PHA-Exchange> Hidden Barriers to Health Coverage (fwd)

[Chan Chee Khoon]

fyi, courtesy of Noorul Ainur (Kuala Lumpur).
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http://www.nytimes.com/2001/08/18/national/18ELLI.htm

New York Times  (August 19, 2001)

MONEY & MEDICINE
Hidden Barriers to Health Coverage
By JENNIFER STEINHAUER
 
The best possible method for getting health insurance
under the current system, of course, is to be
gainfully employed by a company that offers coverage.
That is not to suggest that all care is created equal.
Some employers pay all the premiums, while some pay
less than half. Some offer plain-vanilla H.M.O.'s,
others a fuller range of plans. And some are strong
voices for employees in disputes with insurers, while
others do very little to help.

But it is also true that some employers raise the bar
enough to prevent or discourage their own workers from
getting the insurance they do offer. 

Some companies insist, for instance, that their
workers foot a big portion of the monthly bills, and
the only plans they offer may have high premiums,
putting them out of the reach of most lower- paid
workers. Others require workers to endure long waiting
periods before they can enroll, while most refuse to
cover part-time workers. And the employers — who are
generally fed up with having to administer benefits
and fight with insurance companies — are often
low-energy advocates for their workers when they face
off with the insurers over coverage.

The Commonwealth Fund, a health care research
foundation based in New York, found in a study this
summer that high premiums and tight restrictions
played a major role in keeping many workers without
coverage, even when they are employed by companies
that offer insurance plans.

The problems are most acute for low-wage earners —
those earning less than $20,000 a year. The
Commonwealth Fund found that companies with few such
employees insure proportionately more of their work
forces. Sometimes, even a small increase in the amount
employees must contribute toward their insurance is
enough to persuade them to change or reduce coverage.
A $10 increase in monthly contributions raises the
probability that a worker will switch plans to 25
percent from 5 percent, the foundation said. 

Workers may also be discouraged by an absence of
choices. About 87 percent of workers in small
companies have only one choice, generally an H.M.O.,
when it comes to health plans. Tack on obstacles like
exclusions of care for pre-existing conditions and a
load of other restrictions, and it becomes cheaper and
more attractive for some people to take their chances
and pay for medical care out of pocket when they
become ill. 

Most companies have waiting periods before new workers
can enroll in health insurance. But the longer the
wait, the fewer become eligible, apparently because
some may leave their jobs or change their schedules to
part-time work. The Commonwealth study found that
about 30 percent fewer people were eligible for
insurance in companies with waiting periods longer
than four months, compared with those in companies
with short or nonexistent periods.

"Employer eligibility policies play an important role
in coverage," said Jon Gabel, a vice president of the
Health Research Educational Trust, which contributed
to the Commonwealth study. He added that one in four
employees working for companies that offer insurance
are ineligible because of the waiting periods and
other restrictions.

State regulations requiring shorter waiting periods
could address this issue, but regulations have not
been a panacea when it comes to solving many health
care problems, and often do not help to contain
overall care costs.

And workers may find that their employers are not
their best advocates when it come to battling
insurance companies. Some workers may not want their
help anyway, preferring to keep their bosses out of
their personal business, even if that means opting out
of health insurance. 

"If a worker needs mental health services, or has a
drug-addicted spouse, or a daughter who wants an
abortion or a son with AIDS," wrote Greg Scandlen, in
last winter's issue of Health Care News, a trade
newsletter, "the employer might well be the last
person an employee would confide in."

Mr. Scandlen, a senior fellow at the National Center
for Policy Analysis, also said that setting the same
high premium for all workers would likely force
lower-paid, younger new employees to decline coverage,
leaving behind older, often less healthy participants.

Among the industries surveyed by the Commonwealth
Fund, the retail sector had the lowest rate of insured
employees. That may be attributed to its high
percentage of part-time workers and to the fact that
its employees make an average monthly contribution of
$46 for their insurance premiums, well above the $29
average among industries surveyed.

Are employers best suited to solve the problems of the
uninsured and underinsured? Many health care policy
experts contend that they are not, and that universal
health care or medical savings accounts are better
solutions. But for now, the social contract between
workers and the best employers still includes health
benefits. Bosses could do more, sometimes at little
extra cost, to increase the percentage of insured
workers in their midst. 

Jennifer Steinhauer covers health care for The Times.
Her column on the economics of health care appears the
third Sunday of each month. E-mail:
jestei at nytimes.com.
============================

CHAN Chee Khoon, Sc.D.
Associate Professor
(Epidemiology & Health Policy)
Development Studies Program
School of Social Sciences
Universiti Sains Malaysia
11800 Penang, MALAYSIA.
tel: ++ 60-4-6577888  ext 3352
fax: ++ 60-4-6570918
e-mail: ckchan at usm.my
 
Co-ordinator
Citizens' Health Initiative
website:  http://prn.usm.my/chi.html