With health reform mandates looming a little more than a year away ...

Employers across Oklahoma are trying to figure out how Affordable Care Act mandates will affect their bottom lines.
by Paula Burkes Modified: October 13, 2012 at 12:02 am •  Published: October 15, 2012

“Oklahoma's small employers don't want to offer health care, then after January 2014, pull it and pay the penalties. That would make employees mad,” Shaw said.

In Oklahoma's fully-insured health insurance market, health reform has eliminated much of the competition, with smaller companies bowing out because of narrow profit margins, Shaw said. There are now only three major insurers: Blue Cross/Blue Shield; United, which bought Principal; and Aetna, which bought Coventry, he said.

That leaves consumers with fewer choices and higher prices, he said. The Kaiser Foundation cites an incremental increase of 4 percent in health insurance costs this year, but Shaw said increases across the fully-insured market range from 5 percent to 40 percent.

Florida journalist Nick Tate, author of “ObamaCare Survival Guide: The Affordable Care Act and What It Means for You and Your Healthcare,” believes the law will help sole propietors but will stunt the growth of many companies.

“Why would an employer of 25 or fewer workers that offers health insurance grow, if they stand to lose tax benefits of 30 percent to 50 percent?” Tate said. “And why would an employer under 50 grow to 51, where they're subject to the mandate to provide workers health insurance?”

Such questions are some of what spur Oklahoma City startups such as Salerno Health (salernohealth.com), which launched June 1 with six primary care physicians in the greater Oklahoma City area, and MedEncentive (medencentive.com), which taps psychosocial motivators between patients and doctors for more efficient health care and reduced costs.

Salerno's fees for direct medical services range from $30 for an office visit, which includes labs and X-rays, to $50 for an MRI, which Old School Bagel co-owner Wayne Hansen has scheduled for later this month to address a painful shoulder injury he's lived with for the past 16 months.

Health insurance never was intended to cover preventive care costs, Salerno CEO David Rothwell said.

Business owner Doug Tolliver of Masters Heating and Air in Del City is paying Salerno the $49 base rate for any of his 11 employees who wants the medical coverage.

“I want to make this a place where people want to work,” Tolliver said. “If you find good people, you gotta keep them.”

Sort of 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.

Of Variety Care's 37,000 medical patients, half are adults, she said. And of those, 40 percent are uninsured, and most work at least one part-time job, she said.

“Community clinics — which offer care on a sliding income-based scale to everybody — are well-positioned, with medical, vision, dental and behavioral health services, to care for diabetics and other complicated patients,” Carmichael said. “We save the system money, and citizens huge suffering from things like blindness, amputation and dialysis. Early care is always cheaper and less invasive.”

Meanwhile, New York-based AIG and IHC Risk Solutions, two of the country's top 10 reinsurers, have agreed to offer a 5 percent discount on stop-loss insurance to self-insured companies who use the online cost-containment product of 8-year-old MedEncentive of Oklahoma City. Stop-loss protection insures companies who offer self-funded health plans against deep losses.

Independent research studies found return on investment on MedEncentive's product — which has been sold in Oklahoma, Washington and Pennsylvania for $3 per member per month — ranges from 3-to-1 to 17-to-1, considering financial incentives and fees, CEO Jeff Greene said.

“Based on best practices, the product educates and tests patients on their understanding and management of their respective diseases, be that hypertension or diabetes, and merges behavioral economics with the psychosocial motivators between us and doctors,” Greene said.

Patients stand to prosper and have their co-pays waived, he said, while providers bolster their reputations and receive some $15 rewards on office visits.

“It encourages both parties to up their games,” Greene said.


by Paula Burkes
Reporter
A 1981 journalism graduate of Oklahoma State University, Paula Burkes has more than 30 years experience writing and editing award-winning material for newspapers and healthcare, educational and telecommunications institutions in Tulsa, Oklahoma...
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at a glance

Did you know?

About 61 percent of firms nationwide offer workers annual health benefits. For employer-sponsored coverage, annual premiums average $15,745 — of which workers pay about $4,316.

Premiums for employer-sponsored coverage climbed only 4 percent from last year. But since 2002, annual premiums have shot up 97 percent — compared with wages and inflation, which over the same time period have increased only 33 percent and 28 percent, respectively.

Growing in popularity, health savings accounts/high-deductible health plans cover 13.5 million Americans, up from 4.5 million five years ago and 18 percent since last year.

The state's “SoonerCare” Medicaid state-federal system — which provides free health care to largely low-income women and children — hit 1 million members in July.

As of September, there are 16,525 members in the state's Insure Oklahoma program, which uses state tobacco tax revenues matched with federal funds to subsidize at least 60 percent of premiums for low-income ($20,420 for individuals; $41,000 for a family of four) self-employed workers and those who work at businesses with 99 or fewer workers. There are about 4,811 corporate members; all but 362 of them work at companies that employ 25 or fewer workers.

SOURCES: Kaiser Foundation, America's Health Insurance Plans and SoonerCare

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