|BILL OF HEALTH?
Should the government pass legislation
regulating managed care?
July 21, 1998
in this forum:
Should Congress pass legislation regulating managed care? What responsibility do employers share in the current managed care problem? What are the benefits of managed care? Isn't the HMO debate really a debate over whether health-care should be affordable and accessible for all? Is there a better system for healthcare and if so, what is it? Michael Tong of Chicago, IL, asks: Given that employers choose the form of health care for their employees, what responsibility do they share in the current managed care problem?
Bill Gradison, president of Health Insurance Association of America, responds:
Employers currently play an integral role in providing health coverage to literally millions of Americans. Approximately 150 million Americans get health coverage through employers. Employers pay the lion's share of their employees' health insurance premiums - typically, anywhere from 70 percent to 85 percent - and employers have a strong incentive to provide their workforce with coverage that meets their needs and that is affordable.
Indeed, with regard to managed care, employers are part of the solution, not part of the problem. Despite well-publicized ancedotal reports, overall, managed care has improved the quality of health care (and our ability to measure it), and has controlled health care cost inflation, thereby making health insurance more affordable to consumers, All of these accomplishments have taken place in large part because of employers' involvement and active participation.
For example, most employer-sponsored managed care plans have consumer protections in place, including well-defined grievance and appeals procedures. A report released earlier this year by the General Accounting Office (GAO) indicates that most of the HMOs that it surveyed had most of the criteria identified as important by the GAO for complaint and appeal systems.
Problems do exisst within the current system -just as they did before the advent of managed care. However, polls show that the current system is responding to the demands of consumers. Furthermore, we fear that managed care plans will be hampered in their ability to provide innovative new services to consumers if additional federal regulation is imposed.
Judy Waxman, director of government affairs at Families USA, responds:
Employers that offer health coverage are driven by conflicting imperatives: on the one hand, they want to ensure that the health plans they offer to their employees provide high-quality care; on the other hand, they want to minimize costs. Too often, in a voluntary system, employers elect to cut costs at the expense of quality. In order to ensure quality for all health plans, employers should support enforceable federal standards.
In addition, more than one-third of those with employer-provided insurance are in so-called "self-insured" plans under ERISA; these plans--generally offered by the largest employers--are exempted from state laws regulating insurance. Employees covered under these self-insured plans have only the inadequate protections required by the ERISA statute, which was enacted to regulate pension plans, not health coverage. Many of the large companies that offer such plans have actively opposed federal regulation, arguing that they can do an adequate job of protecting their employees. In order to ensure that all Americans--regardless of their employer--receive high quality care, employers should support the enactment of enforceable federal standards.