin Community College Thursday.

When it comes to new ways to fight disease, Central DuPage Hospital President Brian Lemon said one colleague spends a whole hour every morning just reading up on what new developments have been reported in the field of molecular diagnostics over the past 24 hours.

U.S. Rep. Randy Hultgren, R-Winfield, convened the forum, which centered on three panels of experts talking about the impact of the Affordable Care Act (the ACA, or “Obamacare”), new technology in medicine, and barriers that limit access to care. Hultgren said it was the third such community forum he has led, the first two having dealt with heroin and narcotics abuse and the impact of Common Core Standards on education.

Hultgren began by stating his own position on the ACA: that it should be replaced by allowing people to buy insurance across state lines, limiting malpractice lawsuits, allowing people to save for their own health expenses in tax-free savings accounts, attacking fraud in Medicare and Medicaid, and allowing small businesses to pool together so they can buy employee insurance with increased buying power.

The panelists discussing the ACA also seemed to come mainly from the conservative side. Three were insurance brokers or insurance company executives and one an official of the National Federation of Independent Businesses. One, Rodrigue, was an insurance specialist for AMAC, which began as a politically conservative alternative to AARP.

No more small policies

One of the biggest consequences of the ACA, Rodrigue said, is that “small-employer health insurance policies are going away and they’re going away fast.” He said large corporations may continue to buy insurance on behalf of their workers, but ACA provisions make it prohibitively expensive for small businesses to buy insurance for their employees. He said employees usually can buy it much more cheaply for themselves on the new federally subsidized state and federal exchanges.

Another unintended consequence in Illinois, according to insurance broker Steven Tucker, is that the Blagojevich administration and General Assembly moved to guarantee health care for all Illinois children by making families earning as much as $83,000 a year eligible to treat their children through Medicaid. But now that the ACA is in effect, any child eligible for Medicaid is ineligible to buy insurance through the subsidized exchanges. While Illinois parents of such families can sign up through the exchanges, their children must sign up for Illinois Medicaid.

Tucker said that doesn’t provide nearly as good care as a regular insurance policy, it embarrasses the parents and it wastes taxpayer money.

Not-for-profit

Jason Montrie said one new player in the local arena will be Land of Lincoln Health, one of 24 not-for-profit “COOP” (“Consumer-Oriented and -Operated Plan”) health insurance companies set up under the ACA. Montrie said that during open enrollment last fall, before Land of Lincoln went into business, 92 percent of people who signed up for the insurance-exchange policies chose policies from Blue Cross/Blue Shield, because its policies tended to be the cheapest and the company is well known. But he said he expects his COOP to be more competitive when the next open enrollment season starts on Nov. 15.

Uninsured individuals must sign up between Nov. 15 and Dec. 15 to be covered by Jan. 1. The open enrollment period will end altogether on Feb. 15, 2015, so that people don’t wait to sign up for insurance until they are already sick.

Another unintended ACA consequence, Rodrigue said, comes from the federal law’s rule that insurance companies must use at least 80 percent of their income to pay claims, leaving just 20 percent of the premium for overhead and profit.

First, he said, that “medical-loss rule” drove most insurance companies out of the business of insuring individuals because they can’t cover their overhead for a small policy on 20 percent of the premium. Also, the ACA was intended to drive down overall medical costs, such as by taxing hospitals who readmit past patients too often. But Rodrigue argued that the 80 percent rule gives an incentive to insurance companies to pay more for care because the more they pay out, the more they get to keep for themselves, assuming that premiums can go up.

New tech

But several things that may cut overall costs and improve patient outcomes were discussed by the panelists talking about new technology.

Dan Yunker of the Metropolitan Chicago Health Care Council said its Metro Chicago Health Information Exchange allows member hospitals, doctors and labs to share a patient’s medical records online. The exchange serves 31 hospitals so far and shares information with three downstate information exchanges.

Yunker said that saves money by avoiding medical tests and X-rays that have already been done before somewhere else.

David Miller of the Illinois Biotechnology Industry Organization and Jeff Coney of Northwestern University (whose faculty invented the nerve-pain drug Lyrica) told about the expense and difficulty of bringing new drugs and medical devices to market. Coney said a ”valley of death” often keeps a promising new idea from moving into actual production because of the cost of proving the product is safe and effective.

He and Miller said new drugs and devices go to market years faster in Europe because of looser government requirements.

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2 Comments

  • Health industry changes: 'Whatever you thought you knew, you don't know ... - Affordable Health Care Exchange | Affordable Health Care Exchange

    […] Health industry changes: 'Whatever you thought you knew, you don't know … He said large corporations may continue to buy insurance on behalf of their workers, but ACA provisions make it prohibitively expensive for small businesses to buy insurance for their employees. He said … Another unintended consequence in Illinois … Read more on Elgin Courier News […]

    2014-09-01 17:35:40 | Reply
  • Health industry changes: 'Whatever you thought you knew, you don't know … - FinanceBOXX.com

    […] Health industry changes: 'Whatever you thought you knew, you don't know … Randy Hultgren, R-Winfield, convened the forum, which centered on three panels of experts talking about the impact of the Affordable Care Act (the ACA, or “Obamacare”), new technology in medicine, and barriers that limit access to care. … Hultgren … Read more on Elgin Courier News […]

    2014-09-01 16:49:46 | Reply

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