Health care issues stall during sluggish session

You have no doubt heard it before: "This Missouri legislative session was nothing spectacular." This is especially true for health care-related bills. Not only did the General Assembly again fail to bring Missouri into compliance with the federal Health Insurance Portability and Accountability Act of 1996, it also did not pass any health care reform measures.

In a previous article in the March 27 issue of SBJ, you read about House Bill 1362 sponsored by Tim Harlan, a Democrat from Columbia. This bill was essentially dead for the session by the end of March because of too much government involvement, coupled with too little clear direction on how it would affect business and insured individuals.

While there was no doubt this bill would be beneficial to a small segment of the population, the overall cost was too great for everyone else. Remember, this bill could have cost up to $20 million of our taxes and our premium dollars.

What was surprising is that, in an election year, health care was not at the forefront of hard fought battles on the chamber floors.

However, with a number of first-time legislators looking for a spot in Jefferson City, the 2001 session will be one to watch.

On the federal level, there has been considerable debate and concern on two issues the Patients' Bill of Rights and prescription drug coverage for Medicare recipients.

Patients' Bill of Rights

The federal legislation known as the Patients' Bill of Rights will have little effect in Missouri. The four key parts of the bill are:

Pediatricians are recognized as primary care physicians.

Health maintenance organizations are liable/accountable for their decisions.

Emergency treatment is available without prior plan approval.

External review of decisions/appeals by physicians are provided.

In 1997 the Missouri Legislature passed HB 335, which answers all of these concerns for Missourians.

HB 335 also mandated that health plan medical directors be licensed physicians and set up a specific and complete grievance and appeals process which includes review by the Missouri Department of Insurance.

We were fortunate to have managed care arrive late. It provided the carriers an opportunity to meet the demands and concerns of the covered individuals without all the problems that plague other states. These marketplace demands have also ensured quality benefit plans coupled with quality health care.

The Patients' Bill of Rights was passed by the Senate (Senate Bill 1344), but has been in a House-Senate conference committee for three months. The committee has made significant progress in this time, but it has yet to determine how much federal law will pre-empt state law and how to make health care more affordable for everyone.

Medicare prescription drug coverage

Affordability is the No. 1 concern in making prescription drug coverage available to Medicare recipients. SB 2319 was introduced, read and referred to the Senate Committee on Finance.

The bill's major provision is that Medicare recipients may elect to receive coverage for outpatient prescription drugs with a combined deductible. Currently only Medicare HMOs and Medicare supplement plans H, I and J provide any type of prescription drug coverage. However, these benefits have a limit of $500 to $3,000 annually.

National statistics show that prescription drug coverage is 12 percent to 16 percent of total health care costs, and there is no relief in sight. Not only is it the fastest growing segment, it is also the most costly, and there is little chance that the pricing will be controlled.

With Medicare already in financial trouble, this provision would only compound the problems. The toughest single problem is that the current working population is not large enough to support the baby boomers who will retire in the next five to 10 years and will be eligible for Medicare.

So, what can you do to, help curb these problems and keep a collar on your costs?

Be educated about your health care. Look at the costs of the benefits and compare that to the risks. Are you as careful a consumer of health care as you were prior to managed care?

Evaluate your plan. Does its design encourage utilization?

Call your employee benefit adviser for assistance.

(Mike Scott is an account executive with the employee benefit division of BPJ Insurance.)