The next set of challenges
Now it’s time to move on to issues involving efficiency, sustainability
For employers, last week’s U.S. Supreme Court ruling clears up the legal uncertainty that had surrounded the Patient Protection and Affordable Care Act and affected everyone’s ability to move forward with certainty. Employers that sponsor health plans can continue to implement the law’s provisions required in the next couple years.
These provisions include providing employees a government-mandated summary of their benefits and coverage, reporting the value of health benefits on employees’ W-2 forms, automatically enrolling employees in a default health plan if they do not choose one, and covering all employees who work at least 30 or more hours a week. The ruling also means that employers must continue the plan benefit changes and plan rules that they had already implemented, including extending coverage to adult children to age 26 and mandatory independent review of coverage denials.
With predictability, we can all refocus on finding solutions to the challenges not really dealt with in the law, including the need to control costs, the need to eliminate waste and overuse, and the need to use system and busi- ness process re-engineering to improve productivity in the health system. We can also work together on payment and delivery system reform.
The National Business Group on Health and employers will continue to work with the regulatory agencies to avoid unintended consequences of the provisions of the law and to ensure the flexibility required to accommodate a multitude of differences among employer plans. Flexibility will be particularly important as employers assess and adjust their benefit plans to ensure that they comply with the ACA’s requirements for the employer mandate and the looming excise “Cadillac tax.”
Today’s ruling also means that employers, states, the federal government and insurers must redouble efforts to work with hospitals and physicians to improve healthcare delivery. Though the ACA is expected to expand coverage to 30-plus million previously uninsured people, which is desirable, it would truly be a wasted opportunity if we all ended up paying for billions of dollars of care that is delivered inefficiently and in some cases unnecessarily.
We applaud and support the new initiative by leading physician specialty associations to identify the most common overused and unnecessary procedures and take steps to reduce them.
In addition, leading employers have worked with a number of hospitals and health systems to streamline their processes of care delivery and their management of care, sharing their methods for continuous quality improvement, better supply-chain management and more efficient operations with great results. With more joint efforts like this, the healthcare community and employers and other payers of healthcare can ensure the long-term sustainability of access to affordable, high-quality, personalized healthcare delivered with world-class efficiency.
Helen Darling is president and CEO of the National Business
Group on Health