Health Insurance Quotes Reform EasyToInsureME

Week of December 7, 2009

The Senate began to slog its way through amendments (see below) last week in a process that promises to get harder, not easier. In the meantime, the debate continues as to whether the Senate bill would do anything significant to slow rising health care costs, and a Bloomberg story points out that a number of economists and analysts are doubtful that it will. The White House defends the bill's ability to slow costs, but some analysts predict that Congress will need to make many more tough decisions to have a real impact. According to Bloomberg, a group of Senators that includes Joe Lieberman (I-CT) and Susan Collins (R-ME) is taking aim at rising costs with an amendment that would include new requirements on providers to try to wring more costs out of the system. Anyone concerned about the rising cost of health care should be engaged in the process by reaching out to their Senators to urge a greater focus on bending the cost curve.

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Federal
The Senate debate on health care reform actually consists of three simultaneous debates. The first is public on C-SPAN, and it's going slowly as Republicans are pressing for 60 votes as often as they can while Democrats try to speed things up. Nothing of any great moment has been passed or decided. The second debate is the one Majority Leader Harry Reid is conducting behind closed doors as he tries to garner 60 Democratic votes for some acceptable form of a public option. Once this is accomplished, most observers believe Reid will immediately file cloture to cut off debate on the bill itself. If successful at getting 60 votes, he will go straight to final passage, which would require 51 votes. This could happen before Christmas. The third debate is the one Reid is having with House Speaker Nancy Pelosi over whether to have a conference at all. If the Senate can pass a bill the House can accept "as is," then there will be no need for a time-consuming conference that could unravel the bill. Thus, Reid is checking in with Pelosi frequently to see what he needs to be able to pass a bill and avoid a conference.

Since returning from its Thanksgiving break last week, the Senate has slowly been making its way through a number of amendments. Key votes so far include: approved an amendment that would require first-dollar coverage (no cost sharing) for certain preventive services; approved an amendment stating that nothing in the bill reduce guaranteed benefits under Medicare; defeated a motion that would have sent the bill back to the Finance Committee for the purpose of removing proposed cuts to Medicare; defeated an amendment that would have removed the CLASS Act provisions from the bill; defeated a motion that would have sent the bill back to the Finance Committee to eliminate the proposed Medicare Advantage funding cuts; approved an amendment requiring that nothing in the bill shall eliminate benefits “guaranteed by law” to Medicare Advantage enrollees (protects only benefits also covered by traditional Medicare and does not protect extra benefits and services provided by MA plans); and defeated an amendment that would have placed limits on how much attorneys can earn from medical malpractice lawsuits.

States
ALL STATES: The National Governors Association (NGA) has announced an initiative outlining preparations for federal health care reform. Titled "Rx for Health Reform - Affordable, Accessible, Accountable," the 2009-2010 initiative is led by Vermont Governor and NGA Chair James Douglas. It will focus on: providing governors with the information needed to transition to a new health care system; developing state-based system improvements and cost containment measures, including tools necessary to develop delivery system enhancements, looking at what is required under federal legislation, and highlighting other reforms the states could undertake to create a more efficient and effective health care system; and preparing states for implementing insurance market reforms, state-based exchanges, new mechanisms to support delivery system reform, and other national health reforms. The NGA's Health Care Task Force includes Governor Douglas and West Virginia Governor Joe Manchin, both serving as co-chairs, as well as Indiana Governor Mitch Daniels, Mississippi Governor Haley Barbour, New Hampshire Governor John Lynch, and Oregon Governor Ted Kulongoski.

CALIFORNIA: The California Medical Association (CMA), the second largest medical association after Texas, has announced its opposition to the “Patient Protection and Affordable Care Act,” the health care reform bill being debated in the Senate. The CMA also opposed Governor Arnold Schwarzenegger’s comprehensive health care reform proposal in 2007. In other news, Republican Governor Schwarzenegger has appointed State Senator Abel Maldonado to serve as Lieutenant Governor, but Democrats in the legislature have vowed not to confirm the Republican Senator because they view him as a viable state-wide candidate who could be elected easily to the position. Maldonado still must be confirmed by the legislature, which has 90 days to act.

COLORADO: The Colorado Medical Society (CMS) continues to seek support for a bill that would define the practice of medicine as including medical necessity determinations and utilization reviews performed by health plan medical directors. As currently drafted, the proposal would potentially expose medical directors to disciplinary action by the state Board of Medicine when medical necessity or utilization review decisions are challenged. Several discussions have been held with the executive director of CMS to ascertain the nature of the problem the association is trying to address, particularly since the organization as a whole may not be supporting the bill.

ILLINOIS: Illinois' fiscal situation is "grim and getting worse." Illinois has a reported $12 billion structural budget deficit. Comptroller Hynes said Illinois had nearly $4.6 billion in unpaid bills at the end of September, a record development for the first quarter of any fiscal year. This, despite the state having borrowed $2.25 billion in short-term loans, which must be repaid before the end of FY2010. Hynes identified two factors that have had a major impact on the deteriorating fiscal position: the steep decline in economy-driven revenues, such as personal and corporate income taxes and sales taxes, and record lapse-period spending. Hynes predicted fiscal pressures would continue well into FY2011 and warned of record and prolonged payment delays for most categories of state programs and operations, including health care and social services. There will be increasing pressure on health care programs as the economic stimulus funds expire and the amount of money demanded by utilization increases continue to be realized. There are already significant payment cycle delays on portions of the State employee health plan. The budget situation will dominate discussions in the General Assembly, which reconvenes in January.

KANSAS: At the request of Kansas Congresswoman Lynn Jenkins, the Kansas Health Policy Authority recently announced that it estimates the health reform bill passed by the U.S. House would provide health insurance for 240,000 Kansans without coverage and possibly save the state treasury up to $25 million a year. It estimated the U.S. Senate Finance Committee bill would insure an estimated 190,000 Kansans and reduce state costs by $25 million to $50 million a year. The Authority also concluded that the House bill would provide more federal matching dollars for Medicaid and likely would allow a reduced package of benefits for Medicaid beneficiaries added to the state rolls as a result of health reform. Current Kansas Medicaid eligibility is among the strictest in the nation, with benefits generally available only to the oldest and youngest of the state’s poor. Childless adults of working age are not eligible and parents are enrolled only if they earn less than about 27 percent of poverty guidelines. Exceptions are made for pregnant women.

MICHIGAN: State House Democrats announced a plan last week to cut auto insurance rates through tighter restrictions on auto insurance companies and the medical portion of those claims, affecting subrogation and coordination of benefits for Aetna and Cofinity®. Generally, the proposal requires auto insurance companies to offer low-cost auto insurance to low-income drivers with good driving records. The bill also would: allow the state insurance commissioner to deny rate changes by auto insurance companies before they take effect; prohibit auto insurance rate increases for those with good driving records; prohibit auto insurers from using certain types of rating factors; and limit fees paid to doctors and hospitals for treating auto accident injuries. Michigan is the only state that requires all auto insurance policies to give unlimited medical coverage for injuries suffered in auto accidents. The proposal would change that requirement and allow motorists to buy maximum medical coverage as low as $50,000. This means that rate-regulated provider groups would likely have group policies pay auto claims rather than wait for adjudication of the claim in court, as they would not want their fees limited. In addition, the allowance of low medical coverage on auto claims would affect Aetna's subrogation and coordination of benefit activities with both auto carriers and Aetna enrollees.

MISSOURI: The Department of Insurance recently released its 2008 HMO Annual Report showing that the entire managed care market is declining. The report shows that the number of people enrolled in either an HMO or a major medical health insurance plan decreased 15 percent since 2006. PPO plans are gaining the most enrollment, and POS plans remain more popular in certain areas than HMO plans. Total premiums for managed care coverage continue to rise with the industry reporting a 7.5 percent increase from 2004 to 2008. The medical cost ratio for all HMOs operating in Missouri, covering only Missouri business, was 82 percent in 2008, compared to the nationwide industry number of 83.6 percent.

NEW JERSEY: The legislature returned from its extended recess and took action on legislation to establish a medical home demonstration project for the Medicaid population. Upon federal approval, the state Medicaid program would set out a three-year demonstration project with an annual evaluation and reporting requirement by the Division of Medicaid Assistance Services to the Governor and legislature. On the Senate side, Aetna offered support for legislation requiring chain restaurants to provide nutritional information for food and beverages on their menus. Similar legislation is currently making its way through the Assembly and will likely receive a full vote in both chambers prior to the end of the session.

NEW YORK: The legislature passed another deficit reduction plan, trimming spending and using unspent funds to plug a $2.7 billion dollar budget deficit. A large percentage of the revenue used to fill the gap came from federal stimulus money that was originally designated for the 2010 budget and cuts to the Medicaid trend factor. After intense lobbying and coalition efforts, the legislature did not pass the Governor's proposed 0.25 percent increase to the patient services assessment or "sick tax". In addition, the Senate did not pass the Marriage Equality Act, effectively defeating the bill for the year. The legislature will return to face a multi-billion dollar deficit again in January, and it is likely that increases to health insurance taxes will be back on the table.

UTAH: The Department of Insurance remains committed to pursuing legislation to expand the Utah Health Exchange Network Portal to include a master patient index that providers could access to obtain coverage eligibility information. The bill contains a number of troubling provisions, including a monthly batch reporting requirement on health plans. The proposal also includes a July 1, 2010 effective date allowing no time to update and test affected internal systems.