Scott Kowalski offers insights on future of health insurance

Scott Kowalski, Executive Vice President of WPS Health Insurance, presented at the 2018 Mega Conference in Wisconsin Dells. Kowalski was part of a general session panel on Jan. 17. The panel’s topic was the future of health care in Wisconsin.

Kowalski traced the history of the Affordable Care Act, summarized the current situation, and offered some observations for the future.

He said the ACA was intended to reduce the number of uninsured people; establish minimum benefit levels for all plans; create tiered plans to make it easier for consumers to shop and compare; eliminate the pre-existing condition exclusion; and provide for an unlimited lifetime maximum benefit.

However, the ACA had little to do with care, and everything to do with insurance, Kowalski said. And it had little to do with the affordability of insurance. The federal government just picked up more of the premium. The ACA also had little or no impact on the cost of care, and it didn’t have any impact on access to care.

“It should come as no surprise that all the sick people bought plans on the Exchange, and the young healthies stayed away because the fine (for not purchasing health insurance) was not punitive enough,” Kowalski said.

He then commented on recent political developments and the outlook for 2018.

“Republicans now own this issue because they went for the home run (repeal and replace the ACA) and failed,” Kowalski said, noting that it’s virtually impossible for either party to take away a benefit once it has been provided.

“In my opinion, a better approach would have been to work with the Democrats to correct some of the bad policy components of the law. Republicans could have declared victory without eliminating the benefits that now too many people are receiving,” he said.

Now we are left with no cost-sharing reduction payments (for premiums and out-of-pocket costs); the health insurance tax is back for 2018; states are submitting waiver requests to consider re-insurance programs; and Executive Orders can change the rules pertaining to health insurance.

“If smaller employer groups are allowed to more easily band together (through association plans) to purchase insurance, this may put the brakes on recent trends of smaller employers considering self-insurance as a way to modify benefits, take more direct responsibility for the expenses associated with their employer-sponsored plans, avoid some taxation, and generally avoid some of the more damaging aspects of the ACA,” Kowalski said.

Kowalski predicted there will be continued efforts by payors and providers to find ways to work more closely together (such as the Aspirus Arise model in Wisconsin); general consolidation in the insurance industry, even amongst local HMOs; and acquisition of medical practices, hospitals and HMOs by large comprehensive health systems.


About the Mega Conference: It was presented by the American Association of Healthcare Administrative Management, Healthcare Financial Management Association, Wisconsin Medical Group Management Association, and Health Insurance Portability and Accountability Act Collaborative of Wisconsin (HIPAA COW).