Health plan providers offer roadmap
for state-supported universal coverage
"This initiative is a fundamental repositioning," acknowledged AHIP President and CEO Karen Ignagni. "Our board is committed to ensuring that no American falls between the cracks of public and private programs and that individuals can have their disputes reviewed by an objective third party." AHIP said a recent survey it conducted found that 18 million individuals currently have private health insurance in the U.S. and that about 89% of those who apply are offered at least some healthcare coverage.
Because healthcare insurance and medical plans are regulated at the state level, AHIP's reform plan proposes that states establish Guarantee Access Plans to cover uninsured individuals with the highest expected medical costs. Under AHIP's proposal, individuals whose healthcare claims costs are projected by underwriters to be more than twice the statewide average would be eligible to obtain coverage under the Guarantee Access Plans. Premiums for participants in the state-funded high-risk pools would be capped at 1.5 times the standard rate.
Individuals who aren't eligible for the state-funded high-risk plans would be guaranteed coverage, and healthcare plans would not be allowed to charge any such individual seeking coverage more than 1.5 times the standard premium rate. Exclusions for pre-existing medical conditions would be limited, and plan providers would be able to rescind coverage only when individuals withhold information that reasonably should be disclosed in an application for coverage. States would establish independent board to review decision to rescind coverage or deny coverage of pre-existing conditions.
AHIP's proposal is based on states' adopting plans requiring universal healthcare coverage. That means states would have to develop systems for verifying universal coverage among their citizens; enforcing a requirement to purchase and maintain coverage, automatically enrolling those who move into the state, providing subsidies to help lower-income citizens pay the premiums and paying for related state-administered programs.
Meanwhile, the Employee Benefit Research Institute (EBRI) issued a study last month confirming that "the vast majority of American workers and their families who have health insurance" continue to obtain it through their jobs. EBRI acknowledged that some employer groups are pushing for fundamental reforms of the employment-based health insurance system. But recent data confirm that "large employers are not on the verge of dropping benefits," EBRI said.
EBRI's study found that the percentage of workers reporting access to health benefits through their jobs is largely unchanged since the mid-1990s and has declined only slightly from levels reported in the late 1980s. In 2005, for example, 74% of workers who weren't self-employed said they were eligible for health benefits through their jobs—a percentage that was unchanged from 1995 levels. The percentage of workers with employment-based health benefits has fallen recently but not sharply, EBRI said. After holding steady at between 73% and 75% during the period from 1994 to 2000, the percentage of workers with health benefits has fallen to about 71% since 2000, EBRI said.
Premiums for employer-provided coverage have increased dramatically, however. For employee-only coverage, premiums rose 86% and the average annual deductible for those covered under preferred provider organization (PPO) plans increased 75% during the period from 2000 to 2006, EBRI said.
EBRI acknowledged a push by national associations representing corporate CEOs (The Business Roundtable), major employers (the HR Policy Association and the ERISA Industry Committee), small business owners (National Federation of Independent Business), retirees (AARP) and union workers ( the Service Employees International Union) for a national healthcare debate under a newly elected president in 2009.
All the organizations are promoting "a common message that employers have reached a tipping point with health benefits and are either proposing alternatives to the status quo or are on the verge of releasing such a proposal," said Paul Fronstin, director of EBRI's health research and education program. But recent interviews of 10 large employers (with 18,000 to more than 200,000 workers each) found the companies still believed that offering health benefits to workers had "a positive impact on the bottom line, through wellness, disease management and worker productivity," EBRI said.
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