Little Opposition to Bill Mandating Employer-Provided Health Insurance

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There was little opposition to a bill that would require employers who are licensed in the territory to provide health insurance to their employees at a sparsely attended town meeting on Monday, March 6.

The meeting was organized by Senator at Large Craig Barshinger, who is the chairman of the V.I. Senate’s Health Committee. Barshinger invited Dr. Jacqueline Hoop-Sinicrope, Health Insurance Reform Initiative project manager, and Lauritz Mills, the project’s chief investigator, to answer residents’ questions regarding the bill.

Most Uninsured Are Employed
According to a territory-wide study conducted by the reform project, most uninsured people in the territory are employed.

Eighty percent of territory businesses have 10 or fewer employees, and cannot afford the high administrative costs associated with fully comprehensive insurance plans, said Hoop-Sinicrope.

In order to help the businesses in the territory comply with the bill requiring employer-provided health insurance, a mutual employer trust has been created.

“The trust acts as the administrative human resources department for all of the businesses involved,” said Hoop-Sinicrope. “It handles all the paperwork, and all the processing.”

The premiums are lower than commercial insurance plans, because the cost is based on the amount of people in the trust’s pool.

Similar Plans Used Stateside
The actual benefits are managed by a Florida-based third-party administrator. Thirty-two state governments and hundreds of school districts use self-funded plans similar to the mutual employer trust, said Hoop-Sinicrope.

The PPO (Preferred Provider Organization) plan covers, per year, 60 semi-private hospital days, 30 intensive care days, seven primary care physician visits, an unlimited number of specialist visits, emergency room care, durable medical equipment, diagnostic imaging, one vision visit and one dental visit.

The deductible is $250, with the trust covering 80 percent of medical bills from providers in an on-island network. A network of off-island providers, in the U.S. and Puerto Rico, is included in the plan, and 70 percent of costs are covered by the trust.

Sixty percent of out of network care is covered, whether it is on- or off-island.

Territory Offices
The trust has been asked to have offices in the Virgin Islands, bringing the processing, and millions of dollars to the local economy.

“We want them to bring the processing, and the money, on island,” said Hoop-Sinicrope, who added that because commercial insurance companies don’t have local offices, “millions of dollars are not going through the economy.”

During the first 90 days after approval of the bill, pre-existing conditions will not be considered for those who join the plan. After 90 days, a “standard pre-existing” clause will be included in the plan, said Hoop-Sinicrope. That may include higher premiums for those who have recently been diagnosed, or a one-year waiting period, during which the trust will not cover medical bills related to a pre-existing condition.

The cost for the plan is estimated at $182 a month, and the bill requires employers to pay half of each employee’s premium.

Government Assistance Available
Those who make less than $24,500 per year can apply for assistance. In these cases, the government would pay one-third of the premium, and the employer and employee would split the remaining two-thirds.

The reform project is also investigating offering assistance to businesses who simply can’t afford the premiums offered by the trust. “We are so concerned about small businesses going out of business,” said Barshinger. “We’re going to look at creating ‘extreme assistance.’ We are absolutely committed to keeping small businesses in business.” This plan is designed not only to provide affordable coverage to the territory’s uninsured; it also aims to save money for the government.

Insured and Uninsured Connected
Each year, $50 million dollars is given to the territory’s hospitals by the legislature to cover the costs incurred by caring for the uninsured.

“We are connected to the uninsured,” said Hoop-Sinicrope.

By providing the insurance plan, Hoop-Sinicrope said she hopes that people who have an illness like hypertension will be willing to seek treatment earlier, thereby avoiding costly hospital bills associated with serious side effects of leaving the disease untreated, such as heart attack or stroke.

After speaking with business owners at the town meeting, Hoop-Sinicrope said more dialogue is needed with businesses like restaurants and construction companies, who tend to hire people on a short-term or seasonal basis. Persons must have worked at least 90 days for an employer to be eligible for the plan.

The mutual employer trust plan will be available to employers who currently provide health insurance to their employees. One business owner said she is interested in the plan, because her employees are currently paying as much as $300 a month for insurance.

“We want to bring this dignity and serenity for every person,” said Barshinger.