Download - Healthcare Exchange Webinar
A Legislative Update:Implications of
Healthcare Reform
Reid Rasmussen & Guest Contributors
Agenda
• The New Issue: Cooperatives• The Kennedy Factor• The Future of Healthcare • The Legislative Process: A Reminder & What We’ll See• Resources For Staying Engaged
Cooperatives
• “If not a Public Plan, then let’s build Cooperatives”• Version 1: Senator Kent Conrad’s Description• Version 2: House Bill Language• Version 3: Real-World Examples• The Growing Discussion
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Cooperatives: Senator Kent Conrad’s Description
• Cooperative Plan– An insurance option sold within
Exchange(s)– Democratically controlled by members;
governed by an elected Board.– Surpluses retuned to members or
reinvested – Non-profit
• Funding– Initial seed $: Government & Others– Then self-sustaining
• Considerations?– Individuals? Groups?– State Law – Conversion of existing Insurance Plan?
Elected Board
$??
Exchange $
$6B
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Cooperatives: House Bill Language
• Cooperative Plan– Not for profit, member-run– Sold through Exchange(s)– Once established, Co-op is at risk– Can be regional; state has acceptance
authority• Funding
– $5 Billion, for 36 mo. disbursement– Gov’t: Gift $ for Reserves– Gov’t: Loan $ for startup Administration– Priority for Funds: Integrated,
Statewide & Non-Gov’t support• Qualifications for Funds
– Has to be a new entity– Can’t be a Carrier or Gov’t subsidiary
Elected Board
Exchange $
$5B
Cooperatives: Real-World Examples
• Most Applicable Existing Models• Group Health Cooperative &
HealthPartners– Sell through Brokers– GHC: 2/3 in-house Drs/Facilities– HP: 1/3 in-house Drs/Facilities– Act just like other Insurance
Companies– Large HMOs– Members identify more with HMO
philosophy than with membership– Tremendous information– Efficiency? Yes & No– Decisions of members often very
similar to decisions of owners
Elected Board
$Broker
Cooperatives: The Growing Discussion
• Examples That Don’t Apply– Health Insurance Purchasing Cooperatives (HIPCs)– Population-Specific Business Cooperatives
• Market Implications– More Insurance Companies– Will Brokers be Able to Sell Cooperative Products?
• How Can We Drive the Discussion?– How will they improve competition?– Why will they be more honest than Insurance Carriers?– Where is proof they’re more efficient?
Future of Healthcare Forum
• Highlights From New World of Healthcare Forum• Future of Products?• Future of Carriers?• Future of Brokers?• Future of Broker Commissions?• How Can We Affect Change?
Future of Products?
• Transparency• Individualized by Patient• Rankings by Price / Quality• Behavior Change: Fun• Horse Power Challenge• Incentives & Rewards Work• New Approaches • Virtual Health Records• Social Networks by Disease• Make it Fun
Mike McCallisterPresident & CEO, Humana
Future of Carriers?
Brian SassiPresident & CEO , WellPoint Consumer Business
• Merge Small Group / Individual• New Pricing• In-Migration of High Risk
Members?• COBRA Members • Uninsured (Mixed)• Multi-Line Products by Carriers• Bigger Market for Specialty • Carrier Consolidation• Growth of Individual
Future of Brokers?
• What Makes a Top Firm?• Engaged Leadership• Clearly Articulate Differentiator• A Plan• Best Players• Training & Performance Mgmt• Sell Themselves, Not a Product• Value Added Differentiation• Protect Relationships!
Ken FasolaFormer CEO, Secure Horizons
Future of Brokers, In Light of Exchanges?
• Limit the Exchange– A Regulatory Agency– Defining the Plans– Monitoring Body
• Set to Replace Brokers• Explaining Role of Broker• Exchange Would Cost Billions• Use Infrastructure in Place• BenefitMall Lobbyists at Work• Launching Online Community • For Brokers / Carriers to
Communicate & Participate
Bernie DiFioreCEO, BenefitMall
Future of Broker Commissions?
• Not Fundamentally Change
• Probably Not Always Tied to Medical Inflation
• Work Still Needs to be Done
• Work Needs to be Paid For
• Will Still Vary By Carrier
Mike McCallister
Future of Broker Commissions?
• Physician/Hospital Comp Will Change
• Brokers’ Probably Will, Too• If Comp Reduced, Doesn’t
Mean We Can’t Generate Income
• Time Is Not Our Ally• Have Your Voice Heard
Ken Fasola
How Can We Affect Change?
• Media Usage?• Best: “Un-Earned Media”
– TV– Radio Talk Shows– Op-Eds– Letter to Editor– Quoted in Articles
• Value: Volume of Hits• Read Local Editorials • Respond: Short Letter to
Editor• Member of Congress
Reads Daily
Janet TrautweinCEO, National Association of Health Underwriters
The Legislative Process
• A Reminder of the Process– Road Map to a Health Reform Law– What We’ll See This Fall
• Building Blocks of 2009 Reforms
Senate Passes House Passes Bill Combined Bill via Rules Committee
Debate & Passage Debate & PassageIn Senate In House
Bipartisan Work to Combine Bills Conference Committee Sets Rules for Debate & Votes
Senate HouseFinance
Committee
Health EducationLabor & Pension (HELP)
Committee
Education & Labor
Committee
Energy & CommerceCommittee
Ways & Means
Committee
Finance Bill
HELPBill
HouseBill
SenateBill
CombinedBill
HenryWaxman
GeorgeMiller
CharlesRangel
MaxBaucus
TedKennedy
HarryReid
NancyPelosi
FinalBill
Road Map to a Health Reform Law
Cost Containment
Strategies
Government SubsidiesIndividual Mandate
EmployerMandate
Building Blocks of 2009 Reforms
Connector /Exchange
Large Fund-RaisingMechanisms
Cooperative
Public Insurance
Plan
IndividualsEmployers
Staying Engaged On Reform
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