Ronald E. Bachman is president and CEO of Healthcare Visions, a thought leadership firm dedicated to advancing ideas and policy initiatives that are transforming the U.S. healthcare market. The major goals of Healthcare Visions are to advance consumer-based solutions to lower the number of uninsureds, improve mental health coverages, develop the concept of consumer-centric Medicare and Medicaid, and advance employer introductions of healthcare consumerism.
Mr. Bachman is also a Senior Fellow of the Center for Health Transformation (CHT), the Georgia Public Policy Foundation (GPPF), the National Center for Policy Analysis (NCPA), and at the Wye River Group on Health. Mr. Bachman is an actuary with extensive experience in healthcare strategy for payers, providers and employers. Ron is a retired partner from PricewaterhouseCoopers where he consulted to a broad range of clients including: employers, HMOs, hospitals, physicians, indemnity carriers, BlueCross BlueShield plans, as well as State and Federal Agency clients.
In 2008 and 2009, Ron facilitated the Georgia Uninsured Work Group and the passage state health reform legislation to reach 500,000 uninsured in Georgia. That legislation has been praised as a new market-based approach to dealing with the uninsured in the United States. Ron is actively working with other states to pass similar reforms and create a coalition of like minded state desirous of market based solutions. As a Sr. Fellow since 2005, Ron has worked on special projects with CHT and Speaker Gingrich regarding the uninsureds, health policy issues, and market transformation ideas.
In 2008, Ron has testified before the U.S. Congress on “Engaging American Ingenuity to Solve the Uninsured Problem.” Ron worked closely with the Bush White House and Treasury on the language and principles of the 2002 Health Reimbursement Arrangement (HRA) guidelines. In 2003 and 2004, Ron worked through the CHT to provide policy input on Health Savings Accounts (HSA). Ron has consulted with various government agencies on national health issues and legislative and regulatory proposals. He has served as a designated expert on actuarial issues to the Centers for Medicare and Medicaid Services, the Congressional Budget Office, the Department of Labor, the National Institute of Mental Health, and several members of Congress.
Ron was instrumental in providing technical and market advice on mental health that resulted in the passage of the 2008 Wellstone-Domenici Parity Act. Mr. Bachman was an expert resource on mental health policy to several members of Congress, including Senator Ted Kennedy and Senator Pete Domenici. During the past two decades, Ron testified in over 30 states on the costs of mental health. He produced several financial studies and analyses of national and state proposals for mental health parity.
Ron is active in several American Academy of Actuaries Work Groups including: Mental Health, Individual Health Insurance, Consumer-Driven Healthcare, Genetic Testing, Mandated Coverages, High Risk Pools, The Uninsured, Small Group, and Healthcare & Tax Credits.
Mr. Bachman is the author of several publications, including “Consumer-Driven Healthcare – The Future in Now”, “Giving Patients More Control” published by the National Center for Policy Analysis. He has written numerous articles such as, “Boomers Will Revise an Aged, Ineffective System” and “Consumer-centric Medicare” both articles co-authored with Newt Gingrich, founder of the Center for Health Transformation. As an advisor to the Wye River Group on Health (WRGH), Mr. Bachman was instrumental in three seminal reports entitled “An Employer’s Guide to Patient-Directed Healthcare Benefits”, “An Employer’s Guide to Health Care Consumerism”, and “An Employer’s Guide to Pharmaceutical Benefits.” Ron is a member of the American Academy of Actuaries Mental Health Parity Work Group that produced the 2005 report entitled, “Mental Health Parity: Often Separate, Usually Unequal.”
A sample listing of other articles and papers written by Mr. Bachman are: Healthcare Consumerism – the basis of a 21st Century Intelligent Health System; HSAs Myths and Facts –The Inconvenient Truths; Clinical Depression – A Bottom Line Issue, If CEOs Only Knew; A Legislator’s Guide to Creating an HSA State; Consumer-centric Medicare; A Roadmap for Legislators on Market Reform for Health Insurance; and Georgia Collaboration Succeeds in Market Reforms.
Ron is a Fellow of the Society of Actuaries, a Member of the American Academy of Actuaries, a past Board member of the Southeastern Actuaries Club, and past President of the Atlanta Actuaries Club. Mr. Bachman is on the Board of Directors of the National Mental Health Association of Georgia, the Georgia Free Clinic Network, and Skyland Trail.
Ron holds a Masters in Actuarial Science from Georgia State University and a Bachelor of Science in Applied Mathematics from the Georgia Institute of Technology. He is an active member of the Simpsonwood United Methodist Church in Atlanta, Georgia.
Few have read the 2,700 page Patient Protection and Affordable Care Act (PPACA). Even if you have, it is difficult to absorb the full implications of the health reform bill. Each week the Department of Labor (DOL), the Department of Health & Human Services (HHS), and Treasury produce new regulations. With so much happening so fast how can employers, insurance agents, consultants, lawyers, or insurance companies keep up with decisions to set strategies, make rational choices, and be legally compliant?
Several regulatory pronouncements have recently been released. In particular, two important Interim Final Regulations (IFRs) have been issued requiring employers to make key financial decisions regarding their health plans:
- On June 14, 2010, the Treasury, DOL, and HHS jointly released an IFR for group health plans to qualify as “grandfathered.” Plans applying for “grandfather” status can avoid some mandated benefits required by the PPACA.
- On June 28, 2010, an IFR was released for preventive care. The new preventive care coverages are effective for plan years beginning on or after September 23, 2010. Plans that are not grandfathered must cover – without cost-sharing – preventive services rated “A” or “B” by the U.S. Preventive Services Task Force (USPSTF). They must also cover certain immunizations and other preventive services for infants, children, adolescents and women in guidelines developed by HHS.
These regulations create major strategic and financial decisions for employers. There is no single answer. Each employer will need to assess its situation and strategic goals to determine what is in its own best interests.
Even if a plan claims “grandfathered” status it will have to comply with several new mandates beginning in 2011. Grandfathered plans must offer dependent coverage to children until age 26. They cannot impose pre-existing conditions on children under age 19. Grandfathered plans cannot have annual and lifetime dollar limits on benefits. To keep grandfathered status plans will be limited in changing insurance companies, benefit designs and employee cost-sharing. The new rule requires plans to provide employees notice of its decision to be a grandfathered plan.
What does a plan save by being grandfathered? The main savings is avoidance of the mandated preventive care services at 100%. A secondary issue is avoidance of the mandated guaranteed access requirements to OB-GYNs and pediatricians.
The mandated preventive care services are complex. There are USPSTF exceptions and limits allowed for many of the coverages. The general understanding is coverage identified by the USPSTF with an A or B rating. But that is only one source of required coverages. PPACA mandates:
(1) USPSTF evidence-based items or services rating of ‘A’ or ‘B,
(2) The Advisory Committee on Immunization Practices (ACIP) recommendations for immunizations,
(3) Health Resources and Services Administration (HRSA) recommendations on infants, children, and adolescents screenings, and
(4) Health Resources and Services Administration recommendations on screenings for women.
Get Ron Bachman Feed
Loading ...
