Business Strategy

Some health insurers are hoping that new benefit designs targeting individuals will attract some of the uninsured and the self-employed, who either don't realize that they can get insurance or don't know how much they can afford.

Detroit's Big Three automakers are considering shifting future retiree healthcare costs to union-controlled trust funds and are eyeing a new contract between Goodyear Tire & Rubber Co. and the United Steelworkers (USW) union.

Wal-Mart and the Service Employees International Union (SEIU) have formed what industry watchers have called an "unusual" partnership to push for quality, affordable healthcare.

Legislation encouraging more equitable coverage of mental illness is moving forward in Congress following important modification of previous requirements. The Senate Health, Education, Labor and Pensions (HELP) Committee recently approved a bill that requires health plans to offer similar benefits for mental and physical illness in terms of deductibles, copayments and treatment limitations. But the new measure no longer mandates that group health plans cover mental illness.

The Bush administration spending plan for 2008 proposes major funding curbs for Medicare, Medicaid, children's health and other government health programs.

Consumerism in health benefits has moved beyond buzzword status to a mainstream strategy. Increasingly, health plans and employers view consumerism with a global approach to benefits-a collaboration with employees financially, organizationally and personally.

Millions of people's lives have been influenced by the work of Mollie Orshansky, even though very few people know who she is. Dozens of health-related programs throughout history have benefitted from Mollie's contributions, including programs through HHS, charitable agencies, private companies and managed care. In 1963, it was Mollie-an accomplished mathematical genius and daughter of a poor immigrant family-who developed the U.S. government's official measure of poverty and the guidelines for what we call the Federal Poverty Level (FPL) today.

When you're the most populous state in the union, any extraordinary policies you sketch out could likely become a national catalyst for change. California has begun working on its state initiative for comprehensive healthcare reform, not simply for lack of a national proposal, but also because the health of its 36.1 million residents is at stake.

Rising pressure to reduce federal spending for Medicare has put the spotlight on payments and policies governing the Medicare Advantage program. MA plans are "vastly overpaid," according to Rep. Pete Stark (D-Calif.), chairman of the House Ways & Means Health subcommittee, largely because they sign up more healthy beneficiaries. Senate Finance Committee chairman Max Baucus (D-Mont.) is looking closely at whether "funneling dollars into private plans gets us the most bang for our healthcare buck."

William Copeland JR.'s assessment of the United States' healthcare system is crystal clear: The system is a financial and structural mess.

The campaign to provide healthcare to all Americans is making headlines once more as business, labor and consumer groups join with healthcare insurers and providers to urge major changes in the nation's healthcare system.

In an attempt to reduce healthcare costs, a U.S. company is encouraging its employees to go abroad for necessary medical or surgical care. A recent article in the Christian Science Monitor noted that Blue Ridge Paper Products in North Carolina is sending an employee to India for two surgeries that will cost about $20,000-far less than the estimated $100,000 for comparable procedures in the United States.

WITH changes on Capitol Hill and at the state level after 2006 mid-term elections, experts are expecting more focus on broadening Medicaid coverage.

In America, we assume that we get what we pay for, whether it be food, clothing or healthcare. Given that healthcare consumes 16% of the Gross Domestic Product and we spend more per capita than any other nation on cutting-edge care, we expect improved outcomes and more bang for the buck. However, these expenditures do not rank the United States first, second or even third in terms of life expectancy, infant mortality, immunization, cancer screening and the like.

The new House leadership delivered on one of its prime campaign promises last month by pushing through legislation requiring the Health and Human Services (HHS) secretary to negotiate directly with pharmaceutical companies on prices for medications covered by the Medicare drug benefit. The bill (HR 4) repeals the so-called "non-interference" clause in the Medicare Modernization Act (MMA) and replaces it with a provision requiring the secretary to negotiate prices that manufacturers may charge prescription drug plans (PDPs) and Medicare Advantage drug plans (MA-PDs).

An annual government analysis of healthcare spending indicates that outlays for healthcare rose only 6.9% in 2005, continuing a three-year slow-growth trend. Total U.S. healthcare spending reached almost $2 trillion, or $6,697 per person, but this reflects the slowest growth in outlays since 1999, when "enrollment in more tightly managed care plans peaked," according to analysts at the Centers for Medicare and Medicaid Services (CMS).

Everyone is jumping into the pool-the state-purchasing pool that is. States are beginning to dive into healthcare overhaul with almost artistic creativity, coming up with state-specific, collectively funded plans to fix the leaks in coverage.

When health savings accounts (HSAs) are attached to high-deductible health plans, employers find the accounts' low cost and high employee accountability attractive. They can bring in lower health insurance premiums, reduce payroll taxes and, for employees, serve as tax incentives and an additional source of retirement savings.

In the late 1990s, the idea of a disaster preparedness strategy hardly registered for most of the nation's hospitals, but today more and more are coordinating individual and regional strategies. Hospitals in those communities where disasters have previously occurred are the most likely to have ongoing disaster preparedness plans in place.

Washington, D.C.-As members of Congress headed out of town for the holidays in December, they managed to push through legislation containing a number of important policy initiatives for health plans and payers. A major tax bill delivered a reprieve for doctors from planned Medicare rate cuts. The bill freezes Medicare fees to physicians for one year, which could lead to an even bigger cut in 2008. It also offers a small bonus to those doctors who comply with quality reporting requirements. And to further bolster pay-for-performance initiatives, the legislation calls for hospitals and clinics to report on quality measures.

Washington, D.C.-Medicare pays private plans too much, and the system needs to be fixed, according to a new report from the Commonwealth Fund. The study finds that the government paid Medicare Advantage plans 12.4% more in 2005 than if the same patients had been enrolled in the traditional fee-for-service program. The extra payments totaled more than $5.2 billion in 2005, or an extra $922 for each of the 5.6 million MA enrollees.

Medicaid Enrolees who suffer from expensive, chronic conditions tend to suffer from so many comorbidities and complicating social problems-such as homelessness and lack of transportation-that isolating a single disease state for intervention is ineffective. And states are beginning to recognize that.

Just like the rest of healthcare, dental and vision ancillary benefit providers are adopting cost-sharing strategies that offer options to employees but demand more skin in the game. With less financial responsibility on the shoulders of employers, ancillary benefits have become more flexible, varied and are more closely tied to the overall health of individuals, who are assuming more risk for their health.

The Supreme Court has referred to U.S. antitrust laws as the Magna Carta of free enterprise-a set of laws as important to the preservation of economic freedom as the Bill of Rights is to the protection of personal freedoms. While these laws are typically enforced by state and federal governments, i.e., the Department of Justice and state attorneys general, they also provide for a private right of action enforceable by persons who have been injured by activities that are forbidden by the antitrust laws.

The high-profile health policy issues for the new Congress are to reduce Medicare prescription drug prices and expand federal government funding for embryonic stem cell research. Congressional leaders want to enact legislation that will permit the federal government to negotiate drug prices (see Newswire), a move that eventually could alter the role of private plans in providing healthcare benefits to seniors.