Ted DeCorte has taken an irregular career path to become president of the Clark County Association of Health Underwriters. A former dean of students at Bishop Gorman High School, then a district director for former Nevada Democratic Rep. Jim Bilbray, DeCorte worked for 15 years for Nevada's largest managed dental care organization, what is now UnitedHealthcare Dental.

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This year he started working full time for his 13-year-old business, DeCorte and Associates, doing marketing and public relations primarily in the health insurance field.

And now he represents a 270-member organization of insurance agents and brokers, professionals who handle health benefits for companies and health insurance representatives — during a time when health insurance costs are skyrocketing and becoming a major issue for many individuals and businesses.

DeCorte talked to In Business Las Vegas about the sources of rising health insurance premiums, and about what he believes can be done to help.

It seems like when it comes to health insurance the thing that people talk about the most is the health insurance crisis, how prices are going up. How serious is that from your perspective?

The crisis is really a health care crisis. And yes, it is very, very real. We need to be able to provide affordable and accessible health care to all Americans, and that is our goal with the association. In fact two of the main public policies of the national association and also the local association are one, to reduce the number of the uninsured, which is climbing in the country. In fact Nevada has one of the highest percentages of uninsured in the country for a variety of reasons. And the second public policy is to make sure that in every one of the 50 states that we have a very competitive and vibrant private insurance market. Americans value choice, and they value provider selection, and the best way is by having many carriers in the market.

Do you think Nevada has enough carriers?

No. The major carriers just fly over Nevada between the East Coast and the West Coast because they have always viewed California as a critical market. So in California you have competitors stumbling over each other. Nevada is the most vibrant economy in the country, the most growing economy in the country, but when you compare the numbers in Nevada to (those in) a suburb in Los Angeles, the major health carriers don't see it as a viable marketing place for them. And with that comes the idea for the people who actually underwrite, do the numbers crunching — because we don't have an economic base, number population, plus we have a lifestyle that is different from every other place in the country — the numbers just don't crunch well for many of the national carriers. Nevada is at the bottom of the list for many lifestyle issues: smokers, high diabetes, we have heart disease. It's a 24-hour town, and it's just different from both of our neighbors on the east and the west. That makes our health care costs higher.

That said, it's interesting — the health care crisis is critical, but I went on the Web sites of the two major political parties, and only one of them mentions health care as an issue.

Which one is that?

Your readers can go to the Web sites and investigate for themselves.

The association is a nonpartisan and a bipartisan organization that does understand the health care crisis. We need to be able to work within the parameters of our free market system to fix it. If it can't be fixed within the free market, then that's where government needs to step in.

Do you think this is an issue that politicians don't want to touch?

The association has been working on this high-risk pool concept, which is in 33 states in the country, and Nevada is one of the states that does not have one. There is always a group of individuals in society who can afford to purchase health care and health insurance, but they can't qualify. In 33 states those individuals are able to purchase through a high-risk pool concept. It's private insurance, but there is this pool that sort of underwrites this catastrophic care. It's done on a state level, and there are federal grants. In fact the association members here worked with our congressional delegation to make sure there was an extension to these federal grants, this seed money. Nevada doesn't have that, and we've talked to legislators and just can't get it on the plate.

I know that some of the managed care companies I talked to are nervous that the plans can go bankrupt and they would be forced to tax their normal policies more.

There are a couple of issues here. One is that Nevada's demographics and lifestyle are different from the rest of the country. No. 2 is that we don't have as many players, carriers, to spread the risk around. In California you may have 30 companies that would be involved in this risk pool as far as consumers being able to purchase health care.

And how many does Nevada have?

If you look at major players as far as managed care, you're only talking about three. You're talking about the major, 800-pound gorilla, which is Sierra Health, the Health Plan of Nevada. Then you have two other players in this market, PacifiCare and NevadaCare. Now PacifiCare has just been purchased by UnitedHealthcare, which is good in the sense that PacifiCare now has deeper pockets from which to draw. It has more national programs from which to draw, and so we're beginning to see NevadaCare being able to move into what I think is going to be a much more competitive environment.

The other company that is making a move here is Anthem — we've seen the Anthem-WellPoint merger. Again, you have deeper pockets as far as financial stability, and we begin to see Anthem looking to do new types of products. One of them is that Tonik product , which is specifically targeting the young adults group. They're healthy, they're active and most of them, about 84,000 of them here in Nevada, are uninsured. It's interesting.

Anthem has told me they have a lot more of those tailored plans coming out. How does that appear to people in the industry?

I think it is smart marketing, and it's innovative. People just look at health plans as being very vanilla. If they can just begin to sell and market like we market computers and automobiles and whatnot, people are going to take note. And it's interesting, the names that are on those new Tonik plans are things like the Daredevil and the Thrill Seeker. They are specifically going after a normally healthy group of people, and it makes financial sense. I do think you're going to be seeing programs and plans that market to niche markets. If you go on their Web site, it's very trendy.

Do you think some of the other insurers are going to start going in that direction?

They're going to have to, but there's always the wait-and-see. Let's see what happens to Anthem. Anthem has that strategy. The other strategy that they were criticized for is that they reduced payment to those medical providers, I've heard anywhere from 40 to 70 percent, which is a big hit for many doctors'offices.

How is that rippling through Las Vegas?

I think you have to understand why they did it. The word on the street is that Nevada is different in that we have a huge employer base that is covered by self-insured programs. They are outside of the private insurance market. We're talking about hotels. We are a gambling town, and hotels understand risk. They set the risk every day for gambling. They also self-insure most of their employees'medical (coverage). So they are self-insured, and then you have most of the unions. The Culinary is the largest single health contract in the country. It insures almost all of the employees on the Strip.

How does that relate to what Anthem did?

Anthem is trying to position itself to be able to go in and be a provider for self-insured programs. That is a huge business. I was in that particular niche for 15 years. We provided dental benefits for the union employees at the hotels. And that also extends to the school district. It extends to the employees at the sanitation department, your county workers. That is a huge business that traditionally private insurers haven't understood. The risk factor is different, the demographic is different, the way you service it is different. In my opinion it requires a local presence. I was successful with the company I was with because we were a local company, and we were very, very hands-on. Sierra has done that. They are also successful for the same reason. They are local and very hands-on and understand the politics. They understand the full demand from the consumer standpoint.

Is Sierra right now linked with some of those self-insured plans?

Sierra does have business in the school district and in some of the other unions, so they have been in that for a period of time. They also have a network that is available for some of the self-insured. So Anthem, and not just Anthem but any of the other national carriers, are going to look and say, "Where actually is the primo business?" And the primo business is in those large employer groups linked with the hotels, the school district, the government, and that is where you want to go.

That being said, most of us in Nevada work for small businesses, and that is where the problem is. Your mom-and-pop businesses, your businesses with less than 50 (employees), less than a dozen: Those individuals are getting squeezed. That's where you begin to see health care costs skyrocketing, and because health care costs are skyrocketing, you then have health insurance skyrocketing. More and more small-business owners are either dropping the coverage altogether because it's unaffordable, or they're placing in health insurance that employees really can't afford to use: high-deductible plans and whatnot.

You don't think high-deductible plans are a good idea?

They are, in a couple of ways. But it's a transition that is going to take some time. I remember when I personally transitioned to that type of program with an employer, and it takes education to understand what is actually going on. It's the concept of consumer-driven health care, and you have two things going on. One, you have choice, and Nevadans love choice. Nevadans are very, very independent whether it be in health care or the laws that are enacted, they have sort of a libertarian philosophy whether they're Republican or Democrat. The consumer-driven health plans, once they understand them, I think will work here, because it gives choice.

Secondly, you have choice but you have responsibility. At the point when I had change in benefits, I had to be responsible to be educated, whether it be health savings accounts, medical savings account, high-deductible plans and whatnot. You have to begin thinking ahead to put money aside, and it's almost 50 percent of the average consumer who does not put aside money for health care.

You said you believe Nevadans will accept it in time. What do you think needs to happen?

We need a shift in our consciousness as consumers, and what I mean by that is that a study was done (The 1006 Great-West Healthcare Consumer Attitude Survey) that showed that the average consumer could nail down the price of a Honda Accord within $1,000, but they couldn't tell you how much it would cost to stay in a hospital for four days.

Sixty-eight percent of all consumers cannot tell you what their health care bill is going to be until they receive it. That doesn't make sense, and I am guilty of it myself. We've always taken for granted that you go in and get your services done, and someone else is then responsible for that and you pay your co-insurance, your deductible and whatnot. You have no responsibility factor there, you have no education factor.

What is needed is a consciousness shift. Consumers need to be aware of the cost of health care, and it's outrageous.

Source: In Business Los Vegas