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Business Review Western MI
Business Review Western MI
HMOs reform put off for individual debate
(2008-02-13)
(wgvu) - HMOs reform put off for individual debate

Feb. 14, 2008

By Mark Sanchez
marks@mbusinessreview.com

A planned effort to overhaul state regulations over HMOs in Michigan
are on hold, pending the outcome of the ongoing debate over proposed
reforms in the individual health insurance market.

Given that the individual market is by far the largest growth driver,
the Michigan Asso ciation of Health Plans needs to devote time and
resources to a three-bill package backed by Blue Cross Blue Shield of
Michigan.

Fearing the bills, if passed in their present form, would hurt the
ability of HMOs to compete in the e merging individual market, the
association decided that a reform package for its industry must wait,
Executive Director Rick Murdock said.

We need to get (individual reform) to work for us. If it does not,
then going forward (with HMO reforms) doesn't make a whole lot of
sense, Murdock said. We need to have assurances that the HMO
industry can compete in the individual market.
Blue Cross projects the individual health insurance market to grow to
15 to 25 percent of its subscriber base within five years.

The individual market now accounts for six percent of Blue Cross's
membership.

Forrester Research estimates individual insurance nationwide as a
potentially $115 billion market opportunity, driven by an erosion in
employer-sponsored health coverage and the rising uninsured population.

The health plans association, representing 21 HMOs in Michigan and with
a collective membership of 2.1 million, had been hoping to offer and
push reforms this year that allow health plans to achieve regulatory
parity with commercial health insurance carriers.

The goal was to seek greater flexibility by redefining what constitutes
basic coverage, which could allow HMO to begin designing benefit
packages for employers that are more affordable.

The association began putting the HMO reforms on the back burner when
the individual reforms bills were introduced and quickly passed the
state House late last year. The bills are now under consideration by the
Senate Health Policy Committee.

That's where our efforts need to be focused, Murdock said.
We can only focus our efforts on so many things at once.
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