The Transcript recently asked Blue Cross Blue Shield of Oklahoma, the state's largest health care insurer, five questions about the ongoing debate in Washington that could potentially have a major impact on the insurer's operations and the way they conduct business. Nicole Amend, a spokeswoman with for BCBSOK, answered the questions.



Q:What is BCBSOK's official stance on proposed health care reform currently being discussed in Washington?



A:"Blue Cross and Blue Shield of Oklahoma strongly believes health care system change is needed. The country must get health care costs under control, and we need to ensure that all Americans have access to quality, affordable health care. We have a unique opportunity now to improve the system and we do not want to see that opportunity lost.

But we also agree with the vast majority of Americans that changes should not jeopardize those qualities that make our system the best in the world - choice, innovation and competition.

In addition to controlling rising health care costs, our current system needs reforming to increase access for the uninsured populations and enhance quality throughout the system.

To address these issues, Blue Cross and Blue Shield of Oklahoma believes that we must build on the current employer-based system, which provides coverage to more than 165 million Americans."



Q: As a private health insurer, what is BCBSOK's most prominent concern regarding President Barack Obama's proposed health care reform? In other words, which issue under the plan seems to pose the largest hazard to your business?

A: "Any hazards in the current health care proposals are not to our business as so much as to our customers, all Oklahomans and all Americans. We want a reformed health care system that truly works for everyone and in which everyone can afford to participate. The issue of affordability is in danger of being lost. A weakened personal responsibility requirement, coupled with other factors, is likely to cause premiums to soar for many people.

A report released recently by Oliver Wyman Inc. estimates that without a strong individual requirement, a new individual health insurance policy would cost 50 percent more five years from now, not including medical inflation. For Oklahoma, this would translate into premium increases of nearly $1,300 annually for single coverage and $3,000 for family coverage in today's dollars for Oklahomans purchasing new policies. Requiring insurers to cover everyone regardless of pre-existing conditions without an effective personal responsibility requirement will mean that people will wait to purchase coverage until they need it -- causing premiums to increase for most new purchasers.

Young, healthier people are price sensitive, and it's important to have them in the system to help keep costs down for everyone. Oliver Wyman Inc. estimates a strong requirement will draw nearly 3 million young and healthy members into the reformed individual market. This healthier insurance pool will result in lower premiums than a weak personal responsibility requirement."



Q: Do you feel like too much government involvement is bad for the health care industry?



A: "Government health care programs can be problematic because they shift costs. Medicare and Medicaid pay providers at a lower rate than private insurers, and to compensate for that loss of income, providers increase their charges to those who are privately insured. A new government-run plan would exacerbate this problem and cause employer premiums to increase and employees to drop coverage.

Private health plans lead the way in implementing condition management programs for patients with complex chronic conditions. Medicare lacks integrated condition management programs despite the high prevalence of beneficiary chronic conditions. In addition, a government plan will not be able to quickly and effectively respond to patients' needs or implement changes that reduce costs and improve quality because of political pressures that would threaten such efforts.

Private health plans are able to innovate in designing benefit plans that enhance value for patients based on best evidence and consumer research. However, under government programs, changes in benefits often require Congressional action. As an example, outpatient prescription drug coverage was not provided under traditional Medicare before passage of the Medicare Modernization Act in 2003; whereas, private plans have covered prescription drugs for several decades."



Q: So many negative things are said about health care insurers in the U.S. What are some things the industry is doing right?



A: "While there are a significant number of people who don't have health coverage, 85 percent of Americans do and the vast majority of them like and want to keep it. We need to make sure that their interests are protected in whichever type of reform we pursue. More than 90 percent of our company's customers are satisfied with the service we provide.

Also, private health insurers excel in innovation. We go above and beyond paying claims by advocating for quality assurance and improvement. For example, Blue Cross and Blue Shield of Oklahoma recently conducted a patient safety study focused on office-based cardiovascular stress testing. The study identified and alerted physicians of lifesaving problems such as dead batteries on automated defibrillators, and we supplied doctors with checklists to help them maintain quality service. Quality assurance programs help secure the safety of patients, limit costs and reduce potentially preventable adverse events, such as hospital and emergency room admissions."



Q: From your company's perspective, what would happen if the government ran private health care insurers out of the industry?

A: "This is the most important questioned asked. Without a healthy system of private-sector competition, doctors and hospitals would have nowhere to turn to offset their lower reimbursement rates paid by Medicare and Medicaid. These government programs often pay less than the actual cost of the services provided by doctors and hospitals.

From conversations with providers, we believe that this loss of income will lead many doctors to retire, take cash for payment or be driven out of business. Hospitals, who are usually a large employer in rural areas, may be forced to make cutbacks or close their doors. These results would further hinder our health care system, which is already experiencing a shortage of health care providers. This is particularly true with primary care physicians and doctors in rural communities."

-- Compiled by Andrew Knittle