January 11, 2016

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HEALTHCARE ROUNDTABLE

January 11, 2016

This year we're going to see those rates go up quite a bit in the individual market. So those that have split up those groups in the last couple of years may now be saying, wow, we may want to bring that group back together and take advantage of maybe some lower rates in the small business side, but also the pretax benefits. So they have to weigh that cost of the individual market with the advanced premium tax credit versus the pretax benefits under the group insurance.

BELL: We have over 600 small groups. We haven't seen a tremendous amount of dissolving the group benefit options with the 50 and below. We see a lot of high increases coming around the corner, and we're concerned about that. So we might see more dissolving of the groups as we get into that.

BENTZ: I'm seeing a huge increase in small businesses coming in. A lot of it has to do with the competition—how can we attract and retain our employees, because now our competitor is offering a benefit package? They're having to look at the whole platform now, the investments they're making.

McOMBER: The Utah Medical Association is a small business, and we have not seen a decrease in the cost of premiums over time. We've actually seen just as much of an increase since passage of the ACA. So in terms of controlling costs, we haven't seen any of that from the side of the small business. In fact, I've had to increase the portion that our employees pay for their insurance premiums because we just can't cover the 20 percent increase. And we have healthy employees. But we're seeing huge increases in premiums every year.

SLONAKER: We find that small businesses that haven't been able to offer insurance—and they still aren't—are able now to have their employees get coverage through the federal insurance marketplace. That leverages the advanced premium tax credit. That's been a pretty important thing that a lot of small businesses we've been working with have realized.

BINGHAM: What we're seeing is a huge flux in these level-funded or partially self-funded plans for much smaller organizations. But the result is the risky business is getting stuck with the community rates or these certain pools, and then the good risk is pulling out to go do association plans or agency-level plans. Which is great for those, but I worry we're going to have a negative affect on the community—maybe rates have become more even across the board, but we've still seen those 9, 10, 11, 12-percent-plus rate increases. So we're seeing more competition, but a lot of it's just more competition in other types of plans that are really reverting back to the rule from previously where you look at health risk.

I just worry that we're doing this circular thing that's just going to lead us right back to where we're at. There's not a perfect solution that's going to solve that. It's great if you get into that healthy pool, but then it's very bad for those others that are stuck with the status quo.

 Utah is always ranked near the lowest as far as physicians per capita in the country. What do you think we can do to continue to attract and hopefully increase the number of physicians practicing in Utah?

BABITZ: The medical school recently increased the number of its students; unfortunately, the medical school doesn't have a track record of turning out the physicians we need in terms of primary care. And we don't have enough residency slots in Utah, especially in primary care, to even keep them here if they were able to do that. Is there any possibility of increasing residency slots, particularly in specialties we need? That would include general surgery and some of the subspecialties, but mostly primary care, general internal medicine.

Utah's a great place to practice medicine. It's a great place to live. It’s also not an expensive place to live compared to many other states. And our salaries in Utah for physicians reflect a lower cost of living. In other words, we have lower salaries. So when you compare the salary offered in Utah versus the salary in many other places, it's 20 percent lower. What many don't realize is the cost of living here is probably going to be 20 to 25 percent lower compared to those places. That is why the revolving payment programs are critical for us to be able to offer something to get people to come and experience Utah, and help them know that they can make up the difference in terms of income to help them pay off debt. Because student loans are another big issue for physicians.

McOMBER: We do have a unique system in terms of insurance here in Utah. So if you are being recruited to come to Utah, one of the things you look at outside of salary is can you get on insurance panels. If you aren't going to be able to get onto an insurance panel, you know that you can't survive here in Utah. And we have fewer insurance plans here in Utah than you do in other states. So that actually is something that could be a barrier to recruitment in Utah.

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