Dr. Michelle Khoury of Crystal Run Health Care in Middletown, right, questions Troy Oechsner, deputy superintendent for the state Health Insurance Department.
Looking for some eye-opening summer reading? Try “Overtreated” by Shannon Brownlee. The book is subtitled: “Why too much medicine is making us sicker and poorer” and it dares to wonder why CT scans are now standard treatment for a bump on the noggin and why achin”™ backs so often lead to scalpels.
So suggested state Insurance Department Deputy Superintendent Troy Oechsner during a July 14 breakfast with Orange County Chamber of Commerce members.
Whether you are a sole proprietor or the CEO of a Fortune 500 company, you can”™t escape the need for insurance, an industry that remains unregulated in New York and is becoming more burdensome with each passing season. Oechsner told Orange County chamber members the spiraling cost of staying protected in the Empire State is becoming beyond the reach of employers to cover workers adequately; and in some cases, for the employers to cover themselves.Â
James Smith, owner of Advance Testing in Campbell Hall, said his company is contemplating expanding into the Binghamton area. But because of the rising cost of commercial insurance, combined with escalating premiums for employees”™ health care, Smith says the expansion may not see fruition.
In business for 25 years, Smith said the cost of being able to provide employees with health care coverage may trump the company”™s plans to expand. He will continue to try to keep current employees under the insurance umbrella. He doesn”™t plan on leaving them high and dry.
But somewhere in the equation, job creation is becoming too expensive to make it financially viable to expand and create jobs. “The health care noose is getting tighter, strangling businesses here in the state, especially small employers,” Smith told the audience and Oechsner.
Oechsner, a former member of the attorney general”™s office before taking on the job in the state Insurance Department, noted, “98 percent of large corporations provide health insurance to their employees, but only half of the small business community can afford that luxury. Because of its inability to offer this important perk, small business cannot attract the skilled talent it needs to stay competitive.”
With the state perhaps near the bottom of its economic barrel and 800,000 New Yorkers out of work at present, the Insurance Dept. is working to change COBRA costs for those who have lost jobs, making it possible for them to pay the same rate they had while employed and extending coverage from 18 months to 36 months.
Another option the state should consider is allowing parents to continue covering their adult children on company health insurance plans through a COBRA-based payment system for those in the 19 -29 age group. “Of the 2.5 million unemployed in New York, this is the largest group of uninsured in the state,” Oechsner said. “Most of them are working are in low-paying jobs that do not offer health care.”Â
While Child Health Plus provides a safety net for those under 19, those over the age limit typically wait until their health problem reaches a crisis point before acting ”“ more than likely seeking medical attention at their nearest emergency room.  Oechsner said, “There is Medicaid money for in-hospital treatment, but little for well-care visits,” a paradox that Congress cannot seem to find the wherewithal to correct because of the complicated method of distributing Medicaid money. “There is no way to track an individual as the system now stands. We have no way of knowing which patient is receiving what care and how much is being spent on them,” said Oechsner. “The federal system is managed by the state, but the state cannot change the system without Congress – and the federal government has several methods of doling out Medicaid funding, creating no paper trail to follow the money.”
While employers struggle to meet medical coverage for themselves and employees, they also face the growing costs attached to commercial plans, where 25 cents of every dollar spent goes to administrative costs. “It”™s not a partisan issue,” said Oechsner. “We need to regain the ability to approve rates before they go into effect.”
Despite Medicaid”™s morass and the need for a streamlined system, all insurance companies can move to make costs clear and cohesive. Oechsner said he”™s got “a good feeling about the changes in the offing in Washington, but they aren”™t going to come easy. Health insurance is critical for small business to remain up and running.”
For small business owner and cancer survivor Rich Rossi of Walden, health insurance is out of the question. “My wife and I are both cancer survivors. Periodically, we”™ve been able to get insurance but the costs are so high we haven”™t been able to maintain it. Now, she”™s working and after three years, her employer was finally able to add her to the plan. But they can”™t afford to add me. I will remain among the uninsured and take my chances. It”™s no joke ”“ it is very frightening to be without health insurance.”Â
For those who have had enough with Washington”™s inability to come up with a plan, Oechsner suggests they start knocking on their elected officials”™ doors to make their voices heard on Capitol Hill. “Eligibility rules, as well as changing the way we track the way Medicaid is spent, is in the hands of the federal government. The people will have to take their case to them to get anything done.”
The breakfast, attended by several hospital administrators, health care providers and insurance companies, was sponsored by CDPHP (Capital District Physicians”™ Health Plan) at The Fountains, formerly the Wallkill Golf Club, in Middletown.Â
“Health care coverage is the No. 1 issue our members are concerned about,” said John D”™Ambrosio, president of the 2,400-member chamber of commerce, who said health care rate increases need to be regulated. “Since 2001, health care costs have risen by 129 per cent on average. Have salaries kept up with those kinds of increases?”Â
