Affordable Care Act (ACA)

The comprehensive federal health care reform law enacted in March 2010.

Coinsurance

The percentage of charges a member pays when receiving a covered service. The member’s health plan coverage pays the balance up to the health plan’s allowance. Coinsurance amounts vary depending on the member’s plan and the service provided.

Copayment

The fixed dollar amount a member pays when receiving certain covered services or prescriptions. The member’s health insurance pays the rest. Copayments vary depending on the member’s plan and the service provided.

Cost share

The portion of charges for a service or prescription that the member is responsible for paying, such as a copayment, coinsurance or deductible payment.

Deductible

The fixed amount a member must pay in a calendar or contract year for certain health care services before the member’s health insurance begins to pay.

Dependent

A family member, such as a spouse, child or partner, who is covered under a policyholder or subscriber’s plan.

Federal financial assistance (subsidy)

Financial assistance in the form of reduced premiums and reduced out-of-pocket expenses to provide help for some people to pay for health coverage or care. The government will pay part of the premium and the out-of-pocket expenses directly to the health plan issuer. Usually determined by income level and family size.

Grandfathered plan

A group health plan that was created or an individual health insurance policy that was purchased on or before March 23, 2010. Grandfathered plans are exempted from many changes required under the Affordable Care Act.

Health care reform

A general term for the major health policy changes put in place by the federal Affordable Care Act of March 2010 and any state laws passed to put it in place.

Health Insurance Marketplaces

Government-run online markets, formerly called Health Insurance Exchanges, where individuals and small businesses will be able to compare and enroll in health plans, get answers to questions, and find out if they are eligible for financial assistance or special programs.

The marketplace

A common nickname for the Health Insurance Marketplaces, also called “exchanges.”

Medicaid

A government insurance plan for the poor and disabled; in California, it’s known as Medi-Cal.

Out-of-pocket expenses

These include the copayments, coinsurance and/or deductible payments members make for the health care services they receive, as opposed to the premium they pay each month to their insurers.

Pre-existing conditions

Medical conditions that a person has before he or she applies for a new health insurance policy.

Premium

The amount a member and/or the member’s employer pays, usually each month, for health care coverage.

Michael Hurley was the education director for the Coalition of Kaiser Permanente Unions for several years, and he and his team designed many of the LMP programs used to support unit-based team education. 

1. Know why we use interest-based problem solving

Interest-based problem solving (IBPS) is a collaborative approach to solving problems, a process for negotiating differences amicably without giving in. When you’re in an ongoing partnership—whether it’s a labor-management partnership or, say, a marriage—you likely have multiple objectives you want to satisfy when resolving differences. Those include not only the desire to solve the problem in a way that meets your needs, but also to solve it in a way that doesn’t cost too much (in time, money or emotional wear and tear), and that leaves the relationship intact or even improves it. Because down the road, you know you’re going to be working together again to solve the next problem that crops up.

2. Understand key terms

Four words are at the heart of the interest-based process. The issue is the problem or subject area to be addressed. A position is a proposed solution. The interest is the underlying need, motivation or concern that may have to be addressed in order to reach a solution; you can tell an interest in part because there is usually more than one way to satisfy it. An option is a potential way to address the issue, in whole or in part.

Your position tells us what you want but not necessarily why you want it.

• A spouse wants to put 5 percent of income into a retirement savings account.
• A parent wants a child in bed by 9:30 on a weeknight.
• A union wants a 3 percent across-the-board wage increase in collective bargaining.

Your interests tell us what is important to you.

• A spouse wants enough saved to have a comfortable retirement.
• A parent wants a child to be well rested for school the next day.
• A union rep wants a compensation package for members that aids recruitment and retention.

3. Ask: Is that ‘interest’ really a position?

What do you do when you’ve got a position masquerading as an interest? Usually, you can get to the interests that underlie a position if you listen carefully and ask the right questions. Find out the needs and concerns behind the position. Here’s an example:

Statement by wife: “I hate living in Los Angeles. We should move to Oregon.”

Reaction to self: “Great, here we go again.”

Question to wife: “Why should we move to Oregon?”

Answer: “We’re in a rut. We’ve lived our whole lives here. I’m tired of it.”

Question: “What else appeals to you about Oregon?”

Answers: “The weather is too hot here, and we spend so much time stuck in traffic. We have to do all our exercising here at the gym. Oregon is cooler and there are prettier roads for biking. We can get to the woods and good hiking faster. People are more relaxed there. “

Interests: Change in weather, less traffic, easier access to uncrowded outdoors, less stress.

By starting with a discussion of interests, the parties can talk about what is important to them without staking out what they want the outcome to be. It opens the door to collaborative problem solving, as opposed to competition or compromise. 

4. Agree on the information

Find agreement on what data to collect and how to collect it, vet it and report it—or you’ll just argue about the data. 

5. Make an action plan

Create an action plan for turning solutions into reality. Be clear on who’s accountable for what. Establish a timeline. 

6. Set ground rules

Remember, interest-based processes don’t always work. In my experience, they have the best chance for success if the parties agree to:

• Focus on the issue, not personalities.
• Share information fully and early.
• Listen actively.
• Work hard to meet interests, not sell positions.
• Be open to options.
• Look for ways to build trust.