News & Information

 

FEATURED PRODUCT

5500 Preparer's Manual for 2012 Plan Years
The premier resource in the field of Form 5500 preparation, 5500 Preparer's Manual will help you handle the required annual Form 5500 filings for both pension benefits and welfare benefit plans.

Learn More »

CCH® BENEFITS — 2/6/08

Blue Cross And Blue Shield Association Unveils Five-Point Plan For Health Care Coverage For All Americans

From Spencer's Benefits Reports: Stating that “a system that is unaffordable for many today won’t work for even more people tomorrow,” Blue Cross and Blue Shield Association (BCBSA) president and chief executive officer Scott P. Serota on January 23 unveiled a five-point plan—The Pathway to Covering America—for building on the employer-based health care system to improve quality, rein in costs, and expand coverage to all Americans. According to the BCBSA, its proposal would extend coverage to 30 to 35 million of the 47 million uninsured at an annual cost to the U.S. of $50 to $100 billion.

The Pathway document states that “BCBSA believes every American should have health insurance. In achieving this goal, the underlying problems of our current system must be addressed. We can build upon the employer-based system with tailored solutions to enhance and sustain this system, while providing affordable options for those without employer-sponsored coverage.”

Specifically, the BCBSA’s five-point plan for reform includes the following recommendations for government action:

1. Encourage Research On What Works

The Association recommends an independent institute to support research comparing the relative effectiveness of new and existing medical procedures, drugs, devices, and biologics.

The BCBSA believes that the institute should be funded by assessments on all private coverage (insured and self-funded) and public health care coverage. The BCBSA recommends a budget not to exceed $375 million annually.

2. Change Incentives To Promote Better Care

The federal government should do the following:

• continue its efforts to incorporate pay-for-quality incentives into Medicare and other government programs;
• promote management of chronic illness by preserving and building upon the Medicare Advantage program;
• give the Food and Druge Administration (FDA) authority to approve scientifically feasible and safe generic versions of biological products, without imposing inappropriately long periods of market exclusivity for brand-name biopharmaceutical products;
• provide the FDA with sufficient resources to pare the growing backlog of generic applications; and
• enact effective medical liability reform.

3. Empower Consumers And Providers

The Pathway document recommends that the government promote greater quality and cost transparency by continuing to use consensus-based quality measures, such as those developed by the National Quality Forum, the Hospital Quality Alliance, and the Ambulatory Quality Alliance to promote transparency with patients.

The BCBSA also wants the government to encourage adoption of health information technology by establishing a national health information network—with electronic health records in every doctor’s office.

4. Promote Health And Wellness

The BCBSA recommends the following government reforms to support employer efforts to promote healthy lifestyles:

• providing wellness incentives for individual workers by removing legal barriers that hinder employer efforts to encourage healthy employee lifestyles (e.g., requiring employers to give non-smoker discounts to smokers who enroll in, but do not successfully complete, cessation programs);
• establishing lifestyle factors for group rating by preempting state rules that limit insurers’ ability to give group discounts for smoking and wellness rating factors;
• offering other employer incentives such as tax incentives to encourage employers to adopt smoking bans, providing employees with exercise time during the work day, offering subsidized gym memberships, and implementing Occupational Safety and Health Administration workplace best practices;
• establishing new federal funding to support increased physical education requirements to five days per week at all grades;
• providing health education on diet/nutrition and tobacco use prevention and conditioning existing federal funding for school meal/snack programs on better nutritional quality;
• funding school-based programs to ensure that recommended vaccinations are provided to all children;
• creating incentives and improving coverage for smoking cessation for Medicaid enrollees and incorporating wellness and disease management program features into Medicaid;
• offering nutrition and meal planning/preparation education to Food Stamps enrollees and providing incentives to use Food Stamps for healthy foods; and
• providing tax and other incentives for grocery stores to locate in underserved low-income neighborhoods.

5. Foster Public-Private Coverage Solutions

Recommendations in the Pathway document to decrease the uninsured population include these:

• To help those who currently have difficulty affording coverage, the BCBSA recommends that the government provide: (1) tax credits for low-wage workers in small firms; (2) tax credits for individuals struggling with health care costs; (3) tax credits for those between jobs; and (4) a new tax deduction for those without access to employer-provided coverage;
• Public program coverage should be extended to everyone with incomes at or below the federal poverty level ($10,210 annually for individuals/$20,650 annually for a family of four in 2007) and not already eligible for Medicaid.
• Current federal support for state high risk pools should be made permanent and should cover at least 50% of the pools’ annual operating losses.
• A new federal grant program should be created to encourage innovative partnerships among insurers, physicians, and hospitals to develop low-cost insurance products for uninsured individuals and their families.
• A new federal grant program should be established to allow states to develop their own initiatives. For example, some states might want to develop a special strategy to improve coverage for migrant workers, while others might want to focus on a rural strategy or improving support for community health centers.
• The State Children’s Health Insurance Program (SCHIP) should be reauthorized and exapanded to ensure that children currently eligible are able to enroll.
• States should be empowered to enroll Medicaid/SCHIP beneficiaries in employer-provided plans. States should pay the employee premium for children of working parents whose children are eligible for Medicaid and/or SCHIP, as an alternative to obtaining coverage through public programs when employer coverage is available.

For more information, visit http://www.bcbs.com.

For more information on this and related topics, consult the CCH Pension Plan Guide, CCH Employee Benefits Management, and Spencer's Benefits Reports.

Visit our News Library to read more news stories.