The Amazing Maze of US Health Care

Last week’s post highlighted encouraging initiatives in several states to implement a single payer system within a single state.

This was always a daunting challenge even before health reform.  The Patient Protection and Affordable Care Act has raised the bar even higher.

Hawaii

ERISA and its preemption

Before PPACA a legal hurdle called the ERISA preemption severely hamstrung state health reform efforts.  For those of us in the employee benefits profession, ERISA, including its preemption clause, is our bible or at least our Deuteronomy.

ERISA was passed by Congress in 1974 to regulate employee benefit plans.  The preemption clause precludes states from regulating employee benefit plans.  There were two exceptions to that preemption and both are instructive. Read the rest of this entry »

The single payer movement was not invited into the national health reform debate.

But they are not going away.

July 30, 2010 was the 45^th anniversary of Medicare.  Activists across the country took the opportunity to remind us that Medicare works for older Americans and it can work for the rest of us.

Medicare at 45

The Obama administration took the opportunity to tout improvements in Medicare as a result of the Patient Protection and Affordable Care Act (PPACA):

• More benefits, especially preventative benefits
• More tools to fight fraud and abuse
• Lower drug cots for seniors
• Improved quality of care through pilot programs that encourage more integrated and coordinated care delivery Read the rest of this entry »

In an article in Employee Benefit News, Nancy Bolton expressed some of the concern, confusion, and questions of many in the employee benefits profession right now.

Where are we going?

Will health care reform be good for employee benefit plans?

Readers familiar with my musings and rants will know that I will not mourn the demise of employer sponsored health coverage.  But I am also no fan of an individual mandate.

Good guys

Nevertheless, Bolton’s perspective is an interesting one.  Like me, she administers a public plan.  She asks the question, “Aren’t employers the good guys?”

Why didn’t the politicians who loudly proclaimed support for employment based health care, do more to underwrite its cost. Read the rest of this entry »

For all of the fuss about “big government” and about 2,000 page pieces of legislation, you might think there would be more pressure for legislators to take the simple route.

Not!

Take the provision in the Patient Protection and Affordable Care Act that extends care to dependents up to age 26.

HR 676 – the single payer legislation that is still before the House of Representatives – has this to say about eligibility:

All individuals residing in the United States (including any territory of the United States) are covered under the USNHI Program entitling them to a universal, best quality standard of care.

Compare that with language in the Patient Protection and Affordable Care Act (PPACA) regarding eligibility just for those young adults up to age 26 who are children of parents with employer sponsored health insurance. Read the rest of this entry »

Mr. Gay Burke, writing for the Denver Post asks the question, “Why should employers pay for health care?”

To Mr. Burke:

An upside down world

Right question.

Wrong answer.

Employers tend to be a smart group.  Otherwise they would not be running successful businesses.  But on health care, they have been stupid, blind and stubborn.

I can say that, in part, because I have spent nearly thirty years in the employee benefits profession.

The stubborn follows from the blind and stupid.

So let’s look at stupid first

Mr. Burke is onto something when he questions the role of employers in providing health insurance to employees.  This is an admittedly illogical system.  For starters, the doctor patient relationship is one that relies on continuity.  Fostering that continuity is one of the major ingredients in proposals for health care delivery reform. Read the rest of this entry »