Changes for employers, health insurers coming with health reform implementation

Starting in September, changes to health insurance could significantly alter how insurers operate and how employers provide coverage for workers.

The Milwaukee Journal-Sentinel: "Starting Sept. 23, health insurers must file annual reports that summarize what percentage of customers' premiums went to pay medical bills. Health insurers who pay out less than 80% of the premiums they collect from people who either buy their own insurance or receive it from small employers will have to provide rebates next year. That's just one example of the pending changes under federal health care reform that will remake the market for health insurance. The biggest changes could come in the market for individuals and families who don't get health benefits through an employer." That's a market that "has been subject to little state scrutiny." High annual premium increases helped propel the legislation through Congress. In Wisconsin, competition has regulated the market. "The real driver in health insurance premiums is health care spending, and Wisconsin has a competitive insurance market compared to some states. Yet, how health insurers determine rates leaves most consumers flummoxed and frustrated, particularly those who buy insurance on their own" (Boulton, 7/11).

North Bay (Calif.) Business Journal: Although Democrats promised consumers that they could keep their current health plans if they liked them, insurance "brokers said such a prospect seems slim, and employers will face a series of tough choices regarding what type of plan they choose to offer employees as they attempt to grapple with still-rising costs." Following the release of federal regulations about how plans can keep their grandfathered status, some analysts say that few grandfathered group plans will remain by 2014. The regulations "quickly created a buzz among brokers - most of whom in the North Bay expressed doubt that the promise to keep plans as is would not be met for the majority of both group plans and individual plans. Changes that would alter the status of plans include the elimination of any specific benefit, an increase in employee co-insurance, an increase in deductible or the out-of-pocket maximum, any increase in employee co-payment, a decrease in employer contribution of more than five percent, changes to annual policy limits and change of carrier for a new policy." Small employer plans, some warn, could lose flexibility, especially those that offer health care savings accounts (Verel, 7/12).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.