Employers powerless to contain health costs

A little more than half of employers offer health insurance to their employees. That means a little more than half of business owners are ripping their hair out this month – the start of the open enrollment period -- as they come to grips with another round of rate hikes: The average plan is projected to see an increase of 7 percent. That is extreme but not unexpected. Premiums have always risen at a rate that’s a multiple of inflation, making the benefit a constant source of frustration.

In recent years we’ve done everything possible to buck the trend, from education and the institution of a high deductible plan to launching a wellness program and holding health-related contests. But there’s only so much that we as the employer can do to help people manage their health and, in turn, manage our costs (and theirs). Employers have their hands tied when it comes to healthcare.

Consider the plight of Flambeau. The Wisconsin manufacturer of tool cases and tackle boxes launched a wellness program and two requirements for participation were health risk assessment and biometric testing. The Equal Employment Opportunity Commission caught wind and filed a lawsuit against Flambeau citing safe harbor provisions under the Americans with Disabilities Act (ADA).

Think about that. The company is trying to mitigate its risks and those of the plan participants by requiring that they receive annual check-ups so the participants are abreast of their current health and any markers present. But, the EEOC wants nothing of it and would rather that people who make bad health decisions continue to go down a path that might one day really put them under the ADA’s auspices by making them oblivious to diabetes, heart disease, and cancer that testing could warn them of.

It’s that mindset that’s also made HIPAA a monster. In its purest form, privacy of medical records is a good thing, but why can’t details be shared with the employers who are spending thousands of dollars on an individual’s insurance? They are investing in that person’s health and it would be good if the investor and that employee could work together to ensure the best for both parties.

I guarantee some readers just stopped and yelled, “you want insurers to share personal information with corporations and you expect them to do good with it?!” Exactly, that is what I’m saying. As I’ve said before, almost all private sector employers (99.7 percent) are small businesses. They aren’t the “evil” big corporations. They’re farms, lawn care companies, pizza joints, dental offices and factories like mine. They’re owned and run by real people, your neighbors, folks who actually give a hoot about the people they work with.

And, maybe that’s where I erred. My company pays the entire deductible for our coworkers, one of just a few in WNY that do that good deed. Likely because of that, my coworkers haven’t changed their behaviors in the marketplace (which is counterintuitive to high deductible plans); as with a traditional plan, they don’t have skin in the game. The proof is in the pudding: My coworkers and their families visited ERs or urgent care facilities 80 times this past year. Of those, 80 percent were ER trips and only 3 were actual emergencies, meaning we blew thousands on costly visits to ERs when cheaper UC or doctors could have been chosen.  

While I can’t be told who specifically went to the ER, I can know their reasons, most of which run the gamut of the mundane. Could I know, I would educate the employee. Similarly, 37 people at the plant don’t have a primary physician (which might explain ER visits). Again, I can’t be told who, so I can’t help them find one.

If HIPAA and the ADA weren’t so restricting, I would be able to work with my coworkers on these and many other items which would ensure better health and lower costs for the company, the workers (they pay 30 percent of the annual bill) and my clients. But, I can’t be the good guy and offer assistance to those who need it. The law won’t let me.

And everyone wonders why healthcare is so costly in America.              


From the 19 October 2015 Greater Niagara Newspapers