Back in 1984, when Bill Clinton was a relatively obscure Arkansas politician, M. Angelina Guirindola was already trying to control corporate health care expenses at Los Angeles-based California Federal Bank.
Today, Guirindola, Calfed's vice president in charge of employee benefits, takes pride in the results. Over the last seven years, Calfed's health care costs per employee have risen at slightly less than 10% annually--far more than inflation throughout the economy, but below the health care increases paid by many other large employers.
For all that, Guirindola says only a broad-based national reform will protect employers and workers alike from soaring health care costs.
She is generally optimistic that the Clinton health care proposal would perform as advertised, cutting costs even as it expanded coverage to the 37 million Americans who are now uninsured. She has high hopes for the Administration's plans to curb malpractice suits, to simplify the filing of insurance claims and to form regional alliances for buying health coverage at reduced rates.
Her main worries concern Calfed: Would new, minimum benefits mandated by the federal government require the bank to pay more for health care coverage? Would Calfed find itself having to deal with new, unwieldy federal bureaucracies?
Under Clinton's plan, corporations with 5,000 or more employees could choose to continue administering their own health benefit plans. Smaller firms--including Calfed, which has a payroll of 3,100 workers--would put the decision-making about health care for their employees in the hands of a regional health insurance purchasing alliance.
Clinton chose to exempt big companies from joining the regional alliances because many have been aggressive at trying to contain health costs and do not want to relinquish control of their plans to the government. But the firms that exercise this option would have to pay a 1% penalty to the government.
All corporations would have to pay at least 80% of the premium costs for their employees, no matter whether they administered the plans themselves or allowed the government to do it. But no company would have to contribute more than 7.9% of their payroll to health care.
If the Clinton program is adopted, Guirindola said, Calfed might need to rethink one of its hiring strategies. A few years ago it began filling more of its openings with part-time workers, who receive no health insurance. The Clinton plan would require employers to contribute to part-timers' insurance costs on a prorated basis, and the extra expense might be enough to steer Calfed back to full-timers.
At the same time, if national health care reform successfully cuts costs, Guirindola said, Calfed might also consider restoring such benefits as its wellness programs, which once included classes for losing weight and stopping smoking.
"Everything is open now. We're waiting to see the final results," she said.
The first of the succession of cost-cutting measures introduced by Guirindola came in 1985, when Calfed hired a so-called utilization review firm to scrutinize medical insurance claims. If a doctor recommended, say, a hysterectomy--a surgery some experts say often is performed unnecessarily--the review firm might send the patient to another doctor for a second opinion.
In other cases, the review firm insisted on shorter hospital stays. For instance, it required some patients to check into hospitals the same day their procedures were to be performed, rather than roll up a higher bill by checking in the night before.
Calfed--which describes itself as the nation's fifth-largest publicly traded savings and loan institution with $16 billion in assets--also began increasing the amounts employees contribute toward their medical coverage. The idea, Guirindola said, was to make employees more aware of the costs and less inclined to run up unnecessary expenses.
"A lot of people were going to their doctors for colds. You don't need to do that all of the time," Guirindola said.
Later on, Calfed increasingly pushed its employees to consider health maintenance organizations and other alternatives to traditional fee-for-service health care schemes. Under continued pressure to hold down costs, Calfed eventually made a major break with its past practice by eliminating its fee-for-service health insurance in 1991.
With every change in the company's health coverage, Guirindola says she saw how profoundly worried employees have been about shouldering extra costs and perhaps having to sever their ties with their longtime doctors.
"I'm no different than any other employee," she said. "I look at the choices . . . and determine cost-wise if we can continue with our current doctors."