In the wake of one of the most polarizing elections in many years, at least one aspect of national policy is clear: the Affordable Care Act (ACA) will go forward and its main provisions will kick in starting in January 2014. But significant implementation activities are already underway.

At BlueCross BlueShield of Western New York, we have long been committed to ensuring everyone has high quality, cost-effective coverage. We are continuing our intense planning for the upcoming changes the law mandates. New York is moving to create the New York Health Benefit Exchange, enabled by Gov. Andrew Cuomo’s executive order, which needs to be operational by next October.

This will be an electronic marketplace option for individuals and companies with 50 or fewer employees, to shop for and obtain health insurance that would start Jan. 1, 2014. All coverage offered through the exchange must provide a minimum set of specified benefits.

BlueCross BlueShield leaders are involved in state work groups to provide guidance and input on critical operational details of this process. The state and insurers have much work to do to be ready for offering products on the exchange.

While we are working, in good faith, to implement the law, we’re concerned that some aspects of it will increase premiums for millions of Americans. We are working with legislators and policymakers to address these issues. For example, a health insurance provider tax, slated to begin in 2014, adds hundreds of dollars to family premiums. The Congressional Joint Tax Committee estimates that average family premiums will increase up to $400 a year by 2016.

While making coverage more accessible is important, affordability remains key in whether people will buy it. We have been leading the way to work with doctors, hospitals and other health care professionals to transform the health care system so it rewards quality, improves outcomes for patients, and helps to rein in costs for everyone. We remain committed to these efforts as a way of making health care as affordable as possible.

This time of year brings the Bills’ and [usually] the Sabres’ seasons to Western New York, along with the autumn delights we treasure. For the senior citizens who trust their Medicare coverage to BlueCross BlueShield, and those considering doing so, this is also a time to reinforce those feelings of security and stability in the services we provide.

Hundreds of BlueCross BlueShield teammates work hard all spring and summer so our members have a seamless Fall. Our experts meet with members in community events and in their homes to describe and de-mystify Medicare services. Members learn that we offer health coaches who provide access to personal care and healthy living ideas.

This year, for the first time, BlueCross BlueShield is the only health insurer based in our eight-county region offering our seniors the ever-popular Silver Sneakers program.

We’re there with our seniors if they have a health issue or crisis and support wellness with preventative opportunities like Silver Sneakers, while keeping affordability front of mind. They also know that when they vacation, or visit out-of-town family, they do so secure in the awareness that the Blues and their large network of physicians and hospitals are available – as they are for nearly one in three Americans – throughout the United States.

We counsel seniors and offer classes on how to deal with chronic problems like arthritis, diabetes and osteoporosis, by emphasizing positive actions like better nutrition and fitness, smoking cessation and stress and weight management.

Our teams also focus on concerns seniors may not even articulate to themselves, by partnering to offer health-related discounts for attractive services like eldercare, holistic health, fitness and medical equipment purchase.

BlueCross BlueShield is a senior itself, after all, having provided health care services in Western New York’s eight counties for 76 years. Currently the area’s top-ranked health insurance company, based on local consumer ratings, we know how seniors like to be treated and we are grateful for Medicare Advantage members who continue to put their trust in our services.

The Bills season is underway, the Sabres season hopefully will begin soon, and BlueCross BlueShield’s Medicare team is actively involved in our senior community: Answering questions, assisting in choosing the right plan, and providing the security and stability that only BlueCross BlueShield can offer. Our goal is to provide outstanding service so the only stress a senior may face is how large a pumpkin or what kind of apples to pick for their grandchildren.

Health care and healthy living can be opposite sides of the same coin, but shouldn’t be. If you embrace a healthy lifestyle, you’ll likely avoid most “health care.”

Last month we discussed how 92 percent of the health insurance dollar goes to doctors, hospitals, pharmaceuticals and technology. An obvious and recently more emphasized component of health care is getting people to change to behaviors that positively impact their health. This also helps lower health care costs.

For instance, the Centers for Disease Control recently released its U.S. obesity rates and they are not improving, keeping obesity America’s No. 1 health crisis. More than 35 percent of Americans are considered obese. In 2008, individual medical costs for people who are obese were $1,429 a year higher than those of normal weight. Curbing such costs includes individuals taking charge of their lives.

More than 80 percent of treatable illnesses are preventable, if we make the correct choices. Diabetes, obesity, stroke, skin cancer, heart disease and emphysema are just a few of the chronic conditions that cost Americans billions of dollars a year in treatment and lost productivity that we can control and nearly eradicate if we collectively choose to.

Our campaign, Healthy Changes Everything, isn’t just about physical health, but spiritual, financial, work and home health too. Creating life balance has a huge impact on how we take care of our physical selves. We can live more stress-free lives by adopting a better work-life balance.

Yet, improving and increasing productivity is not about pressuring ourselves as parents, mates or workers. Just the opposite, I’ve found. I’m often asked about the work-life balance. Work provides a feeling of self-worth, value and satisfaction, not to mention the means to live, eat, house and support our families.

But rest, time off and relaxing from whatever it is that stresses us – caring for an aging parent or ill child – are crucial to health. I believe that stressed out people – pressured from within or without – are not at their life’s peak.

Research supports the fact that if people feel they can take care of their personal needs, they’re much more productive in other aspects of their lives.

Stress is a real health factor. Work, whether in a job or as a caregiver, is a health factor like what you eat, how much you exercise, how much alcohol you consume, whether you smoke, if you maintain your proper weight, whether you’re proactive about pain or minor conditions and don’t wait until they become serious.

After access to quality care, most people with health insurance are concerned about cost. Historically, premiums have risen most years. You might be surprised, however, to understand why and how the money you pay for health insurance is spent.

We’ll use BlueCross BlueShield of Western New York’s actual data from 2010-11 – which is publicly available from our filings with the state.

Most of every dollar we receive in premiums – 87 cents – pays for health-care services our customers use. These include doctor visits and diagnoses; operations and care in hospitals; prescription drugs from pharmacies; lab work; and services from other professionals.

Included in these costs are New York State health insurance tax assessments, which statewide total $4.2 billion annually.

It costs us only eight cents on the dollar to administer health plans for our customers. Administrative expenses include programs to help keep customers well and also manage chronic diseases, along with information technology, salaries for employees, rent, and utilities. BlueCross Blue Shield of Western New York’s costs to design and manage health insurance programs are significantly below the national average of about 11 cents on the dollar for not-for-profit insurers like us.

Other state tax and assessments account for one cent of every dollar we receive. Two cents of each dollar are for brokers, who assist businesses in evaluating and purchasing health insurance for their employees.

Finally, we retained two cents of every dollar as reserves in 2010-11. Reserves are required by the State, and they assure our customers that our company is financially solid and we will always have the resources to protect them – for both anticipated and unanticipated medical care expenses.

Clearly, at 87 percent, the cost of health care itself is the principal driving force in rising premiums. There are many reasons for increasing health-care costs: increasing prices for medical services; our aging population; new technologies and treatments, many of which are more costly than existing ones; and an increase in lifestyle-related illnesses, such as obesity.

This is why we focus on improving our 600,000 members’ health, and why we work with health professionals in the communities we serve to improve quality of care and reward efficiencies and quality outcomes.

Our campaign, Healthy Changes Everything, reflects our health care model: If everyone is healthier, the level and frequency of care are reduced, and cost of care is contained.

That’s how healthy really does change everything.

Friday, July 6, 2012

Health care affects everyone. And with the complexity of this industry and at this time of great national conversation, it is more important than ever for me to stay connected with those we serve. With this in mind, I’ve created “AOW Blog.” Thank you for joining me.

As the leading health plan in our region, we have a responsibility to the communities we serve, so I plan to post updates here on relevant and late- breaking health care-related issues. Hopefully, you’ll find my comments insightful and helpful as you navigate our very complex health care system.

The biggest news lately of course is the U.S. Supreme Court’s historic decision upholding the Patient Protection and Affordable Care Act. To help us understand the decision and its impact on our community, on June 29, we held a symposium comprised of local and national experts. The event provided a variety of perspectives and insight into the intricacies of this complex legislation, as well an assessment of how the decision will impact the upcoming presidential campaign. I invite you to view the symposium at www.bcbswny.com.

At BlueCross BlueShield of Western New York, we have been implementing and complying with this law since it was enacted by Congress in 2010. We will continue to do so, but we’ll continue working with policymakers to modify provisions that we believe will increase costs. These provisions include a health insurance provider tax that will add hundreds of dollars to families’ premiums each year. We live in a state that has had several elements of the federal law in place, some for many years, so the disruption will be somewhat less here than in other states. Some of the reforms already in effect in New York include, for example, coverage for children up to age 26, and no copays for preventative care.

Even so, we are all looking at a sea-change in health care. However, there will be no change in our commitment to you to provide high-quality, cost-effective health care coverage and responsive service for you and your family.

We will continue our partnerships with doctors, hospitals, pharmacies, and other providers to help people develop and maintain healthy lifestyles and insure the right care, at the right place, at the right time when you are sick or injured. That’s our promise and our pledge.

So, wherever this debate leads between now and this November’s election and beyond, you can rely on us to be your trusted resource of information. Our commitment to providing you security and stability as the leading health plan in our community for 75 years and counting will not change.

I look forward to continuing the conversation in the months ahead. Stay tuned. Thank you.

Alphonso O’Neil-White