With clock ticking, state and local health leaders plan for federal health reform
- on July 19, 2012
While Gov. Sam Brownback is opposed to federal health care reform and is taking a wait-and-see approach in hopes it will be overturned by newly elected leaders this fall, Kansas hospitals, insurance companies and the Insurance Department are complying with regulations that are in effect and planning for future ones.
“The clock is ticking, and we don’t have a lot of time,” said Kansas Insurance Commissioner Sandy Praeger during a panel discussion Thursday at Maceli’s in downtown Lawrence.
She said the state has until Nov. 16 to decide whether it wants to enter into a partnership with the federal government on developing an insurance exchange, which is a Web-based system where consumers can shop for insurance and where eligibility for subsidies would be determined.
By being a partner, Praeger said, Kansas would be able to determine what plans are sold on the exchange and what those plans would entail, and her department would continue to provide consumer assistance.
“Right now, we hope in our department that we can — at the very least — be a partnership exchange with the federal government,” Praeger said. If not, the state’s exchange will be run by the U.S. Department of Health and Human Services.
About 60 people attended the panel discussion, which was sponsored by the Lawrence Chamber of Commerce. The other panelists were Lawrence Memorial Hospital President and CEO Gene Meyer and Michael Williams, small business vice president for UnitedHealthcare of Kansas City.
Each talked for about five minutes about federal health reform, or the Affordable Care Act, and then answered questions. The discussion touched on a number of issues, including rebates.
Williams said insurance companies have to provide rebates by Aug. 1 if they spent too much on administrative costs and profits and not enough on medical care and quality initiatives. He said UnitedHealthcare didn’t need to send any rebates out in Kansas because it met the requirements.
Beginning Oct. 1, he said, consumers will start receiving an eight-page summary of benefits and coverages if they have insurance coverage —another requirement under federal health reform, also known as the Affordable Care Act. “It’s designed to provide more consistency and clarification,” he said.
In 2014, Williams said there may be some businesses that opt to stop offering insurance to their employees because the new exchanges will be in place.
“If an employer is fed up with every year having to deal with a 10 and 15 percent increase, he or she may just say, ‘I am pushing the eject button on this and I’m walking away from it, so I am going to pay you $250 now in your salary a month extra and you go buy it through the exchange.’ That is a real probability that’s going to exist out there,” he said.
Also, businesses that have 50 or fewer workers are not required to provide insurance for their employees under health reform. Only those with 51 or more workers are required to provide coverage or pay a penalty.
Praeger said about 95 percent of the larger businesses already provide coverage as a way to attract and retain employees. She said she would not be surprised if some of these companies decide to give a direct wage contribution that would be used to buy health insurance through an exchange instead of providing insurance. Praeger said there will have to be changes in the tax codes as well.
“There’s so much to this law,” she said. “It’s very complex.”
Meyer described our health system as broken and the Affordable Care Act as a step in the right direction. He said 52 million people are uninsured and often end up using the emergency room for care. Under health reform, an estimated 32 million Americans are expected to gain coverage.
However, he said, the law does not address how care will be provided for the newly insured. He said there already is a shortage of primary care doctors nationwide and in Lawrence, especially ones who accept Medicaid.
QUESTION ABOUT HEALTH REFORM?
Kansas Insurance Commissioner Sandy Praeger will be available Aug. 1 to answer questions about federal health reform and insurance.
She will participate in an online chat at 10 a.m. on WellCommons.com. Submit your questions at any time at WellCommons.com/chats.
Praeger, a Lawrence resident and Kansas University graduate, is responsible for regulating all insurance sold in Kansas and overseeing the nearly 1,700 insurance companies and more than 94,000 agents licensed to do business in the state. She has been insurance commissioner since 2003.
She was elected previously to the Kansas Senate in 1992, 1996 and 2000, and before that served one term in the Kansas House of Representatives. While in the legislature, she worked to gain passage of patient protection laws, external review of health plans and insurance, and the Kansas expansion of children's health insurance. In 2001 she led the successful campaign for mental health parity in Kansas.
Praeger was president of the National Association of Insurance Commissioners in 2008. She serves as chair of the NAIC Health Insurance and Managed Care Committee and a member of other NAIC committees and task forces.