The Affordable Care Act that passed with healthcare reform provides tax credits for as many as 66,000 small businesses in the state of Tennessee. Nearly half of these companies are not protecting their employees with Tennessee health insurance. These tax credits are important to nine out of ten of Tennessee’s small business owners who saw an increase in their company’s total health care coverage for the previous year.Increases in healthcare costs hit Tennessee employees, as well. More than three in five workers in Tennessee paid up to 15 percent more for health coverage in Tennessee last year. A third of employees switched to plans with higher deductibles in exchange for lower premiums.Can reforming the healthcare industry help Tennessee small companies and their employees? Sixty-one percent of the owners surveyed in July 2009 said that it would. This survey was conducted by the Tennessee Small Business Coalition and the Peabody College Center for Community Studies of Vanderbilt University.What Will Health Insurance In Tennessee Offer Small Businesses?Small firms, which employ approximately 16.6 million Tennessee residents, will be eligible for tax credits through the Affordable Care Act. That’s particularly important because small businesses typically pay higher premiums than large firms. Tax credits to offset the higher cost of health coverage for small firms became available in 2010 and that’s just the beginning.As many as 3.4 million workers in Tennessee may be able to benefit from the tax credits by 2013, and the Congressional Budget Office estimates that tax credits could provide up to $40 billion to subsidize premiums in the coming decade.Savings are expected to increase by 2020 from efforts to cut administrative costs and increased competition among insurance companies through the exchanges.More Affordable Health Insurance in Tennessee Helps Small BusinessesTax credits are just the beginning of healthcare reform when it comes to helping small firms cover their employees with health plans. Beginning in 2010, insurers are required to monitor their spending for administrative costs as well as their profits. By 2011, administrative costs on plans for individuals and small businesses are not to exceed 20 percent of the premiums a company collects. Plan members are to receive a rebate whenever companies violate that rule.In 2014, small businesses will also have access to state health insurance exchanges. By pooling members, these exchanges can offer lower premium costs making healthcare more affordable. Health plans from the exchanges will limit out-of-pocket costs to $5,950 for individuals and to $11,900 for families. Individual plan deductibles will be limited to $2,000 and the maximum deductible for family plans may not exceed $4,000.Tennessee Health Insurance Exchanges Can Increase Access To HealthcareEmployees of small businesses comprise one of the main categories of people who have no access to healthcare. Since 2005, employee premiums have risen by 47 percent, but wages only increased by 18 percent at the same time that inflation climbed 12 percent.If you work for a small company that does not provide health coverage, you’ll be able to buy directly from an exchange in 2014. Families with four members living on incomes up to $88,000 will also have access to subsidies that can help to cover the price of premiums. By that time, insurance companies will no longer be allowed to deny coverage to you if you have an existing health problem.
Get ready, because a similar storm is brewing in the healthcare industry, and an important disruption is about to occur to the conventional system of wellness communication.Important Trends Are at WorkThese powerful fronts are colliding:• Fast, self-help access to healthcare sources and data. Healthcare consumers arm themselves with information by simply using their fingertips. Credible Internet sources abound, and today’s patients can quickly scan reports, share links, ask questions and post comments.• Rising healthcare costs, coupled with anxiety about money issues. Apprehension and hypertension persist. Widespread worry about medical (and other) expenses remains. Many employees are largely covered under their current insurance plans for a variety of medical issues, and some folks also feel confident that they have funds in reserve, but now more than ever, they occupy a global buyer’s market. Healthcare consumers, like savvy retail shoppers, are price-conscious and determined to locate maximum overall value.• Confusion about the future of the U.S. healthcare industry. Are your employees confident that they’ll qualify for a heart surgery or another major procedure in a few years? The more confusing the U.S. healthcare system gets – and the more bickering that persists over upcoming laws and regulations – the more consumers will seek alternative options for care. In general, we don’t like waiting around, especially in order to be told what to do.Patients Are Realizing Their PowerThe combination of these powerful trends will generate at least one important outcome: More of your employees are going to become global patients.”Medical tourism,” the practice of traveling to receive medical, dental or surgical care, isn’t new, but it’s changing. U.S. residents have long been traveling to other countries for care, particularly for cosmetic surgery, dental work, procedures not covered by insurance and procedures not yet approved by the U.S. Food and Drug Administration (FDA). Today, however, many “medical tourists” are fully insured employees seeking all kinds of care-cardiology procedures, orthopedic surgery, spinal fusions, cancer treatments, bariatric surgery, fertility treatments, eye surgery and many more.The biggest attraction for medical tourists is no secret – cost savings that are often huge. A heart-valve replacement priced at $200,000 or more in an American hospital can cost $10,000 in India, according to the University of Delaware, and that price includes airfare and a post-operative vacation package. Medical tourists receiving care in Thailand save about 70 percent on average, and ones traveling to Latin America typically save at least 50 percent, according to the Medical Tourism Association.The simple truth: Individuals will choose to travel for care when the care is of higher quality, more affordable and/or or more easily available than what they can receive at home.”Many people believe markets perform better than governments in allocating resources, and are much faster to respond to the demands of consumers,” says Fred Hansen, a physician and journalist. “Patients are realizing that the power of the consumer vote, exercised many times every day on choices in different markets. The Internet and cheap airfares have greatly increased consumers’ opportunities and choices by creating new consumer-driven markets.”In hopes of securing a piece of that market, several countries – especially India, Singapore and Thailand – offer state-of-the-art facilities that specifically cater to medical tourists. These facilities have advanced technologies and equipment, and often employ physicians trained and board-certified in the United States.Employers and Benefit Firms Are RespondingMore employers and employees are giving medical tourism options serious consideration. A June 2010 survey conducted by the Medical Tourism Association at a Society for Human Resource Management (SHRM) conference found that 48% of the employers surveyed are “interested” in offering medical tourism to their employers on a voluntary basis, with 36% indicating they “might be interested.”Experts say the medical tourism industry could turn a corner if enough U.S. employers and insurers actively promote and underwrite it. Medical tourism is now being considered by industry giants like CIGNA, Aetna and BlueCross BlueShield, all of whom say they have either started or will soon start pilot programs that will offer partial travel medical insurance.Other insurers have already launched pilot programs:• Wellpoint began offering a pilot program with Serigraph Inc., a Wisconsin-based printing company. Under the program, members of Serigraph’s health plan can elect to travel to India to undergo certain procedures, including major joint replacement and upper and lower back fusion, and pay lower out-of-pocket costs.• IDMI Systems Inc., a Georgia-based automation software developer, contracted with Companion Global Healthcare to provide medical tourism options for certain medical procedures to employees and dependents covered by the company’s self-funded health plan.Disruptions Are ComingWe believe more companies will realize the credibility and viability of medical tourism, and will begin offering options for employees. Also, companies with self-funded plans will begin incentivizing employees to travel abroad for care.The coming rise in medical tourism will be disruptive to the conventional healthcare system in profound ways:• It will reduce the power of coalitions’ purchasing power when they approach healthcare providers.• It will lead to new “centers of excellence” located across the world. Latin America is already becoming one for dental work, and India is becoming one for heart surgery.• It will showcase the fact that employers aren’t going to give up their rights to affordable healthcare in an open, global economy.Are You Preparing?Are medical tourism options right for your employees? You need to take into consideration several different factors, including current health plan choices, employee demographics, risk associated with receiving care abroad and the medical tourism benefit options offered by insurers.No matter what you think of medical tourism, it’s wise to prepare your communication. If you choose to help employees seek overseas care, what messages and education materials can you offer so they can gain a clearer understanding of medical tourism’s advantages? Providing and promoting these materials will help them decide whether medical tourism is right for them.If you choose to not help employees seek overseas care, how will you communicate that decision and defend your reasoning?Here are the two most common questions employees have about medical tourism, and perspective you can share:• Why don’t more insurers offer medical tourism options? Insurers want to take reasonable measures that providers overseas have the credentials to provide adequate care. They’re also concerned with continuity of care – for example, how much are they willing to cover for physical therapy back in the U.S.?• Do treatments take place in low-quality facilities? Not usually. Medical tourists can find facilities abroad that are as good as ones in the U.S. About 220 overseas hospitals are certified by Joint Commission International, and most doctors who treat medical tourists have trained in the United States, Australia, Canada or Europe.In addition to answering employees’ questions, here is news to keep in mind when considering (or implementing) a medical tourism benefit option:• New medical tourism guidelines have been created. U.S. organizations have begun to establish medical tourism guidelines and programs to assist people in choosing appropriate health care for their needs. Employers should ensure employees have a wide range of materials available to them to help them decide which route to care is appropriate. These resources include new medical tourism guidelines from the American Medical Association that the organizations says employers, insurance companies and other entities that facilitate or incentivize medical tourism should adhere to. The guidelines suggest that patients should be referred only to facilities that have been accredited by recognized international accrediting bodies, such as the Joint Commission International or the International Society for Quality in Health Care.• The Medical Tourism Association recently launched its Quality of Care Project. The project focuses on enhancing transparency of the quality of care worldwide so that employers, patients and insurers can better assess and compare facilities around the world. The project aims to create a single methodology for reporting certain statistics and quality indicators, so that individuals and companies can compare health care facilities’ quality, costs, patient volumes and patient safety records.