Highmark CEO: More time needed to implement new federal health care rules

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Despite the federal government's drive toward its 2014 health care reform goals, the chief executive of Pennsylvania's largest plan isn't sure there's enough time left on the clock.

There's "a lot of concern about the ability [of the government] to go live," Highmark CEO William Winkenwerder Jr. said this morning.

After meeting with federal health officials in Washington, D.C., recently, he said he came away with the sense that the state-based health care exchanges -- the online clearinghouses where people can shop for health policies -- may not be ready to go by October 2013, when the enrollment period for those exchange-based plans is scheduled to begin.

Beyond the actual construction of the online exchanges, the federal government also has to figure out how the subsidies will be disbursed to those who can't afford full-priced polices and how it will work with the states that want partial, but not full, control over those exchanges.

"It's a lot of complex work, with the IRS, with each of the states," particularly the states that are still uncertain about whether they want to expand their Medicaid programs, he said.

Dr. Winkenwerder met with reporters today to discuss the state of the health care industry and implications of federal health care reform. He would not allow questions about the company's rivalry with UPMC and its on-again, off-again rescue of the financially struggling West Penn Allegheny Health System.

One byproduct of health care reform, he said, will be a steep increase in the premium costs for individual policies for those under 40, particularly young and healthy men. Because of a new regulation that essentially caps the cost of the most expensive policies within a certain product class, young men, used to lower premiums, will end up being charged more.

Some premiums for the so-called "young-and-healthies" could go up by as much as 200 percent, he said.

"That alone is going to be a shocker for a lot of people," he said.

Dr. Winkenwerder also addressed a variety of mechanisms -- more cost sharing with patients, price transparency, new types of care reimbursement models -- that could ease the annual cost of care increases that are customary in the health care industry.

As it stands, health care related spending chews up about 18 percent of the U.S. gross domestic product. It can't -- and shouldn't -- continue to grow unabated, he said.

"It is really incumbent upon the nation to figure this out," he said. "It's a matter of political will."

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Bill Toland: btoland@post-gazette.com or 412-263-2625.


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