Health Care Reform

• The issues
• CIGNA's position on health care reform
• CIGNA and America's Health Insurance Plans (AHIP)
• CIGNA's role promoting positive change

Health Care Reform: The Issues

Health care reform is complex. There is no single issue driving the debate, but rather several we are all working to address - and we can't fix one without fixing the others.

Access

"Too many people don't have coverage."

Although almost 250 million Americans have health care coverage, some 46 million are uninsured for at least part of the year, according to the U.S. Census Bureau. This is unacceptable. The continued shortage of doctors, nurses, and clinicians doesn't help. No one should be locked out of the health care system because of their age or a pre-existing condition. And for many people who do have coverage, the system is confusing and hard to navigate.
See what CIGNA is doing today to address access concerns

Cost

"The high cost of care is devastating people and businesses."

Simply put, health care is too expensive. Despite initiatives by insurers and others, medical costs continue to rise at an unsustainable rate for a host of reasons. This affects average working Americans as well as people who have become unemployed as a result of the challenging economy. Large and medium-sized businesses have cut benefits, and some small businesses have had to significantly reduce or cut them altogether. This threatens America's fiscal foundation when we can least afford it. Sustainable health care reform is not possible without restraining the growth of spending. And doing nothing is the costliest course of action.
See what CIGNA is doing today to lower costs

Quality

"How do I know the doctor I'm seeing is any good?"

Quality is highly variable from doctor to doctor, from city to city, and from state to state. This clinical variation results in fewer patients receiving evidence-based care. It also makes the decision around choosing doctors - whether a primary care physician for a family, or a specialist for surgery - tough for individuals. But quality also means giving people helpful, easy-to-find information with which to make healthy choices and improve their lives.
See what CIGNA is doing today to improve quality

Challenges with a Government-Run Plan

One of the focal points of the health care debate revolves around whether the private or public sector or a combination of both is best equipped to run the U.S. health care system. We believe neither the government nor the private sector can do this alone. In fact, such a plan is not even necessary given the other marketplace reforms already under way to improve quality, provide greater information transparency to the public, expand access, and encourage greater accountability for each individual to better manage his or her own health. In light of this progress, a government-run plan would:

• Threaten employer-based coverage. More than 165 million Americans rely on employer-provided health care coverage. And every survey of individuals with private coverage shows very high satisfaction. An independent analysis by the Lewin Group found that millions of employees would lose their private coverage and be forced to join a new government-run health plan. People will reject proposals that could put at risk their employer-sponsored coverage.
• Turn back the clock on quality. Patients have embraced health plans' innovative programs to coordinate care, manage chronic conditions, and promote prevention and wellness. Experience shows that government-run programs lack the infrastructure, expertise and experience to do the same.
• Worsen cost-shifting. A new government-run plan would exacerbate the already devastating impact of cost-shifting from public health insurance programs to people and businesses in the private sector. Doctors and hospitals across the country say that government-run health insurance programs such as Medicaid pay them less than it costs to treat their patients. These underpayments impose a hidden tax of more than $1,700 on individuals and employers who end up paying significantly higher premiums.
• Be fiscally irresponsible. How can the nation afford a new government-run health insurance plan when Medicare's trustees say the program will begin running a deficit as early as 2016 and that the program faces a $44 trillion unfunded liability? A new government-run health insurance plan will only further increase the burden of debt placed on future generations.
• Create an uneven playing field. A new government-run health insurance plan would not enhance competition in the health insurance marketplace. The government would not negotiate; it would set prices and set the rules in its favor. It's akin to a football game in which one player gets to be both the referee and a player on the field.
• Threaten patients' access and choice. Under a government-run health insurance plan, the government could set reimbursement rates that don't allow doctors and hospitals to cover their costs. Some doctors and hospitals might not be able to afford to provide care to patients.

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Health Care Reform: CIGNA's Position

Expanded access with lower costs and better quality: These are the ultimate goals sought by the public, by legislators, and by CIGNA.

For years, CIGNA has been a vocal supporter of sustainable and meaningful health care reform. We continue to proactively support changes that move America toward these goals, and to seek bipartisan support for our industry. In fact, we are in agreement with legislators and others seeking reform . . . not only on the ultimate goals we all share, but also with many of the core health care issues that are so personal and important to people - such as expanded access to health insurance, not denying coverage based on pre-existing conditions, and emphasizing health improvement and wellness.

Here is CIGNA's position and beliefs about health care reform:

1. Every American should have access to, and be required to have, health insurance. We fully support this individual mandate.
2. The employer-based system - through which more than 160 million Americans currently gain access to a choice of innovative health plans and benefits - should remain the primary source of coverage for working individuals and their families.
3. A coordinated public and private partnership of all health care stakeholders is critical to creating a value-driven market; and, to have a meaningful impact on reducing costs, the focus must be on health improvement and wellness.
4. An enforceable guarantee of coverage is mandatory; no one should be denied coverage on the basis of health status or pre-existing conditions.
5. Subsidies for low-income individuals must be available to ensure affordability of service.
6. Subsidies for small businesses also must be available to allow them to provide coverage to their employees.
7. There must be transparency in selecting a plan that best meets individual and family requirements through exchange networks where private plans can compete openly with one another, for the benefit of all.
8. There must be simplification and standardization of forms and procedures, and implementation of health information technological approaches that will improve the efficiency and quality of delivery.
9. Health care costs must be reduced by making changes in the fee-for-service reimbursement system for health care professionals to reward outcomes - and not simply volume (the number of procedures performed).
10. We will continue to work in a constructive, bipartisan manner to ensure that decision makers at both the Federal and state levels understand the consequences of their actions related to the broader goals of expanding access, controlling costs and improving quality.

We believe private health plans, the government, employers, doctors and clinicians, and individuals are all accountable, each contributing to these solutions in their own ways:

• Individuals should obtain coverage for themselves and their dependents while taking personal responsibility for their own health decisions, to the extent they are able. In other words, we support the individual mandate.
• Employers should continue to provide access to and assist in the financing of meaningful health care coverage for their employees and offer benefit plan designs that help their employees improve their health and quality of life. We do not believe, however, that employers should be mandated to provide health care coverage.
• Doctors, clinicians, and health care professionals should support standards designed to improve both the quality and efficiency of the care they deliver and educate their patients by providing them with the information they need to take greater ownership of their health and wellness.
• The government should play a more active role in facilitating adoption of common regulatory, transparency, technology and transactional standards; enacting tort reforms; making needed changes to the individual insurance market; and providing a safety net for people who do not have the means to buy coverage.
• Private health plans, like CIGNA, should continue to provide innovative solutions that create individual responsibility for health, wellness and financial security and that achieve cost savings.

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CIGNA and AHIP: Common Voices for Positive Change

CIGNA supports sustainable and meaningful health care reform that focuses on the key issues of expanded access, lower costs, and higher quality - the same issues all stakeholders are working to address, including America's Health Insurance Plans (AHIP), of which CIGNA is a member.

AHIP is the national association representing nearly 1,300 member companies providing health insurance coverage to more than 200 million Americans. These companies - which include CIGNA - offer medical insurance, long-term care insurance, disability income insurance, dental insurance, supplemental insurance, stop-loss insurance and reinsurance to individuals, employers and public purchasers.

AHIP provides a unified voice for the community of health insurance plans. One of AHIP's goals is to expand access to high-quality, affordable coverage to all Americans - very consistent with the aims of health care reform. AHIP has developed innovative proposed solutions to promote universal coverage, raise the bar on quality, and make health care services more affordable. These proposals are available at www.AmericanHealthSolution.org in the Reform Resources section.

Visit www.ahip.org and www.AmericanHealthSolution.org for more information.

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Health Care Reform: CIGNA Promoting Change

CIGNA has long offered a variety of innovative products, services, and capabilities that help address many of the issues at the heart of health care reform.

Expanded Access

• Around the clock availability: We are available 24/7 with live customer service, our Employee Assistance Program, our nurse-staffed health information line, and our behavioral health specialists. So we're there when our customers need us at whatever time or day works best for them, helping them better mange their health.
• Making health care easier to understand: People shouldn't be intimidated by paperwork or verbiage. We're working to remove insurance speak from our communications to help make health care easier to understand. This way, people can be more informed about their health and their benefits. At the same time, we're working to reduce the volume of paper-based communications we send out the door.

Lower Costs

• Tools to help people improve their health and manage costs: Our personalized website for customers, www.myCIGNA.com, lets people keep track of claims and benefits status, deductibles, lab results, and more. It also helps people manage their health, providing information for finding the best local doctors and hospitals for treating their medical conditions; finding out whether a procedure is covered (and what portion of the cost is their responsibility); and even offering reminders to schedule annual checkups. Easy-to-use tools help people evaluate things like generic versus brand-name drugs, whether there are potential drug interactions, how much life or disability insurance is necessary, and more. All of this gives people the power to make healthier decisions, improve health care quality, and better manage their own health care expenses.
• Benefit plans that improve quality and lower costs: A two-year study showed that medical cost trend for customers with CIGNA Choice Fund^SM (our consumer-driven health plan) is less than half that of CIGNA's other plan customers. Cost savings also compounded over time, even as customers used more preventive services relative to traditional plan members. This underscores the value of providing people with the information and tools they need to make informed decisions about their health and benefits, coupled with encouraging accountability for managing their health care.
• 100% coverage for preventive care with some plans: We recognize the value of preventive care in identifying health concerns before they become major (and more costly) concerns. For example, some of our plans, like CIGNA Choice Fund^SM, cover 100% of preventive care visits.
• Helping people understand, and be more accountable for, their costs: People need to be accountable for their role in spending health care dollars. That is why CIGNA offers many tools on myCIGNA.com that help people understand their benefits, compare generic vs. brand drug information, and compare the costs of different common procedures. This is at the heart of information transparency.

Improved Quality

• Quality information online: myCIGNA.com lets people access hospital quality information, so they can make more informed decisions about the quality of care at different facilities - and select the one that best suits their needs.
• Emphasis on preventive care: Our emphasis on preventive care and wellness contributes significantly to the quality of care. The earlier people are engaged in their health, the better the quality - and better the outcome.
• Communities of health: CIGNA has begun introducing Communities of Health to help cities, towns and neighborhoods consider the social and environmental factors that determine health and create community-based solutions. We recognize that through such collaboration we can find answers to our health care challenges.
• Resources for feeling better: The CIGNA website www.itstimetofeelbetter.com provides the public with helpful information and resources about healthy living, health trends, and understanding how health care works.
• Support for global health solutions: CIGNA supports the Global Knowledge Exchange Network (GKEN), a non-profit organization whose mission is to search the globe for replicable practices to improve health and the quality of health care around the world.

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