KANSAS CITY, Mo. – Health reform could unintentionally convince some seniors that they don’t need to take better care of themselves, according to participants in a health symposium sponsored by the Greater Kansas City Chamber of Commerce.
The potential disincentive, according to insurers and consultants, comes from the Affordable Care Act’s limit on the age-based differential insurers can charge. The rule applies to customers who purchase their own plans as opposed to having employer-based coverage.
A key premise of the health care law is that its mandate for most adults to have health insurance will create a diversified pool of customers for insurers.
Some experts worry that the penalty for not having health insurance — which could be as low as $95 next year — will be too low to convince younger, healthier consumers to purchase health insurance.
But Carolyn Watley, president of CBIZ Benefits & Insurance Services of Kansas City, said wellness advocates must also battle apathy among older consumers.
“We have to fight as hard as individuals, as employers, and as a community overall against the tendency to feel like, ‘Well, it won’t impact my pricing what my health is, so I don’t have to worry about it’,” she said.
Watley was one of the panelists at a Tuesday symposium, which drew an audience of about 90 people to the chamber offices in Kansas City.
Under the Affordable Care Act, premiums for consumers who are at least 64 years old can be no more than three times more than the amount charged for a 21-year-old purchasing the same coverage.
Some seniors might now pay as much as 20 times more than younger beneficiaries, said David Gentile, chief executive of Blue Cross and Blue Shield of Kansas City.
Other factors besides age — such as gender and health status — can affect the rate. But, the Affordable Care Act restricts those pricing factors as well to geographic location, age, and smoking status.
Gentile said an older individual could see a 70 percent drop in their premiums simply due to the narrowing of that so-called “age band.” Conversely, he said, a younger consumer could see a seven-fold increase in their monthly rate.
The Affordable Care Act also includes a provision that could help spur employee wellness initiatives, said panelist Jennifer Anzalone, human resources director for the Ewing Marion Kauffman Foundation in Kansas City.
The act increases the amount companies can discount premiums as a reward for healthy behavior, she said. That discount can be as much as 30 percent under a provision that takes effect next year; the current ceiling is 20 percent.
Former Kansas City business executive Ned Holland — who is now an assistant secretary for the federal Department of Health and Human Services Department — told the audience that he had helped two locally based companies air their concerns about the Affordable Care Act to policymakers in Washington, D.C.
Executives from H&R Block and JE Dunn Construction, he said, are worried about a provision that makes employees who average as little as 30 hours a week eligible for employer-sponsored plans. That’s a concern for employers, such as Block and Dunn, which hire seasonal workers.
“They were heard,” Holland said. “They were listened to.”
Presenters at the symposium agreed that improving the health of employees is going to be an important factor in moderating health care costs for businesses.
“Wellness is going to drive the success of health care costs moving forward,” Gentile said.
The Affordable Care Act allows businesses to pay a penalty rather than offer health insurance to their employees. But, Gentile argued, employer-based coverage remains a key tool for aiding recruitment, retention and productivity.
Employers, he argued, need to embrace health plans that focus on wellness. “If they don’t, it’s really throwing good money after bad,” Gentile said.
As chief executive of ARC Physical Therapy+ in Overland Park, Matt Condon has built his business around keeping workers healthy. One of his focuses is worker’s compensation claims.
He said his work with the transportation departments in Missouri and Kansas shows that wellness can make a difference.
Between 2005 and 2009, Condon said, the Missouri Department of Transportation reduced its number of lost workdays per year by 87 percent.