BlueCross BlueShield of Tennessee legal counsel Tony Hullender told members of the Pachyderm Club on Monday that the Chattanooga-based insurance giant has been working its way through the complicated mandates of the new Affordable Health Care Law. "We've got our heads to the grindstones working on it," he said.
He said it appears the law is here to stay after clearing a U.S. Supreme Court hurdle in a 5-4 vote. Some legal challenges remain, he said, but it appears that much of the law may remain intact.
He said BlueCross is watching how the market will react to the various facets of the new law. "It's so different than what we had before," he noted.
The speaker said the effect of the law may be to raise premium costs for young and healthy individuals, while modifying them for the sicker elderly.
He noted that there can be no more than a 3:1 cost differential between age groups.
He speculated that the result may be that some healthy young individuals may opt to pay a tax that is as low as $95 and forego getting insurance.
Attorney Hullender pointed out that the majority on the Supreme Court upheld the law on the basis of the government's broad right of taxation. He was present for one of three days of oral arguments on the issue at the Supreme Court. He headed a BlueCross panel focusing on the new law prior to being elevated to chief counsel for the company.
The speaker said one part of the law that was overturned was a section mandating that states had to expand Medicaid coverage or lose existing Medicaid benefits. States now have a choice, and Tennessee is still weighing the decision.
Tennessee did make a choice on the issue of health care exchanges - choosing not to take part. Attorney Hullender said the federal government will operate an exchange within the state.
He said due to the new exchanges that some small businesses may opt to no longer provide health benefits for employees. "They may point them to the exchange for coverage," he said.
The BlueCross official said aspects of the law including allowing dependents to stay on a policy until age 26, no annual or lifetime coverage limits, and a mandate to cover those with pre-existing medical conditions has not caused insurance company costs to go up significantly. In cases of individuals with pre-existing conditions, he said premiums "are still very high."
He said what the law does not directly do is to slow down the ever-rising cost of health care, though he said there are a few sections of the law aimed at doing so.
One strategy, he said, is to pay a "global amount" to a physician or hospital for a certain procedure, such as a colonoscopy, and say, "Do it as efficiently as you can" for the amount provided.
Asked if the law is "good or bad," he said something had to be done to reform the system. On whether this law was the best avenue, he said, "I will take the Fifth on that."