Ask the Experts

Ask the Experts is an event series that features a different topic each installment. Past topics have included strategic marketing, education, healthcare, talent attraction and retention, and more. Panels comprised of local industry experts provide ideas, strategies and tips for success. Experts are chosen from different industries to facilitate well-rounded and valuable conversations—all aimed at helping business leaders and professionals improve the way they do business in Indy!

You Asked, They Answered

Our latest installment of Ask The Experts: Healthcare Reform produced several great questions from attendees that panelists did not have time to address. If your question wasn't answered at Ask The Experts, responses are below.

Joe Gilbert
Regional VP, Individual and Small Group Sales
Anthem BlueCross BlueShield

For group plans with a 50 percent participation requirement, what happens when participation dips below 50 percent?

Joe Gilbert: "The participation requirements for a group plan are now prescribed by the Affordable Care Act. We prefer for our groups to have a 75 percent participation rate to keep rates low. However, groups cannot be denied for missing participation requirements during the Open Enrollment Period (November 15, 2014 to February 15, 2015)."

How will the Affordable Care Act deal with very expensive drugs, which would bankrupt state Medicaid budgets?

Joe Gilbert: "The ACA drug lists used by Carriers must be approved by HHS (the Federal Government). HHS and the Insurance Carriers are in a position to work together to ensure that drugs show the appropriate value in effectively treating members in order to be on the approved list.”

John Gause
President and CEO
Apex Benefits

Do you think more companies will go to HSA plans?

John Gause: “Yes. We do believe, as cost pressure continues to build, more companies will give up grandfather status and move to HSA plans. I think that they’re proven to engage employees in the consumerism model. And, really, we just think the price pressures will do that. Plus, [with] the excise tax really coming into play in 2018, continued pressures will be on cost.”

If we are being asked to pay healthcare for all, why can’t there be some responsibility imposed on people (e.g. no smoking, no obesity)?

John Gause: “People make lifestyle decisions that ultimately will cost more money. Therefore, the people who are actually paying the freight for that end up having to pay more.

"No one knows who’s necessarily going to be a high-cost claimant. If employers can charge higher costs for smokers and, to some extent relative to wellness, provide either higher cost or lower cost for people who are healthier. But, at the end of the day, that’s really the only way to respond.”

Kevin Speer
President and CEO
Hendricks Regional Health

How do wellness and healthy living fit in the Affordable Care Act? It is confusing and sounds like the healthier you are, the more you pay.

Kevin Speer: “There are two concepts here. One is what actuaries have assigned as the premium you’re going to pay. And, the other is the healthcare expenditure side; the healthier you are the less healthcare costs you will incur.

"If I am 50 years old, overweight, and I don’t exercise, I’m headed toward heart disease. I’m headed toward diabetes. I’m headed toward a potential stroke. If I lose 40 pounds, I exercise, I eat lettuce rather than soup, and salmon rather than steak, then those risk factors for diabetes, heart disease, and stroke are diminished and the likelihood that I will incur those expenses both directly in healthcare and to my own personal family are diminished. But, the healthier you are, the less healthcare costs you’re going to incur. From an actuarial perspective, somebody has decided that the healthier you are, perhaps your premiums might go up. So, that’s the difference.”