panel 3: exploring the changes to insurers - Charlotte Chamber of ...

PANEL 3: EXPLORING THE
CHANGES TO INSURERS
MODERATOR: STEVEN CHEROK, TRION
1

THE PANEL
Mark Schmidt—Aetna—Mark is currently the Market Head of Sales (Middle Market) for AR, TN, NC
and SC.
Garland G. Scott—United Healthcare—Garland is currently the CEO for UHC of North and South
Carolina.
Barbara Morales Burke—BCBSNC—Barbara is currently Vice President of Health Policy.
Steven Cherok—Trion—Steve is currently the Managing Partner for Trion/Southeast
2

PANEL FORMAT
‣ 6 questions
‣ Each panelist will take the lead on 2 questions, and provide commentary or supporting replies on
remaining 4 questions
‣ Panel will allow 8-10 minutes per question
3

HEALTH CARE REFORM LEGISLATION IN PERSPECTIVE
• Landmark legislation, but much still to be accomplished to meet Administration’s goals
• Access
• Affordability
• Cost Control
• Lots of new regulations to be issued
• 1,045 references to “the Secretary shall determine………….”
• Reconciliation bill could only “fix” budget-related issues, much more needs to be defined, established, and/or
clarified – even effective date of many provisions uncertain , such as auto-enrollment and CLASS
• Many key employer regulations expected to come jointly from HHS, DOL and IRS – typically a slow process
• Some uncertainties remain about the legislation’s outcome and even future
• States challenging constitutionality and ability to implement (e.g., Medicaid revisions) – HHS likely to give more
discretion/authority to states as long as satisfy federal minimum guidelines
4

HEALTH CARE REFORM PANEL QUESTIONS
‣ Garland: There are a lot of provisions in this bill. What do businesses need to focus on today?
‣ Mark: As an insurance company, how do you define small vs. large group employer sponsored plans? And, what are
the 3 primary HCR challenges handling small groups vs. large groups?
‣ Barbara: The new HCR law set numerous dates for implementing the provisions of reform. The administration has
publicly asked insurers to implement certain provisions earlier than required, on a voluntary basis (e.g., Age 26
dependents, prohibit pre-existing condition exclusion for dependents under age 19, various disclosure and reporting
requirements) As an insurer, how have you reacted - how is this affecting your business?
‣ Garland: As of January 1, 2011 the new HCR law requires insured health plans to comply with a medical loss ration
(MLR) maximum of 85% (for group plans) 80% (for individual plans. As an insurer, what will this mean to employer
sponsors renewing an insured medical plan on or after January 2011?
‣ Barbara: The new HCR law allows each State to establish a State Insurance Exchange by 2014. As an insurer,
what direct benefits will the exchange create for businesses in North Carolina?
‣ Mark: How will this legislation affect our health care costs?