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A desire to see Cadillac tax parked

Preventive medicine seen as better cost control

A desire to see Cadillac tax parked

If there is one change Philia Swam would like federal lawmakers to make in the 2010 health care reform law, it would be repealing the Affordable Care Act's Cadillac tax.

Under that provision, a 40% excise tax is to be imposed on the portion of group health plan premiums that exceeds $10,200 for single coverage and $27,500 for family coverage starting in 2020.

Backers of the tax argue, among other things, that the threat of the tax will encourage more employers to adopt more cost-efficient plans.

But Ms. Swam, manager of health, wellness and group benefits at LafargeHolcim U.S. in Chicago, disagrees.

“When has a tax changed behavior? We made proactive changes a long time ago without facing tax implications by focusing on changing health behavior,” she said, referring to several company initiatives, such as wellness programs, intended to improve employees' health and reduce increases in health plan costs.

Ms. Swam also questions another widely held ACA assumption: With more people getting coverage due to federal premium subsidies, there will be a significant reduction in uncompensated care, a cost that some believe providers have tried to offset by boosting charges for insured patients.

“I'm still not convinced that people are rushing out to find coverage, subsidy or no subsidy, because the public marketplace is still evolving and is complex to use,” she said.

For employers, the law has significantly increased their administrative burdens, Ms. Swam said.

“New taxes, fees, more reporting to the government has complicated matters,” she said. “In addition, to managing health plan costs and the health of employees and their dependents, we now have to perform so many administrative tasks that we didn't have to do before.”

Still, she said, the requirement that preventive services be fully covered is a positive aspect of the health care reform law.

“In order to reduce health care costs over the long term, individuals should be taking preventive measures to learn about their health early on and taking action to mitigate future risks from occurring,” Ms. Swam said.

In addition, she supports the ACA ban on denying coverage for pre-existing medical conditions.

Requiring insurers to cover people with pre-existing conditions allows “individuals to get treatment without fearing that they won't have coverage for specific health conditions they may have,” she said of the company that became LafargeHolcim Ltd. last year with the merger of Lafarge S.A. and Holcim Ltd..

Health plan changes that legacy company Lafarge had to make to comply with the law were relatively minor, Ms. Swam said. For example, Lafarge had to remove a $2 million lifetime limit on participants' claims to comply with the ACA bar on such limits effective in 2014.

Just two Lafarge plan participants hit that maximum dollar coverage limit between 2004 and 2010, which Lafarge eliminated in 2011.

In addition, Lafarge in 2011 amended its health plans to allow employees' adult children to receive coverage up to age 26. Previously, Lafarge, like many employers, ended coverage when employees' children turned 19, though it continued coverage up to age 25 for employees' children who were full-time students.

The financial impact of extending coverage to employees' older children also was minor, Ms. Swam said.

Colleagues say Ms. Swam's ability to plan ahead eased the changes to comply with the health care reform law.

“She is proactive. She has a great ability to stay on top of changes that will need to be made and to keep top management abreast of what will need to be done,” said Laureen Strohl, director of compensation and benefits in Chicago of LafargeHolcim U.S.

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