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Every major reform has winners and losers. Obamacare is no exception. With all the talk about state health exchanges, new fees, and pay-or-play, the opportunity for union trusts to be big winners can be easily overlooked. This webinar will present that perspective. We start by exploring the differences between union trusts and other self-funded plans. Those differences afford union trusts the ability to offer their members a health coverage experience that can be more attractive and less costly than traditional employer-controlled coverage. Those differences, if pursued by union trusts, can also assist in recruiting union membership and countering the impacts of right-to-work and other anti-union initiatives. While not inevitable, the perspective shared in this webinar is as probable as the predictions of doom and gloom that so permeate the discussion around health reform. For more information, please visit: http://www.healthdecisions.com
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Presenter:
Si Nahra, Ph.D., PresidentDecember 18, 2012
Union Trusts:Health Reform’s Most Overlooked Winner?
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Past Webinars AvailableRecordings of past webinars are available upon request, including:
• November 2012 -- Year-end Renewal and Bidding: Opportunities for Control and Savings
• October 2012 – The 5 Most Important Things an Effective Dependent Audit Should Include
• September 2012 - Old Question, New Twist: Is Self-funding Right for Your Group Health Plan?
• August 2012 - Are You Ready to Manage Your Health Plan Costs?
• June 2012 - Group Health Brokers’ Future: Disintermediation or Re-intermediation
• May 2012 – Five Levers of Management Control
• April 2012 – How the AMA Can Help You with Plan Oversight
• March 2012 – Health Data Control
• February 2012 – Health Reform: A Contrarian’s Perspective
• January 2012 – The Road to 100% Transparency
• December 2011 – 2012: What Does it Hold for Self-funded Health Plans?
• November 2011 – Overpayment Collection
• October 2011 – Finding Provider Fraud
For more information, please visit www.healthdecisions.com
Copyright Health Decisions, Inc. 12/2012
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Union Trusts:Health Reform’s Most Overlooked Winner?
First topic to garner advance reactions.
Most important part of topic:
?
?
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POSSIBILITIES not Predictions or a Proposal
Based on what I have observed in the self-funded space.May well apply elsewhere.
Many possible objections and “what abouts” exist.
My intent is to focus on matters that can be addressed via contract.No legislation required. Regulatory compliance presumed.
Orientation
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Current Issue: Are Union Trusts (UT) Qualified Health Plans (QHP) eligible for tax credits
in the as-yet-to-be-established Health Exchanges?
Worst Case (for Unions)Best Case (for QHP)
UT gone in the •lower wage ($44,000 single/$90,000 couple),
•small employer (under
50) trades
Best Case (for Unions)Worst Case (for QHP)
UT as the •“Un-Exchange” • Member/Family Advocate•Employer partner
Most Likely
UT recognized as QHP
Observations
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1. Individuals are now routinely at financial risk and that risk will grow, not diminish.
2. Obamacare’s focus on individuals and individual elections places new responsibilities on us and our families.
3. Obamacare’s focus on small groups and Medicare/Medicaid provider payment reform, leaves the self-funded space to fend for itself.
4. Self-funding and exchanges will battle for the 50-500 employee groups.
5. In self-funded space, employer plans and union trusts are very different.
6. Union assumption of employer plan risks has been done for retiree coverage and is possible elsewhere.
Individuals
Self Funded Plans
Union Trusts
Employer Plans vs. Union Trusts
Employers •want to reduce risk and avoid liability.
•focus on the employee
•shed or cap retiree liability.
•favor defined contribution.
•see benefits as a necessary problem.
Unions •want to provide a member benefit.
•focus on the member & family.
•preserve retiree coverage.
•favor defined benefit.
•view benefits as integral to their value.
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Health Decisions has worked with both Employer Plans and Union Trusts.
They are VERY different.They are VERY different.
Connect Dots
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Differences create opportunities for Unions
What do Unions do best?Organize IndividualsFulfill Contracts with Employers
What is needed post-reform?Individuals need AdvocatesEmployers want Options
Possibility #1
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What if Health Exchanges don’t work at all or as planned? How will Exchanges vary across States?
What happens when Exchanges end in about 5 years?
The “Un-Exchange”
Union Trusts offer an alternative and continuity
for theWary individual and the
Weary employer
Possibility #2
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Directed at Union income by allowing “free riders”. Legal, legislative and electoral challenges will continue.
Enhanced services (in addition to collective bargaining) can help.
Right-to-Work (RTW) “Counter-punch”
Union Trusts offer Another reason to organize and pay dues for members.
Another reason for Employers to work with
Unions.
Possibility #3
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IndividualsHelp dues-paying members and their families fully exercise their HIPAA data rights.
Establish two-way communication with dues-paying members and their families to help them understand and select their best option.
Assist dues-paying members and their families in understanding their health bills and cost-sharing obligations and options.
Your “Advocate”
EmployersCompare members’ data to plan billings to find fraud and abuse.
Monitor elections for all members (employees, spouses and dependents).
Assure subsidies are used and penalties avoided.
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About Health Decisions, Inc.
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For Over 25 YearsFor Over 25 Years
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