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Health industry leaders watch, wait as reform unfolds

As the director of PacificSource Health Plans in Boise, Dave Self hears a lot of questions about the health reform passed by Congress in March and now making its way into public policy.

Most of the questions come from business owners, who ask Self how much the end product of reform will cost them. It’s difficult to know at this point.

“Employers almost universally, whether they support it or do not, are very concerned about the cost,” Self said. “And nobody can predict exactly what that looks like yet. As you move forward to 2014, and you start peeling back all of the prohibitions, and increasing maximums of annual basis and lifetime basis for care, nobody really knows what that cost is.”

The health care overhaul passed by Congress seeks to expand insurance coverage to the estimated 32 million people in the United States who don’t have any health insurance.

The bill includes several changes in law for the insurance industry. Among them: insurance companies will soon be prohibited from denying children coverage based on pre-existing conditions, and in 2014 won’t be able to deny anyone coverage based on pre-existing conditions. Insurance companies will also be required to allow children to stay on their parent’s insurance plans until age 26 – a provision that the insurer Regence BlueShield Idaho put in place in June in anticipation of the change. And consumers will be required to carry health insurance.

Self and other insurance leaders almost all agree that change was needed in the health care industry to control costs.

But reform “will add a layer of regulation and administration that does not currently exist,” Self said.

He added the bill expands coverage without a plan for keeping costs down.

“The legislation as it exists today, if not modified in any way, will ultimately result in increased cost to individual consumers,” he said.

Insurers are also focusing on educating consumers to use health care more responsibly. Unnecessary visits to the emergency room raise every insured customers’ rates, noted Scott Kreiling, president of Regence BlueShield of Idaho, which in 2009 launched a Web site called “What is the Real Cost? The site notes seven out of 10 health care dollars go toward chronic conditions such as diabetes, heart disease and lung cancer, which are related to obesity, smoking, alcohol abuse and other lifestyle choices.

“We need to get real as a country about how we eat, drink and live,” says the site.

It’s clear reform will bring more patients into physician offices. That’s what happened in Massachusetts when 2006 health reform made care available to many previously uninsured residents.

Most areas already have a shortage of primary care doctors, noted Corey Surber, coordinator for advocacy and community benefit at Saint Alphonsus Health System in Boise. “If we have 32 million newly insured people in 2014, we’re going to have a work force issue, especially in primary care,” Surber said.

And it’s clear that cost is still the first concern of insurance executives watching negotiations on the details of the reform bill.

“This health care bill is going to create more benefits for employees and people that buy insurance,” said Martin White, an account executive at Higgins & Rutledge Insurance in Boise.

But “the cost will not go down,” White said. “And the number one reason people are complaining about health care now is because of the cost.”

Idaho Business Review is hosting a roundtable event on health care reform at 7:30 a.m. Aug. 24 in the Legacy Pointe Room at the Idaho Water Center, 322 East Front St., Boise. The roundtable will focus on reform’s impact on the hospitals and the industry. The public is invited to attend and hear a moderated discussion with industry leaders and experts.

For more information, call Anne Allen at 208-639-3530 or e-mail her at anne.allen@idahobusinessreview.com.

About Anne Wallace Allen

Anne Wallace Allen is the editor of the Idaho Business Review.

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