Thirty years of health care “reform” – and it still doesn’t work

Retail’s Big Blog reports:

“The first time I ever wrote about health care reform was around 1980, when health maintenance organizations were becoming popular and I was a young newspaper reporter with a vested interest – I was making the move from my parents’ policy to getting health care benefits of my own.

HMOs were the health care “reform” of the days before computers, iPods or even the Walkman. They were going to make insurance cheaper, make it easier to get in to see a doctor, and costs would be kept manageable with small co-pays instead of paying bills up front and waiting to get reimbursed.

What a joke. Within a few years, HMOs became the gatekeeper of American health care. Doctors pressured to see a maximum number of patients per day for whatever the HMO was willing to pay no longer had time to play Marcus Welby. (Click on the link if you’re not old enough to remember the show.) Your “family doctor” was replaced with a “primary care physician” – HMO-speak for a general practice doctor you had to pay to see in order to get permission to see the eye doctor, ear doctor or other physician you really needed to see. And whose real job was to keep you from getting to see the more expensive specialists.

All along the way, health insurance premiums, co-pays and deductibles continued to rise, soaring to unimaginable levels. It got to the point where millions of Americans were going without health care because they couldn’t afford health insurance. It wasn’t long before the buzzword of “health care reform” came around again, beginning with the Clinton Care of the 1990s.

Two presidents later, health care reform – aka Obamacare – was signed into law in 2010. And after three years of drafting rules and regulations, the new law is set to take effect in 2014.

The only problem is that Washington – with more than a generation to reflect on the issue and the past five years or more to pass a law and write the regulations – got it wrong.

The goal in health care reform was to make coverage more accessible by making it more affordable. Health care reform was supposed to find ways to reduce the cost of medical treatment and also reduce the price of health insurance. Instead, what we got were mandates: Government mandates that all “large” employers – those with more than 50 full-time employees – provide health insurance to full-time workers. Mandates on what must be included in that insurance. Mandates on what constituted “full-time.” Mandates on what would be considered “affordable” insurance. Mandates on how quickly coverage must be offered to new workers. And, finally, mandates on how much employers will be fined if they fail to comply.

Rather than a way to help businesses provide better benefits for their workers, health care reform has instead become an attack on the business community – and retailers are directly in the crosshairs. The costs of all the mandates are so high that some small retailers are being forced to stay under the 50-employee threshold and even larger companies are being forced to cut hours of existing workers so they won’t be counted as full-time. (Under the law, employees working as little as 30 hours would be considered full-time instead of the traditional 40 hours, capturing many workers traditionally considered part-time.) Instead of helping workers, the new law is discouraging job creation.

NRF worked closely with Congress to bring about health care reform that would work, but somewhere along the way lawmakers stopped listening. We have encouraged repeal of the misnamed Affordable Care Act as recently as this month. But given the reality that “reform” is here to stay, we have also formed groups such as the Employers Health Care Clearinghouse to help retailers learn how to comply with the new law.

After going through doldrums where the Administration was slow to issue the regulations retailers and other businesses needed to prepare for the new law, HR executives are drinking from a fire hose of promulgations and announcements. News is coming almost daily on issues such as the package of “essential” benefits or the new “summary of benefits and coverage.” Even though reform doesn’t take full effect until January, businesses soon need to start tracking worker hours to determine who counts as full-time, and more requirements are coming.

NRF has kept up a steady stream of memos to member companies, conducted numerous calls and held many meetings to help retailers figure out how to make sense of all these requirements. On April 4, we will conduct our latest effort when NRF’s Neil Trautwein will host a webinar titled “Ready for the ACA? New Regs, New Challenges”.

Trautwein, by the way, is one of the utmost experts on health care policy in Washington. He has been dealing with these issues almost as long as I’ve been writing about them, and was brought on board at NRF in 2006 specifically to help retailers navigate through health care reform. He guided creation of NRF’s Vision for Health Care Reform, a plan that would have brought forth true reform to benefit employers and workers alike. Had lawmakers listened to his advice, health care reform might have worked.

As for myself, I found the ultimate end-run around HMOs, PPOs and all the other variations of the health insurance system – I married a doctor.”