The number-one domestic concern in the U.S. today is healthcare. Reforming our government- and employer-funded health system is uppermost on people's minds and front-and-center on virtually every politician's policy platform.
Currently the federal government accounts for slightly less than half of this nation's healthcare spending. Nevertheless, the U.S. is the only developed country that does not guarantee its citizens universal access to care. The tipping point is rapidly approaching as to whether the U.S. will have a predominantly public or private-payer healthcare system.
The healthcare debate in the 2008 presidential campaign centers on three categories of issues:
- Covering the increasing population of uninsured
- Reducing health costs and improving quality of care
- Modifying tax laws to support health system changes
The Republican and Democratic parties and their leading presidential candidates are proposing two very different approaches that are likely to drive reform at different speeds.
- Democrats promise broad, immediate changes with mandates for individual and employer insurance, stringent new regulations and expansive new programs. All this will increase government spending for healthcare by an estimated $100 billion during the next decade.
- Republicans take a slower, less detailed approach. They want to encourage individuals to buy insurance through tax incentives and to de-emphasize the employer-sponsored insurance market.
Regardless of which party wins the presidency, the federal government's role in healthcare will almost certainly expand and spending will increase, either through additional tax credits or expansion of government-funded health programs. Several states are not waiting on the federal government to act but launching initiatives of their own.
How we can help you
As a payer, your chief concern is to protect the markets in which you sell your products. Although proposed mandates and tax credits would enlarge your customer base, reforms — toward or away from public funding — will bring major changes in the way you sell your products — and to whom.
Research conducted by PricewaterhouseCoopers identifies three key risks for payers:
- New regulations: Increased regulation directed toward community rating, guarantee issue, and coverage mandates may increase regulatory burdens and limit insurance underwriting strategies.
- Loss of markets to government insurers: New public programs could crowd private plans out of the market and reduce the pool of potential customers.
- Undercutting of employer group coverage: Some reform proposals would move away from dependence on employer-funded group plans toward a retail business model.
We can help steer your organization around the risks and uncertainties of the changing health insurance market and guide you toward competitive advantage.
