Obamacare: Will Oklahoma employers 'play or pay?'
Major health reform mandates are only 10 months away.
“Under the Affordable Care Act, insurers must cover more people and provide more benefits. But there's not a lot in the act to address the rising costs of health care,” she said. In fact, Oklahoma, is among 13 states expected to see hikes of 65 percent to 100 percent, Loomis said.
“We expect Oklahoma to be hit harder, because we're not used to covering conditions like autism,” she said, “or participation in clinical drug trials.”
Steve Wilson of Wilson Insurance Group agrees.
“Raising deductibles and shifting costs to employees won't work any more,” said Wilson, noting insurance over the past 13 years has risen 172 percent, compared with only a 47 percent increase in raises.
Health reform limits insurers from charging more than threefold for the older age band (64 and older), so industry observers expect the rates for younger people to increase 40 percent to 50 percent, Wilson said.
Meanwhile, companies of fewer than 100 employees with positive claims experience will be charged higher rates to offset those with bad claims experience and poorer demographics, he said.
Third-party administrator C.L. Frates suggests employers might consider self-insuring and contracting a firm like Salerno Health for employees' basic, or first-tier, health care needs. An Oklahoma City startup, Salerno (salernohealth.com) offers direct medical care, including primary care, cardiology, orthopedic and other specialty and surgical services, for $118 a month. MRIs are $50 and physical therapy, $10 a session.
“Health insurance was designed for catastrophic care, and never meant to cover urinary tract, sinus and other infections,” said David Rothwell, primary care doctor and Salerno managing partner. “That's like buying $3 windshield wipers at Walmart, and then submitting the bill to your car insurance company for payment.”
Somewhat like Salerno Health, Variety Care — which has several community health centers across Oklahoma County — is coordinating with small churches to provide a menu of prepaid services per member, per month, to their staffs, Chief Executive Officer Lou Carmichael said.
“We are who people go to when their employer is unable to provide insurance or access to care,” Carmichael said.
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