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Employee Benefits

You Have to be Good to Be in Healthcare!

Ed Oleksiak
Ed Oleksiak
Sr. Vice President, Employee Benefits

If you work in the healthcare space, you have to be good, very good — maybe great! Healthcare isn’t something you just dabble in. This applies whether you work for an employer, carrier, consultant, broker, or government agency. And I’m about to tell you a whole lot of reasons why!

We’ve been dealing with the implementation of Healthcare Reform for the last six years, and the saga continues. We’re hearing of double-digit increases in the individual marketplace — some as high as 50 percent. UnitedHealthcare® is pulling out of most individual marketplaces. Co-ops continue to fail. Colorado voters will be voting on a single payer system for the state.

The Equal Employment Opportunity Commission (EEOC) has now provided us with guidance on Wellness and the Genetic Information Nondiscrimination Act (GINA), while the Internal Revenue Service (IRS) has chimed in on clarifying that anything provided under a wellness plan is taxable income unless it is de minimus or too minor to merit consideration (which probably includes anything of greater value than a coffee mug!).

In Dallas alone, Aetna® is teaming up with a healthcare system to create a new health plan. Their new plans, along with others being offered, require in-depth study to determine network adequacy, drug formulary coverages, and other cost containment plan design features.

We have to build future business strategies not knowing whether the Cadillac tax will be enforced in 2020 or pushed out…or even eliminated. We’ll have a new president and administration in November that will have its own game plan, including potentially, U.S. House of Representatives Speaker Paul Ryan’s plan to cap or eliminate the ability to deduct the employer and employee portion of the cost of healthcare.

We have the Supreme Court, Congress, and regulatory agencies defining who and what should be covered by a health plan. Coverages for contraceptives, gender reassignment, specialty drugs, biosimilar, and many more are being defined or evaluated on a regular basis.

New cures and procedures are being announced daily. Just this week, I heard about the ability to do a blood biopsy to detect cancer which will be less dangerous than the invasive current methods. While this will result in better outcomes for many, at what cost to the healthcare system?

It’s complicated, it’s changing, it’s expensive, and it’s personal. To work in the healthcare space, you have to be good, very good — or even great.

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