Health Care Reform: Insurance Companies

Michelle BerryMegan DirksJennifer EllifrittLouisa GolayRoxy JohanningKrystal MorrisHealth Care Reform: Insurance Companies1Health Care ReformInsuranceAlthough this is called the health care reform, all of the changes that are proposed currently involve insurance2History of Health Insurance1930s- Blue Cross/Blue Shield createdBlue Cross-insurance plan to cover hospital careBlue Shield-insurance plan to cover physician care1935- Social Security Act-did not include health care1950s- Commercial insurance companies began1965- Social Security Act amendment to include Medicaid and Medicare1970s-1980s-Health care benefits from employers began 1990s-Managed care plans by employers began to dominate the health care market Pulcini & Hart, 20071935Initally, American Hospital Association and American Medical association were not in favor of a plan to help individuals pre pay for medical or hospital expensesDebt from unpaid bills helped hospitals and physicians recognize the need for this type of planthe belief that persons should pay for their medical care before they actually got sick, thus ensuring some security for both providers and consumers of medical services in time of need was the purpose behind the creation of insurance

1965- Medicare for the aged for disabled, Medicaid in federal and state govts participation was dependent on income and resourcesWithin 10 years of starting medicare and medicaid, costs in health care saw a drastic rise and began to greatly influence policy decisions3Stake HoldersPHARMAHospitalsANAAMAState GovernmentsStakeholders could be anyone who will be affected. When looking at the big picture of who the stakeholders are, anyone who could be affected by the insurance companies is a stakeholders. This list could include employers, employees, business owners, all health care providers, and so on

For the purpose of this presentation, the stakeholders we will be referring to are listed above.

4Social/Legal IssuesAll Americans have health coverage regardless of pre-existing conditionsReform will establish a high-risk pool to enable people who cannot get insurance today to find an affordable health planIndividuals are healthier, with a greater focus on wellness and better management of chronic conditionsEasier for individuals and small businesses to shop, compare and enroll in coverage

Blue Cross and Blue Shield Association, 2009Research proved that a general consensus between we the insurance companies would focus our system on wellness and prevention including: - Developing an integrated, holistic approach to care management to allow for early intervention and education. - Using consumer engagement and targeted incentives to encourage healthful behavior and eliminate unhealthful behaviors. - Promoting coverage policies that encourage the use of high-value health care and address the needs of specific population segments. According to the BCBS website, We support reforms that make the market work for everyone, by bringing more people in rather than creating a new government-run health plan that would cause millions of Americans to lose their private coverage. The website also mentioned that in order for healthcare reform to work, it must include more than insurance reforms. Comprehensive reform also must improve quality, rein in rising costs and ensure everyone has coverage. This is the only way healthcare reform will be sustainable in the future.According to the Health Care Reform website, If we do nothing, by 2019 the number of uninsured people will grow by more than 30 percent in 29 states and by at least 10 percent in every state. Businesses in 27 states will see their premiums more than double. And fewer people will have coverage through an employer.

5Social/Legal IssuesWe will be able to provide coverage to additional consumers at a more affordable costBig cost savings are likely to be found at the level of doctors and hospitals, not in health insurersPhysicians spend on average about 140 hours and $68,000 a year working with insurance companiesApproximately 343,000 people, or 12% of Kansass population, cannot access a primary care provider due to shortages in their communities

Aetna, 2009When it comes to healthcare, private health insurers profit approximately 4%. For example, "every premium dollar we take in, about 83 cents goes out in medical costs -- doctors, hospitals, and drugs. Net income comes to just a few cents per dollar of premiums. Insurance premiums are directly tied to the cost of services in health care.By simplifying and standardizing paperwork and computerizing medical records, doctors will be able to focus on caring for their patients.Health insurance reform will expand and improve programs to increase the number of health care providers; especially in rural and other underserved areas6Economic IssuesReform Malpractice insuranceOver orderingOver charging-15 % of the population does not have health insuranceSustainable Growth Plan (SRG) - 17 % Growth Domestic Product in unsustainable growth in health care spendingCommunity RatingThe Congressional Budget Office report shows that savings would be yielded. The Alternative Dispute Resolution that to takes out the jury system and separates to only those patients that actually got hurt from criminal negligence.This would aid in physicians and hospitals being conservative so they would not over order thereby decreasing the cost of health care.Hospitals and physicians will need to be assured they wont be sued to stop the over ordering.Hospitals over charge for health care. This is done to pay for the 45 million people who do not have health insurance. 7Ethical PrinciplesBill Young, Sr. Vice President and Chief compliance officer for Blue Cross stated:Customers should be able to trust the companies with whom they do business with.We pride ourselves on our companies commitment to integrity, honesty, ethics and to the peace of mind those traits in return bring to our customers.(Blue Cross Blue Shield Association, 2009)

8Americas Health Insurance PlansReform Add about Illness

http://www.youtube.com/watch?v=R36YJl8SagU&feature=player_embedded

9The Best Interest For The PatientAngela Braly, WellPoint CEO stated:The current system, including Medicare, which is administered by the federal government, was inefficient and promotes quantity over quality.She supports guaranteed coverage for all Americans, but wants to ensure that everyone will stay covered too. (Huffington Post, 2009)

10The Golden RuleEqual treatment for all American peopleNo discrimination for people with pre existing health conditions

Insurance companies question their autonomy11Stake Holder AssociationsRelationship with Pharma: Both support he planThe proposed reform reduces the gap in Medicare coverage for seniors.

Relationship with Hospitals: Both support the planThe proposed reform will create an independent commission of doctors and medical experts that are geared toward eliminating wasteWith more seniors being able to afford drugs through better Medicare coverage, the pharmaceutical companies will gain large profits. However, both pharmacy and insurance feel we believe that it should not come at the expense of medical progress; it should not sacrifice patient health; and it should not resort to price controls, which would restrict patient access to vital health care services and kill jobs in a fragile economy.

Hospitals will benefit from reduction in waste because it will reduce their overall costs and allow for increased profits. Insurance companies will benefit from reduced waste by eliminating repaying for unnecessary medical equipment and testing. As a partnership, both will benefit because they will spend less time auditing what will and will not be covered. Plan will also offer high risk patients insurance allowing for reimbursement in situations that previously ended in costly law suits and uncompensated treatment.

PHARMA stance on reform: http://www.phrma.org/about_phrma/straight_talk_from_billy_tauzin/health_care_reform_-_saving_money_is_important%2c_but_so_is_saving_lives

While we support reform, we believe that it should not come at the expense of medical progress; it should not sacrifice patient health; and it should not resort to price controls, which would restrict patient access to vital health care services and kill jobs in a fragile economy.

www.phrma.org

12Stake Holder AssociationsRelationship with ANA: Both support the planThe proposed reform will allow for more primary care to be given in a family practice setting and reduce the number of unnecessary emergency visits. Also, the proposed reform will promote the use of advanced practice nurses when possible for lower reimbursement costs.

Relationship with AMA: Insurance supports, AMA does not support the planThe proposed reform will place a cap on the out of pocket expense that may be charged to a patient and will eliminate extra charges for preventive care.By offering public health option to the uninsured, health promotion will be a forefront of the new plan. Primary care will become a feasible option for all. The role of advanced practice nurses will be greatly increased because a large increase in patients will be seen in clinics.

Medical providers will be required to foot the bill for mammograms, flu shots and other preventative care. Doctors will no longer be able to charge whatever they choose, mandates will be placed on charges and patients will be given more of an option to shop around. High quality medical providers will be forced to lower their costs to keep patients that will be insured by the cheaper insurance plans.13Stake Holder AssociationsRelationships with State Governments: Varies from state to stateRepublicans support, Democrats do not supportRepublican states generally dont support the health care reform proposed by Obama while democratic states tend to support the reform. Congress particularly required editing in the area of abortion coverage and want states to be given subsides if premiums are lower in their particular state. The senate is still awaiting vote on this bill. Insurance companies would particularly support this because any American needing insurance coverage for an abortion would be required to go with a private provider rather then the governmental option.14Closing StatementsPresident Obamas Health Care Reform Plan has three main goals. (whitehouse.gov)Provide more security and stability to those who have health insurance. It will provide insurance for those who don't. Slow the growth of health care costs for our families, our businesses, and our government

15Closing StatementsCurrently approximately 15% or 45 million Americans are without health insurance. (New England Journal of Medicine)

Under President Obamas Health Care Reform Plan this means there are a potential 45 million new health insurance customers for insurance companies to pick up.

More customers = more $$Closing StatementsLinda Blumberg, a health policy analyst at the nonpartisan Urban Institute, a Washington think tank states The insurers are going to do quite well, They are going to have this very stable pool, they're going to have people getting subsidies to help them buy coverage and . . . they will be paid the full costs of the benefits that they provide -- plus their administrative costs. (LA Times)

ReferencesAmericas Health Insurance Plans (2010). Retrieved January 29, 2010, from http://www.ahip.org/

Blue Cross Blue Shield Association (2009). Retrieved January 29, 2010 from http://www.bcbs.com/

Fuchs, V. (2009) The proposed government health insurance company- no substitute for real reform. The New England Journal of Medicine. Retrieved from http://healthcarereform.nejm.org/?p=492.

18ReferencesLos Angeles Times. (2009). Health Insurers Set to Benefit from overhaul. Retrieved from http://articles.latimes.com/2009/aug/24/nation/na- healthcare-insurers24Medscape Today (2009) AMA endorses senate healthcare reform bill, but warns it will withdraw support unless sustainable growth rate formula is amended. Retrieved January 29, 2010, from Medscape Medical News http://www.medscape.com/viewarticle/714177

National Public Radio (2010) Opposing views on health care bill. Retrieved on January 26, 2010,from http://www.npr.org/templates/story/story.php?storyId=122993764

ReferencesThe Huffington Post (2009) Insurance companies support health care reform. Retrieved January 29, 2010, from http://www.huffingtonpost.com/david-dayen/the-insurance-companies-s_b_276838.html. The New York Times (2010) No such thing as simple health reform. Retrieved January 29, 2010, from http://economix.blogs.nytimes.com/2010/01/29/no-such-thing-as-simple-health-reform/

ReferencesThe New York Times (2010) Giving their senators what their constituents have. Retrieved January 29, 2010, from http://economix.blogs.nytimes.com/2010/01/15/giving-senators-the-health-plans-their-constituents-have/ The New York Times (2010) Is community rating in health insurance fair. Retrieved January 29, 2010, from http://economix.blogs.nytimes.com/2010/01/01/is-community-rating-in-health-insurance-fair/ The New York Times (2010) Defining health care reform. Retrieved January 29, 2010, from http://economix.blogs.nytimes.com/2009/03/27/defining-health-care-reform/

ReferencesThe New York Times (2009) Americas health care priorities II: doctors, hospitals and the quality of care. Retrieved January 29, 2010, from http://economix.blogs.nytimes.com/2009/06/23/americas-health-care-priorities-ii-doctors-hospitalsand-the-quality-of-care/ The Wall Street Journal (2010) A good start. Retrieved January 29, 2010, from http://online.wsj.com/article/SB10001424052748704675104575001101419588486.html

ReferencesThe White House (2009). Office of the Press Secretary. Remarks by the President to a joint session of Congress on health care. http://www.whitehouse.govWilensky, G. (2009) Financing health care reform. Retrieved January 29, 2010, from http://finance.senate.gov/Gail%20Wilensky.pdf