By Georgetown University Center on Health Insurance Reforms

Sabrina Corlette of the Georgetown University Center on Health Insurance Reforms joined a panel of witnesses before the Subcommittee on Health, Education, Labor and Pensions of the Education & Workforce Committee to discuss “Innovations in Health Care: Exploring Free-Market Solutions for a Healthy Workforce.” Other panelists at last week’s hearing included Tresia Franklin, an executive with Hallmark Cards, Amy McDonough of Fitbit, Inc., and John Zern, a Vice President with Aon.

The hearing testimony and subsequent question and answer session ranged over a wide range of health care topics, but the efficacy of workplace wellness programs and employer interest in private insurance exchanges were front and center. Also discussed were state and local multi-payer initiatives to spur delivery system and payment reforms to help keep health care cost increases in check. In her testimony, Ms. Corlette emphasized:

• In spite of early fears that the Affordable Care Act (ACA) would result in job losses and a decline in employer sponsored insurance (ESI), the opposite is in fact true. The foundation of ESI as a source of health coverage in this country remains as strong as ever, and employers have further benefited from the significant slowdown in the growth of health care prices, compared to the pre-ACA growth rate.
• But even with these promising trends, affordability remains a challenge. Worker contributions to health plan premiums grew an estimated 83 percent between 2005 and 2015, and employees are struggling to pay medical bills because of high and rising cost-sharing.
• Employers and employees are struggling under the burden of high health care costs, but there are promising multi-payer efforts underway to reduce inefficiencies, lower costs and promote better quality. Many of these have been sparked by the ACA’s new Center for Medicare and Medicaid Innovation (CMMI), created to design, launch, and test new payment models to shift our health care system away from fee-for-service, or volume-based, payment, to value-based payment.
• Workplace wellness programs may be intuitively appealing to employers, and many have implemented innovative, exciting new efforts to promote health in the workplace. But those that tie workers’ achievement of a health outcome (such as lower BMI or lower cholesterol level) to premiums or cost-sharing have not been demonstrated to improve health outcomes or improve productivity. Further, some place the privacy of employees’ personal health information at risk.

In her conclusion, Ms. Corlette observed: “A fundamental challenge for employers and their workers today is the cost of health care. But many proposed reforms don’t get at the primary cost drivers: providers and suppliers, many of whom use market clout to demand reimbursement disproportionate to the actual value they deliver. Ultimately, it falls to employers – in partnership with other major purchasers, including Medicare and Medicaid – to drive the reforms that will ultimately reduce costs and achieve better health outcomes.”