for patients. Health care financing agencies, insurance companies, hospitals, pharmacists, and other health care providers must be networked through outreach programs, such as MEDLINE, if health care delivery is to be successful. Rural Networks and Outreach to Underserved Library and information services should be extended through outreach programs to medically underserved health care providers in urban and rural areas. Access to information reduces professional isolation and improves the quality of decision-making while reducing healthcare costs. Health sciences librarians facilitate the recruitment and retention of health care providers in medically underserved areas by providing them with technical development skills for high performance computing communications and information services that help rural health care providers give quality healthcare to their patients. Health sciences librarians organize networks to share information among their institutions so that materials needed for research, education, and patient care are available to all health care professionals, wherever they practice. The National Library of Medicine, health science librarians and medical librarians must play an important role in the improvement of the quality of networks such as MEDLINE, and continue outreach efforts to the underserved, rural and urban populations. MLA/AAHSLD asks Congress to continue to support outreach initiatives in the upcoming health care reform discussion. The expansion of the National Information Infrastructure and High Performance Computing Communications projects are key if high quality and cost-effective healthcare is to be delivered. The Role of the National Library of Medicine Funding for NLM, as well as other federal agencies involved with medical information access supports efficient information dissemination. NLM's National Network of Libraries of Medicine comprises more that 3,500 libraries in hospitals and academic health sciences centers throughout the nation. It is a network of information that supports networks of health care. The NLM also maintains the world's preeminent collection of biomedical literature and provides systems and services to make it accessible. It supports research efforts in the design, development, and use of health information systems and the continued training of health sciences librarians. For the past four years, NLM's health services research program has been conducted through interagency agreements with the Agency for Health Care Policy Research (AHCPR). The recent enacted NIH Revitalization Act authorized the creation of a National Information Center on Health Services and Health Care Technology at the NLM. These two projects enable the NLM to provide improved access to information useful to those planning and conducting health services research, and should receive your support. It is crucial that the NLM be adequately supported and play an important role to guarantee that medical information is accessible and cost efficient if health care reform is to be successful. Some funding for NLM programs in these areas can come from discretionary sources, but some mechanism should be established that would treat medical information and technology much the same as it does any other medical commodity or supply -- it should be a reimbursable item. In closing Mr. Chairman and members of the subcommittee, I would like to thank you for your interest and efforts on behalf of medical and health sciences libraries throughout the nation. I appreciate the opportunity to testify regarding health care reform and would be happy to answer any questions you may have. Information contained in this testimony obtained from: "MLA/AAHSLD Statement on Health Care Reform and the Sciences Librarian: Excellence in Health through Access to Information." November 1993, Medical Library Association, 6 North Michigan Avenue, Suite 300, Chicago, Il. For copies of this statement, write this address, or call (312) 419-9094. Chairman STARK. Thank you, Ms. Watson. Mr. Kreidler. STATEMENT OF DAVID B. KREIDLER, EXECUTIVE VICE PRESIDENT AND CHIEF EXECUTIVE OFFICER, EASTERN BUILDING MATERIAL DEALERS ASSOCIATION, AND CHAIRMAN, INSURANCE EDUCATION COMMITTEE, AMERICAN SOCIETY OF ASSOCIATION EXECUTIVES Mr. KREIDLER. Mr. Chairman, my name is Dave Kreidler. I am executive vice president and chief executive officer of Eastern Building Material Dealers Association, and I currently serve as chairman of the Insurance Education Committee of the American Society of Association Executives. I have been a volunteer leader in the association community for more than 10 years. ASAE is pleased to have this opportunity to present testimony before the Subcommittee on Health of the House Ways and Means Committee regarding the importance of association plans in health care reform. Mr. Chairman, ASAE is a professional society of over 22,000 association executives representing more than 10,700 national, State and local associations. Most of our members work for associations with fewer than 10 employees. ASAE's members represent taxexempt organizations, mostly under IRS Code 501(c)(6) and 501(c)(3). The future of association-sponsored health plans is in serious doubt, as our Nation debates health care reform. Many proposals for a single-payer system or a managed care system with exclusive health purchasing alliances or cooperatives may deny a role for plans which associations now offer or operate for their members. Associations have for many years sponsored employer group health plans as viable mechanisms for pooling risks along functional and industry lines. Associations have also increased the market leverage and buying power of small employers as consumers of health care services. The association plans were generated by, and composed of, employers which participate directly in the decisionmaking process. and management of their association health plans. For more than 55 years, association-sponsored health plans have been providing millions of people with an effective way to protect themselves and their families against financial catastrophe. Association plans have enabled these millions of citizens to have access to quality, affordable health care, which was often denied to them through the available market. Today, thousands of U.S. trade and professional employer associations provide health coverage benefit programs to industry groups representing millions of employees and their dependents. In an October 1992 survey of Nation's Business readers, 13 percent of the respondents polled reported they purchase their health plans through industry associations. According to a national survey of trade and professional associations conducted by ASAE and William F. Mourneau & Associates, 779 of 6,300 associations reported health premiums paid in 1991 of $6.2 billion. This amount is larger than the total annual health care premium income reported by Prudential, the largest health insurance carrier in the United States. In addition, of the 779 associations surveyed, more than 1.9 million lives were covered. Now, extrapolated against all associations in ASAE, this data suggests that ASAE member associations may be directly involved in the collection of approximately $21 billion in annual health care premiums-more than the 10 largest insurance companies collectively generate in premiums. When examining lives covered, the extrapolation would mean at least 10 million lives are covered by association plans. Under the current U.S. health care system, association plans provide significant health care coverage to a substantial number of small employers throughout the Nation and in a large cross-section of U.S. industries. Many of these small employers are located in rural areas which are underserved by managed care providers. These employers have sought and received the buying power and protection of qualified association plans which provide access to quality, affordable health care. The ASAE survey uncovered three significant facets of association-sponsored plans. One, of those associations offering plans, the average penetration of membership is a significant 27 percent. This clearly shows that this is an important service. Two, 49 percent of the associations with plans have a trust agreement in place. This is a strong indication of the sophistication level of such plans and the degree of effort that is being made to closely manage the programs. Three, the vast majority of plans, 86 percent, in fact, are funded on a fully insured basis, which runs counter to the common stereotype of the underfunded MEWA about to go bankrupt and leave thousands of policyholders with unpaid claims. The importance of the widespread geographic coverage of association health plans can be seen from a study supported by a grant from the Federal Agency for Health Care Policy and Research, which concluded that reform of the U.S. health care system through expansion of governmental-managed competition is feasible in large metropolitan areas. But smaller metropolitan areas and rural areas would require alternative forms of organization and regulations. A substantial number of people live in areas that fall outside the realm of managed competition. In 19 States, the majority of the population-well, listen, you know a lot of this, so I am just going to skip ahead, because that light is on. It is great to go last, but I don't want to make myself unwelcome. Chairman STARK. Well, you are not. [The prepared statement follows:] WRITTEN TESTIMONY OF David B. Kreidler, CAE AMERICAN SOCIETY OF ASSOCIATION EXECUTIVES Mr. Chairman, my name is David B. Kreidler. I am the Executive Vice President and CEO of the Eastern Building Material Dealers Association, and I currently serve as Chairman of the Insurance Education Committee of the American Society of Association Executives (ASAE). I have been a volunteer leader in the association community for over 10 years. ASAE is pleased to have this opportunity to present testimony before the Subcommittee on Health of the House Ways and Means Committee regarding the importance of association plans in health care reform. Mr. Chairman, ASAE is a professional society of over 22,000 association executives representing more than 10,700 national, state, and local associations. Most of our members work for associations with less than 10 employees. ASAE's members represent tax exempt organizations, mostly under Internal Revenue Code Sections 501(c)(6) and 501(c)(3). The future of association sponsored health plans is in serious doubt, as our nation debates health care reform. Many proposals for a single payor system, or a managed care system with exclusive health purchasing alliances or cooperatives may deny a role for plans which associations now offer or operate for their members. Associations have for many years sponsored employer group health plans as viable mechanisms for pooling risks along functional and industry lines. Associations have also increased the market leverage and buying power of small employers as consumers of health care services. The association plans were generated by, and composed of, employers which participate directly in the decision-making process and management of their association health plans. For more than fifty-five years, association-sponsored health plans have been providing millions of people with an effective way to protect themselves and their families against financial catastrophe. Association plans have enabled these millions of citizens to have access to quality, affordable health care, which was often denied to them through the available market. Today, thousands of U.S. trade and professional employer associations provide health coverage benefit programs to industry groups representing millions of employees and their dependents. In an October 1992 survey of Nation's Business readers, 13% of the respondents polled reported they purchase their health plans through industry associations (90% of the respondents were employers with less than 100 employees). According to a national survey of trade and professional associations conducted by ASAE and William F. Morneau & Associates, 779 of 6,300 associations reported health premiums paid in 1991 of $6.2 billion. This amount is larger than the total annual health care premium income reported by Prudential, the largest health insurance carrier in the U.S. In addition, of the 779 associations surveyed, more than 1.9 million lives were covered. Extrapolated against all associations in ASAE, this data suggests that ASAE member associations may be directly involved in the collection of approximately $21 billion in annual health care premiums - more than the ten largest insurance companies collectively generate in premiums. When examining lives covered, the extrapolation would mean that at least 10 million lives are covered by association plans. Under the current U.S. health care system, association plans provide significant health care coverage to a substantial number of small employers throughout the nation and in a large cross-section of U.S. industries. Many of these small employers are located in rural areas which are underserved by managed care providers. These employers have sought and received the buying power and protection of qualified association plans which provide access to quality, affordable health care. The ASAE survey uncovered three significant facets of associationsponsored plans: • Of those associations offering plans, the average penetration of membership (percentage of members participating in the association health plan) is a significant 27%. This is a clearly important member service at these associations. • 49% of associations with plans have a trust agreement in place. This is a strong indication of the sophistication level of such plans and the degree of effort that is being made to closely manage the programs. • The vast majority of plans (86%) are funded on a fully-insured basis. This runs counter to the common stereotype of the underfunded MEWA about to go bankrupt and leave thousands of policyholders with unpaid claims. The importance of the widespread geographic coverage of association health plans can be seen from a study supported by a grant from the Federal Agency for Health Care Policy and Research, which concluded that "reform of the U.S. health care system through expansion of governmental managed competition is feasible in large metropolitan areas. But, smaller metropolitan areas and rural areas would require alternative forms of organization and regulations..." "A substantial number of people live in areas that fall outside" the realm of managed competition, said Richard Krfonic, an assistant professor of Community and Family Medicine at the University of California at San Diego. In 19 states, the majority of the population lives in areas of less than 180,000 persons, where hospital services must be extensively shared. In 42 states, 20% or more of the population lives in such areas. And, while 23 states and the District of Columbia have at least one metropolitan area large enough to support three HMOs, the study found, in only 10 states do the majority of people live in such areas. Association plans are active in all of these areas currently, which demonstrates their viability and market orientation. Association plans also have extensive experience in: designing special plans to meet the financial needs of their members. pooling health risks within organized industry groups. gathering employee data. collecting and disseminating information on health care quality, cost and resource allocation. ⚫ communicating with members and employees. ⚫ administering of benefit programs. All Americans should have equal access to high quality, cost-effective health care through health plans offered under a competitive market system. Employers within the U.S. employment-based system should have the flexibility and freedom to select the most effective organizational mechanisms available for delivering health services. Association plans have proven for years to be such a vehicle. |