Eric Gulko Quoted on Dental Enrollment (BBJ)
January 9, 2020
Families First Coronavirus Act & FMLA
March 23, 2020By Eric Gulko
In an area as complex as healthcare, we feel that there will always be room to improve efficiency and affordability. Reducing complexity and cost is our mission at Innovo, and a key reason I joined the Massachusetts chapter of the National Association of Health Underwriters (NAHU) and serve on its board. A fellow board member and I recently made our annual trip to Washington D.C. to meet with Massachusetts legislators at the Capitol to share the effects of current healthcare legislation we see on our clients, as well as the impact of proposed changes.
Our aim was to meet with the offices of Massachusetts Representatives Katherine Clark and Richard Neal, Chairman of the House Ways and Means Committee, sharing with them the real-world realities our clients’ members are experiencing, offering our insights on possible solutions.
Topics we discussed included:
Surprise Billing
Many patients head into a medical procedure thinking that their health insurance will cover all hospital expenses, such as facility-based providers, since the patient chose an in-network hospital and surgeon. The “surprise” comes when the patient receives a bill for those providers who work as part of the surgeon’s team (anesthesiologists, radiologists, et al.) yet are not considered in-network for the patient. The issue is that in practice, patients may have done “everything right” to properly plan their procedure, yet have almost no way of knowing which providers will be participating on the day of their procedure.
The result is that each year across our country, patients face billions of dollars in surprise billing. We asked Representatives Clark and Neal to help fix this situation by passing legislation that limits patients’ liability for these out-of-network charges with a fair, market-based standard for out-of-network reimbursement, saving patients an estimated $25 billion over 10 years.
Medicare for All
While this has been a hot-button political issue lately, Innovo looks at the topic in a strictly practical manner. We shared our concerns with Representatives Clark and Neal, asking them, would it would reduce costs? Would it improve healthcare for members? Can it eliminate complexities of the current system?
Just by the numbers, it is our professional opinion that Medicare for All would not reduce costs for policyholders. Even while proponents of the plan say that employees would not have to pay for private insurance anymore, NAHU estimates an average tax increase of $24,000 for every U.S. household.
Additionally, we feel that Medicare for All would reduce the standards of quality and access Americans currently enjoy in their healthcare. This plan would introduce unnecessary delays in medical treatment, tests and access to care.
The public option or a Medicare buy-in would compel hospitals and other providers to accept unsustainably low reimbursement rates, which not only artificially undercuts private plans, but, as research has found, would put millions of Americans’ access to care at risk.
Fewer treatment options would in fact hurt healthcare quality, but what about no healthcare options? We feel that the introduction of a public plan or a Medicare buy-in that reimburses providers using Medicare rates could put more than 1,000 rural U.S. hospitals at risk of closure and would compound the financial stresses hospitals are already facing, impacting access to care and provider quality.
Improvements to Current Medicare
Innovo and NAHU both believe that there is more our legislators can do to improve the way Medicare delivers quality healthcare to members. Here are a few proposals we shared with Representatives Clark and Neal.
Let’s allow COBRA coverage to count as creditable coverage (H.R. 2564) for Medicare beneficiaries – the same way employer-sponsored coverage does. This gives beneficiaries access to Part B on a timely basis without penalties for late entry into the program.
Many Medicare beneficiaries are classified as being on “observation.” This has the effect of delivering significantly higher claims and preventing Medicare coverage from being applied for nursing home care for patients who do not have a prior three-day inpatient hospital stay. Proposed bills S. 753 and H.R. 1682 would allow observation stays to be counted toward the three-day mandatory inpatient stay for Medicare coverage of a skilled nursing facility.
We also believe employees can better position themselves for Medicare success if they were able to contribute money to their HSA (H.R. 3796) while employed. Further, as the workforce ages, those over age 65 should be able to continue to contribute to their HSA to allow them to adequately cover out-of-pocket expenses for their healthcare.
Overall, we feel that this year’s trip was extremely effective, raising important issues with those in positions to affect change. When the private sector works closely with government, we can achieve great things. For us, the future of healthcare is the future of our wellbeing.
Do you have ideas on how healthcare can be improved? Let’s talk.