Employer Sponsored Insurance

HEALTH REFORM: Public Support for Reform is High

Joanne Kenen — Mon, 15 Jun 2009 18:41:00 -0400

In case you hadn't noticed, American voters want health care reform. Now.

The latest evidence comes from a Diageo/Hotline poll earlier this month, which found that 62 percent of voters support or strongly support "the President enacting a major overhaul of the U.S. health care system." And support comes from across the board: more than one-third of Republicans, nearly two-thirds of independents, and 87 percent of Democrats favor it. And 94 percent of the health reform supporters want Congress to do it this year.

The over 65-year-olds were the least supportive (we would guess because they are afraid of changes to Medicare) but even in this group 56 percent support reform.

Looking at income levels, those earning $100,000 or more a year were the least supportive. Yet again, more than half (58 percent) of this group backed reform.

"President Obama and the Democrats start with strong public support for their desire to make major changes to health care in this country," commented Amy Walter, Editor-in-Chief of The Hotline. "Even so, those who are likely to be the happiest with the status quo—or at least most worried about change (those over 65 and those in the upper income bracket)—are probably the first to abandon reform once the details are revealed."

Of course, not everyone agrees on exactly what "health care reform" means. We've written before about public attitudes, and about how the public and the policy experts aren't always talking about (or at least emphasizing) the same thing.

The Hotline poll found that 49 percent of voters said "controlling the cost of health care" should be a bigger focus than "expanding coverage for Americans without health insurance" (35 percent). Republicans tended to emphasize cost; Democrats were more focused on coverage expansion. Older voters (who are all covered under Medicare from age 65) also emphasized cost over coverage.

One number that grabbed our attention: as we've noted, you can make a good case that taxing a portion of the health benefits people get through their jobs is both equitable (the tax is regressive and it treats people who get their health benefits through work differently than people who purchase it themselves—often at more cost for poorer coverage) and smart policy.

It's also a hard sell politically.

The poll found strong voter opposition to the idea of taxing health benefits—68 opposed (and most of them "strongly" opposed.) Only 26 supported taxing health benefits, while 68 percent of voters oppose, with 51percent strongly opposing taxing benefits.

In a separate poll for Health Care for America Now, Democratic pollster Celinda Lake found that 80 percent opposed a tax on benefits, compared with 63 percent support for limiting itemized deductions for high earners.

Vice President Joe Biden on NBC's "Meet the Press" noted that the White House remains unenthusiastic about such a tax change, although it hasn't ruled it out, depending on what the overall health bill looks like. "We think that is the wrong way to finance this legislation," Biden said,

Hat tip to Maggie Mahar at Health Beat for noticing this poll before we did...

Health Reform: Wal-Mart Tackles Health Costs and Coverage

Kyle Noonan — Fri, 13 Feb 2009 16:50:00 -0500

The Washington Post's Ceci Connolly reports that Wal-Mart, once widely critiqued for having many uninsured workers, is now seen as an innovator. She writes about how the huge retailer is expanding coverage, trying to control costs, and experimenting with care management programs to improve outcomes and quality. The company still has its critics, naturally, but its efforts also say a lot about what businesses can (or can't) do in the current health care climate:

...Wal-Mart itself warns that in a global market with a weakened economy, it cannot—or will not be able to—accept annual health-care increases of about 8 percent indefinitely.

"It starts to impact us competitively," said Linda Dillman, the company vice president tapped to oversee the health plan.

To Andrew Stern, president of the Service Employees International Union and a frequent Wal-Mart critic, the company's health contributions are not commensurate with its financial success. The moral, he said, is that "volunteerism has its limits."

But to Mark Smith, head of the California HealthCare Foundation, an independent nonprofit focused on health-care quality and efficiency, Wal-Mart's experience provides a different lesson.

"Even a company as big and successful as Wal-Mart cannot possibly solve this problem on its own," he said. "There are limits to what one company can do."

Additional take-home points from Connolly:

Wal-Mart shopped around for value, contracting with the Mayo Clinic for all transplant services, for example, based on its excellent record.

Wal-Mart is utilizing the model of a patient-centered medical home. For its pregnant workers, the company provides a nurse to provide counseling on lifestyle changes and infant care.

Wal-Mart's low-wage workers are still paying a lot of their income for plans, and many have high deductibles.

As Smith noted, comprehensive health reform is too big even for even the nation's largest private employer to tackle alone.

(Disclosure: New America is partially funded by the Wal-Mart Foundation, along with other foundations with a variety of perspectives on health system reform. All support our general approach to creating policy and political space for a bipartisan agreement that will work for all Americans. A complete list of our funders can be seen here).

COST: A Worthwhile Wellness Investment?

Joanne Kenen — Wed, 22 Oct 2008 18:58:00 -0400

A few months ago we wrote about a provocative study that questioned whether job-based wellness programs really paid off—and if so when, and for whom. If a business pays for wellness and prevention in 2008, would any of the workers still be on that payroll when the health-savings accrued years in the future (assuming that the investment did pay off in better health and lower costs?)

It's going to take more than one more study to answer that question, but new research from Blue Cross and Blue Shield of North Carolina does provide some encouraging results. According to a report in the Raleigh News and Observer, companies willing to make even modest investments in wellness initiatives—such as health screenings in the workplace or giving workers paid time off for doctor's visits—saw a healthy return (pun intended) within a few years.

"The things that employees value the most aren't always the things that cost a lot of money, and in fact, it can be just the opposite," Don Bradley, chief medical officer for Blue Cross told the newspaper. "You don't have to build a gym, but just give the opportunity to get outside and do some exercise."

The study found that companies offering comprehensive wellness programs see a 25 percent to 30 percent decrease in medical and absenteeism costs in about 3.6 years. Tthat's a lot more attractive way for businesses to save money than shifting more costs onto their workers.

In North Carolina, 70 percent of employers offer at least three workplace wellness programs, the newspaper reported. Four percent offer none. The study found:

The average return on investment for employers is $3.14 per $1 spent on employee wellness.
The four most commonly offered workplace wellness programs are smoke-free workplace, paid time off for doctor's visits or health care needs, on-site health screenings and health fairs.
The four programs with the highest participation rates: paid time off for doctor's visits or health care needs, healthy cafe or vending options, health fairs and physical activity during work hours.

COST: Rising health care costs cut take-home pay

Len Nichols — Tue, 25 Mar 2008 14:31:00 -0400

On the front page of Monday’s Washington Post Michael Fletcher reported two salient facts. One, the Census Bureau estimates that real (inflation-adjusted) median family income has fallen 2.6%, or a bit more than $1000, since 2000. Two, the Bureau of Labor Statistics reported that as of December 2007, benefits now comprise 30% of total compensation, up from 27.4% in 2000.

Fletcher’s piece attributes the decline in net income to an increasingly vivid tradeoff between wages and employer contributions to employee health insurance, and cites many examples to buttress his point. Firms certainly do try to match total compensation – wages plus benefits -- with worker productivity, and if health care costs keep growing faster than everything else, it makes sense that wage and income growth must suffer as a result.

But what few seem to have noticed is that even if you count employer premium contributions as part of employee income (as most economists argue you should), family health insurance premiums have risen to 17% of median family income (using 2006 data, the latest available), up from 7% in 1987.

In other words, the fundamental problem which employees and employers face together is that health care cost growth exceeds economy-wide productivity growth by large margins, and has for some time.

This core fact means that something has to give. We would contend (and will in increasing detail in the weeks and months to come) that “something” includes wage growth, investment funds, profits, the international competitiveness of many US corporations, and, ultimately, middle class jobs. Excess health care cost growth is why some employers are reducing the generosity of health benefits or declining to offer health insurance altogether (the Post story gives some real life examples), why more workers are declining their employers' increasingly expensive offers, and why the percentage of uninsured rises with health care cost growth. Thus, we cannot solve the uninsured problem until we solve the excess cost growth problem. We have argued before (and will again) that we also cannot solve the cost problem until we get everyone covered and into a far more efficient and sustainable health care delivery system. Thus, our core problems of cost and coverage are linked and must be attacked simultaneously with comprehensive reform strategies.