Attention to prevention

Gene Leis, immersed for 30 years in employee benefits, is one of them.

"Every day, I'm thinking about claims and how much things cost," said Leis, since August benefits director for General Nutrition Centers Inc. and for 13 years before 84 Lumber Co.'s chief benefits administrator.

"Playing with copays, that's boring; office visits, they don't drive my costs," Leis said. "Eighty percent of all claims come from 20 percent of employees, so it's that 20 percent that I need to manage. Quality of care -- there's where the money is."

Most employers believe they must offer health insurance to retain and attract good employees. Concurrently, most companies face annual premium increases ranging from mid-single digit percentages to 15 percent, 20 percent or higher.

For General Nutrition, with 4,000 employees plus dependants covered under its health plans, annual 8 percent to 15 percent cost increases are common, Leis said. The company's annual health care bill totals $26 million.

A national debate is building over whether the nation's health care system is "broken," "failing" or "not working." If that were true, employers, which offer insurance covering more than 153 million Americans, would be fleeing the system.

But they are not, according to a 2007 survey sponsored by the Washington-based Employee Benefit Research Institute. It found that even with small employers, the percentage of companies offering health insurance access since 1996 has remained fairly steady.

Despite rising costs for employers and for employees in terms of copays, coinsurance and premiums, the imminent end of 60-plus years of employer-sponsored health insurance is exaggerated. A tipping point, the moment when the momentum for change becomes unstoppable, isn't seen, experts say.

"The message from employers is they remain committed to offering their employees health insurance," said Paul Fronstin, the research institute's program director.

One interesting survey finding is that a number of employers interviewed agreed if one major employer dropped health benefits, others would follow.

The percentage of workers age 18 to 64 with employer-based health benefits went from 73.3 percent in 1994 to 70.9 percent in 2006, according to the institute's study.

The Pittsburgh Business Group on Health is a coalition of 65 private and public, small, medium and large organizations in the region representing well over 800,000 health care-covered lives and more than $3 billion in annual health care costs. It works to better the existing system.

"We're taking proactive, affordable steps for employers and employees to create a culture of health," said Chris Whipple, the group's executive director. Steps include making the work environment healthy, she added.

Pushing a health lifestyle works for Moon-based FedEx Ground. For the last three years, there's been no employee copay increase, and for the last year, no out-of-pocket cost increase, spokesman Allison Sobczak said. Its annual health care bill for some 17,000 covered employees plus dependants is about $56 million.

"We have a pretty healthy work force, and we really are stressing preventative care," Sobczak said.

Even for companies with fewer than 200 employees, the percentage offering health benefits since 1996 ranged between 59 percent (in 1996, 2005 and 2007) and 68 percent (2000), the study found.

"Small companies are getting tired of double-digit premium increases," said Lee Taddonio , president of SMC Business Councils, which represents about 5,000 small businesses. "It's getting to the point of being an untenable situation."

Between 2000 and 2006, the average monthly premium nationwide for family coverage jumped 80 percent, to $248 from $138, more than four times the rate of inflation, U.S. Bureau of Labor Statistics and Kaiser Family Foundation data show.

"While employer-sponsored health care has not diminished, who's paying for coverage has changed dramatically," said Gerald Katz, a Philadelphia-based health care consultant with Kurt Salmon Associates. "High deductibles and coinsurance -- employees are not receiving the compensation to keep up."

Many business trade groups see the approach of a new presidency as reason to stir debate concerning employer-sponsored health insurance. Proposals address radical reform, if not outright elimination of employer-offered insurance.

Many plans agree on giving employees, not employers health plan choice, offer portability from job to job, and improve on the existing Federal Employees Health Benefits Plan, which covers all members of Congress. Most important, proposals would cover all Americans.

U.S. Sen. Robert Bennett, R-Utah, advocates Senate Bill 334, the Healthy Americans Act. The legislation, which has bipartisan support, would grant Americans insurance choice, would allow individuals to own health insurance and take it from job to job, give employees instead of employers a tax benefit for carrying insurance, promote preventive medicine and force insurers to compete on price, quality and benefits.

"The present health insurance system just isn't working well," Bennett said. "The most significant factor is that people don't stay in one job their entire career. We advocate that when an employee leaves a job, he takes health care with him."

Health care consulting firm Lewin Group issued a study in 2006 saying the Healthy Americans Act would cover more than 99 percent of all Americans, save some $4.5 billion if implemented in 2007 and save $1.5 trillion between 2007 and 2016.

Business leader/educator group the Committee for Economic Development is championing a proposal combining elements of Medicare and free market plans.

"We though it important to move away from the employer-sponsored system, and create an independent agency modeled on the Federal Reserve to oversee regional exchanges that would provide for every individual a selection of competing, private insurance plans," said Jerome Grossman, director of Harvard University's Kennedy School of Health Care Delivery Policy program.

Cost savings under the Committee for Economic Development plan would be similar to those under Bennett's Healthy Americans Act.

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