Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, May 2, 1993 TAG: 9305010037
SECTION: BUSINESS PAGE: C1 EDITION: METRO
SOURCE: MARGO D. BELLER JOURNAL OF COMMERCE
DATELINE: ORLANDO, FLA. LENGTH: Medium
Charles E. Ginsberg, a managing director of the Alexander & Alexander Consulting Group, detailed an array of pending legislation that is likely to pass this legislative session. He made the comments recently at the annual conference of the Risk and Insurance Management Society.
One measure, introduced by Rep. Bill Hughes, D-N.J., in February, would overturn the H&H Music Case that allowed employers to reduce health-care coverage for an employee's condition that previously was covered and treated under the employer's self-insured medical plan.
The Hughes bill, he said, would bar employers from reducing coverage, as well as prohibit discrimination among lifetime benefit levels in a group health plan based on specific conditions such as AIDS, the basis of the lawsuit.
Ginsburg said several related bills affect claims procedures and funding and reserve requirements for multiple employer welfare arrangements that provide health-care benefits.
Also likely to be enacted, he said, is reform of the Occupational Safety and Health Act, and the uncapping of compensatory and punitive damage limits for employment discrimination based on sex, disability or religion.
But the biggest issue on the minds of employee benefits managers, the Clinton health-care reform program, also is the biggest question mark, he added.
"No one knows what reform means, what it will cost and where the funding will come from," he said last week.
Despite an increased focus on health care, actual reform measures will be "piecemeal," he said. A bill based on the recommendations of the presidential task force led by Hillary Rodham Clinton won't be introduced until 1994, he said, noting "It's still a long way from happening."
John Biebel, president and chief executive of St. Joseph's Hospital in Tampa, Fla., said hospitals "welcome reform that is well thought-out, paid for by everyone and doesn't look for culprits."
He said it is too easy for insurance companies and their clients to blame the high cost of health care on high hospital and doctor costs. Hospitals such as St. Joseph's often find themselves at odds with doctors, he said.
"We have 700 doctors with a preponderance of specialists. The rewards go to those in specialty medicine," Biebel said. "The challenge is, we have to reorganize the doctor into an economic unit, integrated with the hospital and the insurance company."
When a radiologist orders a hospital test for a patient, he added, "it's our expense, but for them it is a source of income. These are factors pushing and pulling us."
He noted that employers turning to managed-care programs as a way of cutting their health insurance costs are only "beating discounts out of providers. You're not creating a better program."
Hospitals are particularly squeezed by Medicare and Medicaid reimbursement rates, he said. A hospital is reimbursed for less than 50 percent of the bill for older patients insured by the federal Medicare program, and even less for low-income patients under state Medicaid programs, he said.
"If everyone paid their bill, I'd cut prices by 50 percent," the hospital administrator said.
He noted that changing the health-care delivery system might include closing hospitals, requiring employees to pay more into their employer's health plan and rationing who receives what type of health care, as is currently the case with Medicaid recipients in Oregon.
"While the debate rages, we have to deliver health care one person at a time," Biebel said. "There should be a basic benefits package for all Americans."
by CNB