A three-person panel at Monday's Chamber Forum examined health care changes employers and employees may encounter in the next year.

Angela Dowling, president of Regence BluceCross BlueShield of Oregon, Jeri Reno, chief operating officer at People's Bank of Commerce, and Medford schools Superintendent Brian Shumate discussed consumer issues and potential changes to the Affordable Care Act during the noon meeting at Rogue Valley Country Club.

Dowling said accessibility has improved under the ACA, with the ranks of uninsured falling to 8 percent, but affordability is another matter.

"It's not very affordable," Dowling said. "That's the one thing if we could make some changes to it and find ways to make it more affordable and more predictable over time. There have been tremendous price swings relative to the individual marketplace."

People trying to buy plans outside their place of employment have been plagued with increasing costs, accessibility issues and subsidy eligibility questions.

"It's very confusing and challenging," she said. "It's settled down, and pricing tends to be a little bit more sustainable."

Reno said the cost increases were minimal during the first two years following passage of the ACA. After that, the locally owned bank saw big jumps, including a 17 percent bump in 2016.

"We've been very much challenged with our employee and employer costs," Reno said.

Shumate said the district spends $17 million a year for health care, out of a total budget of $120 million.

"Right now, we're looking at a 12 percent increase every year over the last five years," he said. "The plan itself is becoming unsustainable."

In many fields, lower unemployment has created competition for employees, who often leave for better benefits, said Dowling, who related a conversation she recently had with an employer about health plans.

"We got their health coverage in place, and she turned and said: 'Now I need dental, I need life, I need disability — they didn't have that coverage before. I'm tired of the turnover I have because my competition is taking all my employees because they have that type of coverage.' "

Consumer expectations also have changed when it comes to seeking medical help, Dowling said

Nationally, it takes about six weeks of lead time to get an appointment, and after showing up, the average waiting room stay is 61 minutes before meeting with a provider for 11 minutes, on average.

"The expectation of consumers today is not that; nobody wants that experience anymore," she said. "We've become so attuned to immediate gratification that people want access to care now, or soon — certainly not six weeks out."

Telehealth, however, is available quickly on smartphones, and at a significantly cheaper cost, she said.

"You can schedule that appointment, have that visit with your provider, get that medication via that office visit on your phone and go pick it up immediately," Dowling said.

She said a third of the country, often counties with small populations, have one or two carriers in their market. Asked if giving consumers the option of buying health insurance across state lines would lower costs, Dowling questioned whether such an approach would work long term.

"It's hard to bring in a new carrier when you are covering hundreds of people or just thousands of people," Dowling said. "Remember, we have to spread risk across a large population so it can be affordable. Those locations really need more competition. The question is, can they do it in a sustainable manner? There's nothing worse than going in and then having to later pull out and create a lot of market turmoil."

Shumate said the school district is tackling rising costs by having employees manage their care, but any changes have to go through union negotiations.

"We've got to look at plan changes, we've got to look at increased cost share from the employees, and/or joining (Oregon Educators Benefit Board) and leaving the self-insured realm to increase the risk pool as part of bigger group," Shumate said. "We don't want to do that right now. Again, we're trying to have people become better consumers on the front end."

Reno said People's Bank of Commerce's benefit strategy centered on the use of tools — using mobile devices, Fitbits and Apple watches — to tap into the health care system.

— Reach reporter Greg Stiles at 541-776-4463 or business@mailtribune.com. Follow him on Twitter @GregMTBusiness.