Managed Care

 

Keeping Unemployed Covered In Managed Care’s Interest

MANAGED CARE December 2009. © MediMedia USA
Editor's Memo

Keeping Unemployed Covered In Managed Care’s Interest

John Marcille
MANAGED CARE December 2009. ©MediMedia USA

John Marcille

As we were going to press, legislators were weighing whether to extend the subsidy contained in the American Recovery and Reinvestment Act of 2009 (the stimulus) that allowed thousands of unemployed workers to maintain COBRA coverage.

Some stories in this issue of MANAGED CARE deal with utilization, whether overtly, as does our cover story on page 20, or in a less direct manner, such as in the article about when plans should cover new therapies (page 25), our Q&A with Brent C. James, MD, and, on page 31, the article about just what goes on at the pharmacy counter (page 41).... We’ll stop there.

One way not to manage utilization would be to cut it off entirely. No matter how the COBRA debate plays out (we bet that it will have been extended by the time you read this), clinical executives and administrators have an interest in seeing that the unemployed are not also uninsured. Let’s face it: Insurers don’t want to lose covered lives.

But much more important is the human issue — people need care. Subsidized COBRA keeps beneficiaries on the membership rolls, but how exactly to do it?

Jaan Sidorov, MD, a member of our Editorial Advisory Board, says, “My colleagues in the insurance industry need to pay attention to this because this is another corner of their premium income that has been supported by the feds and that is now threatening to go away. While the industry would probably prefer to ride this gravy train, this speaks to the fickle nature of doing business with the government: It’s stop-and-go laced with brinkmanship.”

COBRA is a societal issue. The federal government, through action and inaction, contributed to the mess that we are in now, and it shouldn’t turn its back on those who are truly and intensely suffering because of its shortsightedness.

Meetings

Private Health Insurance Exchanges Conference Washington, D.C. October 7–8, 2014
National Healthcare Facility Management Summit Palm Beach, FL October 16–17, 2014
National Healthcare CFO Summit Las Vegas, NV October 19–21, 2014
National Healthcare CXO Summit Las Vegas, NV October 19–21, 2014
Innovative Member Engagement Operations For Health Plans Las Vegas, NV October 20–21, 2014
4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014