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Employer-based model in 'jeopardy,' health insurance panel member says

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Panelists Veronica Diaz, Manager, Sales Enablement at Amerihealth NJ, Steven Herbst, Principal at Mazars USA, Carmilla Tan, Sr. Vice President Analytics at Create, Chris Vanderwolk, VP Strategy/Business Development at gente Employee Benefits and HR Solutions and Moderator, David Mordo, Past Chairman of National Legislative Council at NAHU, at the NJBIZ Health Insurance: A Panel Discussion on Tuesday.
Panelists Veronica Diaz, Manager, Sales Enablement at Amerihealth NJ, Steven Herbst, Principal at Mazars USA, Carmilla Tan, Sr. Vice President Analytics at Create, Chris Vanderwolk, VP Strategy/Business Development at gente Employee Benefits and HR Solutions and Moderator, David Mordo, Past Chairman of National Legislative Council at NAHU, at the NJBIZ Health Insurance: A Panel Discussion on Tuesday. - ()

In the aftermath of the midterm elections and as 2019 fast approaches, stakeholders in the health care sector are keeping a close eye on legislative action from the state and federal governments.

As part of NJBIZ’s monthly series of panel discussions, experts on health insurance weighed in Tuesday at The Imperia in Somerset on an array of topics ranging from the Affordable Care Act to prescription drug prices.

With the new Democrat-controlled house, panel members said they didn’t expect to see any change in the ACA.

“It’s safe to say that any effort to repeal and replace the ACA is gone,” said Chris Vanderwolk, vice president strategy/business development at Wayne-based Gente Employee Benefits and HR Solutions.

Vanderwolk said he did believe that there was room for common-ground legislation. “There’s a lot of movement locally in New Jersey with the out-of-network-bill, for example, because that’s a non-partisan issue,” he said.

Despite a lot of uncertainty nationally regarding the individual mandate component of the ACA, experts on the panel believe that New Jersey is in good shape.

”We’re very fortunate here in New Jersey that under Gov. Murphy, they implemented the individual mandate that will go into effect Jan. 1, 2019, as well as the reinsurance program. From a New Jersey perspective, we’re very fortunate to operate in this environment that has become more stable over the past couple of years,” said Veronica Diaz, manager, sales enablement at AmeriHealth New Jersey.

Diaz added that she doesn’t expect the individual mandate to have a major impact in New Jersey.

“Our organization covers about 100,000 consumer members going into next year we expect it to remain flat,” she said. “We think that people will continue to purchase insurance. And that’s a good thing we want to get as many people as we can enrolled in the marketplace throughout the state because that helps us maintain affordability.”

On the legislative front, Steven Herbst, a principal at the accounting firm Mazars USA, told attendees he sees the potential for the Centers for Medicare & Medicaid Services to act independently of the U.S. House of Representatives or Senate in trying to push forward changes in health insurance.

Carmilla Tan, senior vice president analytics at self-funded health plan Create, was bullish on the Medicare Shared Savings Programs, which encourages coordination and cooperation among providers.

“When you look at all the trend surveys they talk about where is the trend coming from for health care,” Tan said. “It’s coming from price, not utilization. The path toward having to share risk where the provider says ‘I’m aligned with you, I’m not going to just do more services to get paid more. I’m going to put my fees at risk and if I get that right then it’s a good thing for both of us.’ That the key to control and it also keeps health care local.”

Telemedicine is expected to play a bigger role in health care in New Jersey next year, panelists said.

Diaz said AmeriHealth New Jersey is focused on consumer engagement and providing members with the tools and resources that they need, “telemedicine being one of them.”

“We want to give folks access to care when they need it,” she said. “Mobile apps are more popular, giving members the opportunity to engage with providers or health insurance companies.”

On the topic of whether or not the employer-based model is safe going forward, panel members were not that optimistic.  

“It’s in severe jeopardy,” said Gente’s Vanderwolk. “Every year someone proposes to take away the employer exclusion so that every dollar that goes towards providing health benefits would be taxed as income.”

Proponents say that will drive employers to continue to do what they’re doing but at a higher cost.

“The opposite will occur. Employers will curtail coverage quickly and people would be dumped into the market without plans. Unless we get pricing under control we will reach a point where employers no longer be able to afford it,” Vanderwolk said.

He also said he believes the employer’s reporting burden will continue to exist as long as individual subsidies exist because it’s the only mechanism to police who should or shouldn’t be getting a subsidy in the large employer market.

When pressed on whether or not “Medicare for all” is likely to ever get off the ground, the majority of the panel members asserted the model is not a good fit, citing taxes, payment and control issues.

“It’s a great political talking point. But not realistic,” said Herbst.

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Anthony Vecchione

Anthony Vecchione covers health care for NJBIZ. You can contact him at: Avecchione@njbiz.com.

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