He was a forerunner in the development of voluntary life, disability health and dental benefits for employees and designed and implemented the first wholly voluntary disability program written by Unum, an employee benefits company based in Chattanooga, Tenn. In addition to leading Reames Employee Benefits Solutions, Mr. Reames has served as a consultant or broker for several governmental bodies and large nonprofit institutions.
Mr. Reames took the time to share his thoughts on the most interesting healthcare issues today, challenges for regional health systems and the responsibilities of consumers, hospitals and insurance providers to steer healthcare delivery in a positive, more sustainable direction.
Question: What do you see as the most interesting issue in healthcare today?
Bert Reames: The original intent of the Affordable Care Act was to provide health insurance to all uninsured Americans. Concessions made by both political parties, in an effort to pass this legislation, have resulted in a law that is now virtually impossible to understand. From the consumer’s perspective it is not easy to navigate, there are problems with HealthCare.gov being down and many seem to have no clear understanding of the whole process. Once insurance is obtained through the marketplace there are instances of premiums being paid and then no evidence of coverage by the insurers. Subsidies are confusing and, many times, if one is not eligible for assistance, the costs of the plans are high and unaffordable.
From the employer’s perspective, the hurdles of counting employees, offering an “affordable” plan that meets the government’s guidelines and the increasing cost of group coverage makes offering health insurance a chore not a benefit. Many small employers may opt out of providing insurance and larger employers may elect to pay a penalty, which may be less than the cost of providing health insurance to their employees. While this legislation has allowed millions more Americans access to healthcare, we have not solved the problem of everyone being insured.
Q: Can regional health systems survive?
BR: If regional health systems are not able to stay competitive they will not survive. They must strive to provide a balance of quality care, up-to-date technology and top-notch physicians, all while they struggle to keep cash flow current. Insurance carriers take longer to adjudicate claims, and it’s more and more challenging for hospitals, without deep pockets, to remain afloat.
From a different perspective, we have found some regional based HMOs are beginning to reinvent themselves; they are partnering with large hospital systems to be the sole healthcare insurance provider, thus making the bond between the two even stronger.
Q: Is healthcare delivery getting better or worse?
BR: While great strides continue to be made with regard to technology, the entire healthcare delivery system is rife with fraud, waste and abuse. Each entity — consumers, physicians, hospitals and the insurance industry — is responsible for this on some level. Patients want access to all care with no understanding of cost, physicians object to managed care and frequently order tests to “cover themselves” in case of legal issues; hospitals fight to maintain their competitive edge with ever-increasing costs and the insurance industry, in an effort to protect their own interests, wreak havoc with everyone.
About Mr. Reames:
When asked, “Gator” Bert Reames admits to laboring in the vineyard of insurance and employee benefits since 1955. He began his insurance career with Prudential and shortly fell into marketing employee benefits. He recalls writing scheduled health benefits of $5 a day room and board, $300 hospital extras and $150 surgical maximum.
His firm, Reames Employee Benefits Solutions, Inc., provides medical and ancillary benefits to employers in a four county area in Central Florida. A large part of his business is institutional/medical related. While his practice is small in comparison to many well-known houses, he has retained relationships with some of his major clients for as many as 45 years. He has been honored many times for his long and continued community involvement.
He is a Charter Partner of United Benefit Advisors, the nation’s leading independent employee benefits advisory organization. At 88 he is still fully active in the business and says, “I just love the action and I’m sticking around to see what happens next.”
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