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Health Insurance Reform State Updates

2010-11-30T09:37:00.000-08:00

The Legislative New Mexico health insurance Health and Human Services Interim Committee has endorsed rate reviews and health insurance exchange bills.

Governor Dave Heineman has announced that Bruce Ramge has been appointed Director of the Department of Nebraska Health Insurance, effective immediately.

Governor Steve Beshear has announced changes designed to save more than $142 million in the Kentucky health insurance Medicaid program over the next two years.

Illinois Health Insurance Reform Implementation Council is requesting public comments on a proposed health insurance exchange.

Florida Health Insurance, Now in special session, a significant Republican majority is emphasizing a message of fewer taxes, more discretion in spending, and greater accountability in state government.

While Governor-elect Jerry Brown has not yet announced his priorities for California health insurance, his website does state that he supports requiring health care cost transparency.

Health Insurance Reform Washington Update

2010-08-17T12:28:00.000-07:00

Summary of what has been happening in Washington as of Aug. 6, 2010.

Senators Introduce New Legislation to Increase Transparency and Competition in Insurance Industry
Senators Mark Pryor (D-AR), Jay Rockefeller (D-WV) and Barbara Boxer (D-CA) introduced “The Insurance Competition and Transparency Act” (S. 3685) in the Senate Committee on Commerce, Science and Transportation on Aug 2. The legislation would authorize the Federal Trade Commission (FTC) to use its authority under the Federal Trade Commission Act to “investigate and disclose information about practices employed by insurance companies that may reduce competition in the marketplace.”

The bill goes a step further and explicitly states that since many insurance companies have non-profit status, it would eliminate the exemption under the Act for non-profit insurers. S. 3685 is based on an amendment that was filed by Senators Pryor, Rockefeller and Boxer during the Senate’s health reform debate in December 2009.

Senate Passes Child Nutrition Bill
Led by the Senate Agriculture Committee Chairwoman Blanche Lincoln (D-AR) and Ranking Member Saxby Chambliss (R-GA), the Senate passed the “Healthy, Hunger-Free Kids Act of 2010” (S. 3307) by unanimous consent on Aug. 5. The legislation authorizes a $4.5 billion increase over 10 years for school lunches and other nutrition programs. It also gives the Agriculture Department authority to set nutrition standards for foods sold in vending machines and in a la carte lines in schools.

Of the $4.5 billion, the legislation provides $1.2 billion to increase the number of children receiving food, in an effort to meet President Barack Obama’s pledge to end childhood hunger by 2015. The remaining $3.2 billion would be used to improve the quality of school meals. The cost of the legislation is entirely offset. Review the Congressional Budget Office’s budgetary impact report.

Chairman Tom Harkin (D-IA) of the Senate Health, Education, Labor and Pensions Committee commended Agriculture Committee Chairwoman Lincoln for her work on the bill, noting that it passed both the Agriculture Committee and the full Senate without a single dissenting vote.

The House of Representatives still needs to pass its version of the bill, “The Improving Nutrition for America’s Children Act” (H.R. 5504), in order for President Obama to sign the bill before Sept. 30, when many of the programs are set to expire. The House Education and Labor Committee approved the measure on July 15.

The American Academy of Pediatrics also commended the Senate for its action on the legislation and pushed the House to follow the Senate’s lead. “The AAP urges the House to follow the Senate’s swift action on this bill and pass strong child nutrition legislation when Congress reconvenes in September. All children deserve a healthy future, which starts with access to healthy, nutritious meals every day.” See the American Academy of Pediatrics’ entire statement.

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Patient Protection, Preventive Care, and Pre-existing Conditions

2010-07-20T13:10:00.000-07:00

Patient Protection, Preventive Care, and Pre-existing Conditions

In this week's Health Insurance Reform Update, we're sharing new information about three provisions: "patient protection" regulations, new preventive care regulations, and high risk pools ("pre-existing condition insurance plans"). While there's a lot of information to digest, we're working hard to make sure you and your clients get the most from the law.

Patient Protection Provisions
The Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury filed a 4-part interim final rule (IFR) on June 23, 2010 that provides further detail on requirements related to pre-existing condition exclusions for kids, lifetime and annual limits, rescission, and other "patient protections". Below is an overview of key points:

Pre-existing conditions
The recently enacted health care reform legislation prohibits health plans from using pre-existing conditions to deny health care coverage to an individual beginning in January 2014. Under the IFR, the Department of Health and Human Services requires health plans to implement this provision for children under the age of 19, beginning with plan years on or after September 23, 2010.

Annual limits
The new legislation also prohibits contracts from having lifetime limits and limits a health insurer's ability to have annual limits on "essential health benefits" (which have yet to be completely defined). Regardless of whether the plan is grandfathered, our plans will no longer include lifetime dollar limits for plan years beginning on or after September 23, 2010. We will also be removing certain annual limits. While we continue to wait on additional guidance from HHS that will further define "essential health benefits", we are making a good faith effort to comply with the regulation prohibiting annual limits on these benefits.

Rescission
Rescission is now limited to fraud or intentional misrepresentation of material fact. Based on the recent IFR, a health insurer may only terminate a member's coverage in the event of a mistake in eligibility (without fraud or misrepresentation) prospectively, not retroactively. We were the first health insurer to implement the rescission provision, implementing federal legislation regarding individual market rescissions effective May 1. This was well ahead of the effective date contained in the legislation, building on our leadership in the early implementation of reform legislation.

"Patient Protections"
The legislation also contains a number of other provisions that the Administration is calling "patient protections." This group of provisions includes:

Primary care physicians - For plans that require a primary care physician, allowing all members to choose any available in-network provider as their primary care doctor, including a participating pediatrician for children
OB-GYN providers - Allows individuals to seek care from an in-network OB-GYN provider without requiring pre-authorization or referral from a primary care physician
Emergency room services - Emergency room services protection including no pre-authorization for emergency services and limited cost-sharing for out of network services

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This Week in Health Insurance Reform

2010-06-07T07:53:00.000-07:00

Did you know health care fraud constitutes nearly 3% of all health care spending, according to the National Health Care Anti-fraud Association? This translates to $69 billion lost to fraud annually, or over $100 million per day. Blue Cross and Blue Shield companies' anti-fraud investigations resulted in overall savings and recoveries of more than $510 million in 2009, according to data released May 26, 2010, by the Blue Cross and Blue Shield Association. This represents a significant increase compared with 2008 and contributed to a three-year average return of $7 for every $1 spent on anti-fraud efforts.

This Week in Health Care Reform: June 4, 2010

As lawmakers complete a week long recess in their home states, Obama administration officials move forward on implementing certain provisions of the health insurance reform legislation. Recent national polling shows a majority of Americans strongly favor repeal of the law.

Health Care Reform

Young Adults Might Not Be Covered Ahead of Schedule: WellPoint's affiliated health plans and other insurers began extending medical coverage for qualifying graduating students on June 1, well in advance of the September 23 deadline. However, many employers plan to wait to provide the extended coverage until they are legally required to do so, with an effective date of January 2011 for most employers.

Senate Fails to Extend Bill for Doctors: Before leaving for the Memorial Day recess, House Democratic leaders scaled back health care language from the jobs bill before passing the bill. In the package, doctors who treat Medicare patients would see a 2.2% payment increase for the remainder of this year and a 1% payment increase in 2011. Extensions of COBRA subsidies and additional Medicaid funding for states were removed from the bill. Lawmakers in the Senate will vote on the bill when they return from recess next week.

Florida Judge Denies Government's Motion: Health and Human Services Secretary Kathleen Sebelius asked a federal judge in Florida for a one-month extension to respond to the joint lawsuit filed by 20 states' attorneys general who challenged the constitutionality of the new health care reform law. U.S. District Judge Roger Vinson denied the administration's request for an extension and instructed HHS officials to respond by the June 16 deadline.

Public Opinion

Americans Want Repeal of Health Care Reform: A recently released Rasmussen report suggests that Americans are strongly in favor of repealing President Barack Obama's health care reform law. Sixty percent of those polled favor repeal, while 62% believe the new legislation will increase the budget deficit.

Majority of Americans Unhappy with Reform: According to a new Quinnipiac University poll, 51% of Americans are unhappy with the new health care reform legislation and 70% are "dissatisfied" or "very dissatisfied" with the way things are going for the nation.

Looking Ahead

Lawmakers return to Washington on Monday ahead of a contentious primary runoff in Arkansas between Democrats Sen. Blanche Lincoln and Lt. Gov. Bill Halter, with health care reform at the center of the debate. The winner of Tuesday's Democratic nomination will face Republican Rep. John Boozman in the November elections.

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Health Care Reform Update from Easy To Insure ME

2010-05-13T08:39:00.000-07:00

May 12, 2010

Read this week about what is happening on the federal legislative front of Health Care Reform.

House Hearing on Health Care Pricing Transparency Proposals
The House Energy and Commerce Subcommittee on Health held a hearing on May 6, 2010 regarding legislative proposals aimed at improving transparency for health insurance consumers. Three separate transparency bills were listed on the hearing agenda, although the discussion among subcommittee members and witnesses focused broadly on the merits of transparency and the possibility of unintended consequences.

Representative Steve Kagen (D-WI) testified in support of the H.R. 4700 bill he has introduced, which would require health care providers and insurers to publicly disclose, on a continuous basis, all prices for health care-related items, products, services and procedures. Kagen said that this bill would “establish a very competitive medical marketplace” and allow families to “make their health care decisions based upon quality, and the price and the service of available caregivers.”

Michael Cowie, an antitrust attorney with Howrey LLP and a former official with the Federal Trade Commission (FTC), expressed concern that the Kagen bill would conflict with existing antitrust provisions that are intended to prevent collusion that could contribute to higher costs. Cowie also cited economic studies showing that mandatory publication of pricing terms often leads to higher pricing.

Steven Summer, a Colorado Hospital Association representative, suggested a four-prong approach to improving transparency: expanding existing transparency efforts through collaborations between states and state hospital associations; requiring insurers to make estimated out-of-pocket costs available on a pre-care basis; conducting more research on the pricing information that consumers want and need; and making pricing information consumer-friendly.

The other transparency bills discussed at the hearing were:

* H.R. 2249, introduced by Representative Michael Burgess (R-TX), would require states, as a condition of participating in Medicaid, to establish laws for the disclosure of information on hospital charges, to make such information available to the public, and to provide individuals with information about estimated out-of-pocket costs for health care services.
* H.R. 4803, introduced by Representative Joe Barton (R-TX), would require health insurance plans to make available to enrollees and potential enrollees specified information, including covered items and services, a list of limitations and restrictions, the number of participating providers according to specialty type, information on cost-sharing, a description of the claims appeal process, and other information.

Although both Democrats and Republicans voiced support for stronger measures to improve transparency, it is not clear at this time whether the subcommittee will be marking up any of the legislative proposals discussed at the hearing.

House Republicans Urge Democrats to Hold Hearings on Health Care Reform Law
Republican Members of the House Energy and Commerce Health Subcommittee repeatedly urged Energy and Commerce Committee Chairman Henry Waxman (D-CA) to hold a series of hearings on the new health insurance reform law during the recent Subcommittee hearing on health care pricing transparency (see above information). Chairman Waxman gave no indication that he intends to hold hearings on the reform legislation.

Republicans have specifically requested to hear the testimony of Centers for Medicare and Medicaid Services Chief Actuary Rick Foster regarding a report his office prepared on the impacts of the health insurance reform legislation. The report estimates that the law will increase health care costs by approximately 1 percent over the next ten years, and will cause approximately 14 million Americans to lose their current employer-sponsored coverage.

In an April 28 letter to Chairman Waxman, Ranking Member Joe Barton (R-TX) wrote, “We believe that inviting Mr. Foster’s testimony is invaluable to our efforts to rein in health care costs and government spending. We therefore ask that you invite him to testify as soon as possible.”

Senator Feinstein Continues Seeking Support for Federal Review of Insurance Rates
Senator Dianne Feinstein (D-CA) continues to seek support for legislation she has introduced, which would give the federal government the authority to review and block health insurance rate increases.

The Health Insurance Rate Authority Act of 2010 (S. 3078) would authorize the HHS Secretary to conduct health insurance rate reviews in states where the state insurance commissioner does not have the authority or capability to do so. The legislation would also give the HHS Secretary the authority to block “unreasonable” rate increases. The bill currently has six cosponsors.

On April 28, Senate Health, Education, Labor, and Pensions Committee Chairman Tom Harkin (D-IA) held a hearing on the legislation in which he stated that “it’s my intention to move toward a markup or at least do something to get the bill moving” this year. Also, Senator Feinstein has indicated that she may seek to move the legislation by offering it as an amendment to an unrelated bill.

Representative Jan Schakowsky (D-IL) has introduced companion legislation (H.R. 4757) in the House, which currently has 27 cosponsors.

Possible McCarran-Ferguson Amendment
Senator Patrick Leahy (D-VT), chairman of the Senate Judiciary Committee, filed an amendment on May 6 that proposes to repeal portions of the McCarran-Ferguson Act as they apply to health insurance plans. Chairman Leahy filed this amendment with respect to the financial regulatory reform bill currently being debated on the Senate floor. Senate leaders are hoping to complete action on this bill by May 14.

The Leahy amendment is based on legislation, Health Insurance Industry Fair Competition Act (H.R. 4626), that the House approved in February. The health insurance industry has repeatedly stated that the McCarran-Ferguson Act is extremely limited in scope and has nothing to do with competition in the health insurance industry, which is the issue the House bill purports to address. However, opponents of repeal say this move could have unintended consequences and could disrupt initiatives to enhance efficiency, reduce costs and improve the quality and safety of patient care. Currently, the federal government intensely examines, and takes action on every merger involving health insurance plans. Also, all insurers are subject to state antitrust laws, as well as state rate regulation and other state laws enforced by State Attorneys General and insurance regulators.

Karen Ignagni, president of America’s Health Insurance Plans (AHIP), said that such legislation “attempts to remedy a problem that does not exist” and that repeal efforts are “based on a misperception of the scope and impact” of the exemption.

As of this writing, Chairman Leahy has not yet offered the amendment for consideration. Among the approximately 130 amendments that have been filed for the financial regulatory reform bill, only a small portion will likely be considered by the Senate. As noted above, Senator Dianne Feinstein (D-CA) has not yet filed an amendment for a federal rate review process.

New HELP Committee Staff
Jenelle Krishnamoorthy has been named health policy director for the Senate Health, Education, Labor and Pensions (HELP) Committee. Krishnamoorthy served as the lead health staff member for HELP Chairman Tom Harkin (D-IA). She succeeds David Bowen, who worked for the HELP Committee for 10 years.

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Current Health Insurance Reform Issues

2010-04-13T11:18:00.000-07:00

No sooner had President Obama signed the last piece of the health insurance reform package on March 30 than he hit the road, traveling to a number of states to sell the public on the new health care law of the land. On their Easter/Passover recess break, many members of Congress were engaged in their own hearts and minds campaign on health reform back in their home districts. A new Gallup poll, however, seems to show that Democratic supporters of the bill have the tougher selling job. The poll shows that 47 percent of Americans believe it is a good thing that the bill passed while 50 percent believe it to be a bad thing. And, the results show that both opponents and proponents agree that the new law does not do nearly enough to address rising health care costs. Health plans, such as Aetna, have maintained that the success of health care reform will hinge on addressing health care costs, and we have pledged to continue working toward reforms that would achieve affordability.

Federal

Since Congress was in recess last week, there is no Federal report this week.

States

ARIZONA: After a lengthy debate in special session, the legislature voted along party lines to permit a lawsuit challenging the newly enacted federal health care reform law. It is unclear whether Governor Jan Brewer will join other states in the lawsuit filed in Florida, since the attorney general has advised that he will not participate in any litigation on this issue. Brewer had asked lawmakers for authority to go around the attorney general and sue on the state's behalf.

COLORADO: A bill prohibiting the use of gender as an underwriting factor in setting rates for individual policies passed both chambers and will become effective with plans issued or renewed after January 1, 2011. The bill is part of Governor Ritter’s health reform package.

GEORGIA: A bill that originally would have imposed a tax on health plans – the language regarding a health plan tax was removed recently -- was passed out of the Senate last week. However, whether the Governor will sign the bill in its current form is not clear.

IDAHO: The legislature adjourned a week early last week, but not before passing a number of items to close out the session. Governor Otter has signed a number of the bills, including the “Idaho Health Freedom Act”, reserving citizens' right to choose or decline health care services without being penalized by the federal government and authorizing the state attorney general to seek legal recourse to uphold this policy. Also signed were bills regulating the relationship between third-party administrators and insurers, and establishing an immunization board to maintain a single distribution center for providers and determine an assessment on carriers to fund the program. Another bill amends the duties of the Commission of Health Information Technology Planning to include monitoring the state’s health data exchange and recommending improvements to IT capabilities. Bills awaiting the governor’s signature include a proposed prohibition on a carrier’s ability to require a participating dentist from charging a member at a non-par rate for services that are not covered under the provider contract, and a proposed requirement that both the prescribing physician and patient be notified by the pharmacist of generic substitutions for epilepsy or seizure drugs. Defeated were mandates for oral chemotherapy parity and prosthetic limbs, an any-willing-provider requirement, and a bill permitting small employers to enroll in the state employees’ plan.

ILLINOIS health insurance : The House has unanimously passed the Illinois Health Information Exchange and Technology Act to establish a state authority to operate the Illinois Health Information Exchange. Expected to pass in the Senate, the bill supports the adoption of electronic health records among health care providers in Illinois, and building the infrastructure necessary to make HIE possible. Aetna was one of three insurers supporting the new act as part of a coalition of provider, consumer groups and unions. The HIE is designed to promote and facilitate the sharing of health information among health care providers within Illinois and in other states, and foster the widespread adoption of electronic health records. The bill also sets forth the Authority's powers, with public and private representation, to facilitate the secure exchange of electronic health records to deliver better health care. No later than January 1, 2015, each state agency that implements, acquires, or upgrades health information technology systems shall use systems and products that meet minimum standards adopted by the Authority for accessing the HIE.

IOWA: The Iowa legislature ended its annual legislative session last week and passed bills that include a clinical trial mandate for cancer patients, a prohibition of dental fee schedules for non-covered services, and an increase in the amount the guaranty association will pay for hospital, med-surg and major med coverage. Also, an Insurance Department omnibus bill that passed includes several insurance reform amendments, including making rate increase applications public record and requiring an annual report from the Commissioner to include information from health plans on medical loss ratios, rate increase data, health care expenditures in Iowa and their effect on premiums, ranking and quantification of the factors that result in higher and lower costs, the plan’s current capital, surplus and reserves, any apparent medical trends affecting insurance costs, and any other data the commissioner might deem pertinent. Carriers now must also notify policyholders of any application for a rate increase exceeding the average annual health spending growth rate stated in the most recent national health expenditure projection published by CMS. Additional amendments included a mental health & substance abuse mandate for veterans, an expansion of IowaCare, the establishment of a health information clearinghouse/exchange, and prohibition of plans using genetic information to discriminate among patients. Bills of interest that died would have created mandate-light health benefit plans, a public access cost and quality transparency portal, mandated coverage for autism, and income tax deductions for section 125 health plans.

MAINE: The legislature passed legislation that would prohibit health plans from imposing annual, lifetime or other caps on the amount they will pay for covered medical services. If signed by Governor John Baldacci as expected, the bill would take effect January 1, 2011. The legislation defines "health plan" as a plan offered or administered by a carrier that provides for the financing or delivery of health care services to persons enrolled in the plan (other than a plan that provides only accidental injury, specified disease, hospital indemnity, Medicare supplement, disability income, long-term care or other limited benefit coverage). A similar provision in the federal health care reform legislation recently enacted by Congress abolishes lifetime or annual dollar limits on essential health benefits. The federal reform law allows health plans to establish restricted annual limits on essential health benefits prior to January 2014 and to place limits on benefits that are considered non-essential health benefits.

MASSACHUSETTS: The Massachusetts Division of Insurance (DOI) has rejected 235 of 274 rate increases filed for small businesses, using 90-day emergency regulations that require HMOs to file any proposed increases to small group rates or changes to small group rating factors at least 30 days in advance of their effective dates. The emergency regulations also require HMOs to provide a significant amount of additional information when filing any proposed small group rate increases or rate changes. The DOI sent letters to carriers outlining the reasons for its actions, including: the disapproved rate filings failed to illustrate how the carriers pay similarly situated providers differing rates of reimbursement based solely on quality of care, mix of patients, intensity of services, and geographic location at which care is provided; the disapproved rate filings failed to demonstrate that carriers have renegotiated provider reimbursement rates; and the disapproved rate filings were significantly above the medical consumer price index without an adequate explanation for the wide difference.

MICHIGAN: Pulling attention away from the legislature's individual market reform bills, Governor Jennifer Granholm implemented an executive order that would put into motion a cabinet level workgroup titled "Health Insurance Reform Coordinating Council" on federal health care reform issues to be implemented in Michigan. Her goal is to identify steps that must be taken to ensure that Michigan citizens reap the full benefits outlined in the federal reform bill, including benefits for dependents to age 26, tax credits for small business, Medicaid expansion beginning in 2014, insurance reforms (e.g., eliminating pre-existing condition exclusions and rescissions),a health insurance exchange, preventative services without co-pays, and changes in the Medicare donut hole. Office of Financial and Insurance Regulation Director Ken Ross will be part of the overall implementation. His immediate assignment is to create a health insurance ombudsman office, begin the framework for the health insurance exchange, as well as have ongoing communication with Health and Human Services and NAIC on the overall rules.

SOUTH DAKOTA: As the legislature adjourned last week, Governor Mike Rounds vetoed a subrogation bill that would have prevented insurers from any subrogation rights until the injured party was first "made whole." The Senate tried but failed to overturn the veto. Legislation that was signed by the Governor included a bill prohibiting contracts between an insurer and a dentist that require the use of a fee schedule for non-covered services, a bill changing the premium rate-setting procedure for the high-risk pool,and a Joint Resolution opposing the federal health care reform proposals passed in the U.S. Senate and House. Several significant bills that died included a provision to allow South Dakota to opt out of federal health reform and a bill repealing premium and annuity taxes for insurers.

TEXAS: Last week, the Senate Committee on State Affairs held a joint hearing with the Senate Committee on Health & Human Services to discuss the impact of federal health care reform on the state. The committee heard from Health & Human Services Commissioner Tom Suehs, Texas Department of Insurance Commissioner Mike Geeslin and Special Projects Director Dianne Longley, and the Employees Retirement System. Suehs estimated the cost to the State would total $27 billion over 10 years. When asked why his estimate was so much higher than that of the CBO, Suehs stated that “I know that I’ve got a higher population of uninsured than most states have total population.” Commissioner Geeslin focused his opening comments on the massive scope of the bill and how much change it will bring to consumers. In response to a question, Geeslin said that a new rate review authority could respond to a rate increase they deemed unjustified not with an enforcement action but only to inform the public that the rate increase was deemed unjustified. He also pointed out that the state can opt out in 2017 if it can demonstrate that it could provide similar coverage. He clarified that the exchange function could be outsourced but not to a Medicaid agency or a private insurer. Both agency heads confirmed that their need to add staff to implement the law will be substantial. The Committee members were in agreement that many future hearings would be required to keep up with the pace of reform implementation. Aetna will continue to monitor these hearings.

WASHINGTON: Partisan debate over federal health care reform is moving from the nation's Capitol to the states. Several states, including Washington, are challenging its individual mandate in federal court. Governor Chris Gregoire, a supporter of the health-care overhaul, is threatening to file a lawsuit against Attorney General Rob McKenna in an effort to block his participation in the suit organized and funded through the Florida Attorney General’s office. At the same time, the Democrat-controlled legislature may try to block McKenna’s participation by cutting funding to the Attorney General’s Office, or requiring that McKenna receive approval from the Governor prior to continued participation. Fourteen states are now participating in the lawsuit.

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Health Reform What am I paying for?

2010-04-02T12:17:00.000-07:00

Health Care Reform - Timeline

The federal health care reform legislation, known as the Patient Protection and Affordable Care Act, signed by the President on March 23, 2010, and the Health Care and Education Reconciliation Act approved by Congress, signed by the President today, will expand the availability of health care coverage to millions of Americans. While some of the measures will be implemented this year, many do not take effect until 2014 and some extend out to 2020.

Below is a high-level overview of the timeline. It is important to note that many of these reforms and their effective dates are subject to the rules and regulations process both at the state and federal levels – which could alter the intended timing of implementation.

2010

New Programs:
* Temporary retiree reinsurance program is established
* National risk pool is created, small business tax credit is established
* $250 rebate for Medicare members who reach the ”doughnut hole”

Insurance Reforms:
* Prohibits lifetime benefit limits – based on dollar amounts
* Allows restricted annual limits on the dollar value of certain benefits
* Coverage rescissions/cancellations are prohibited (except for fraud or intentional misrepresentation)
* Cost-sharing obligations for preventive services are prohibited
* Dependent coverage up to age 26 is mandated
* Internal and external appeal processes must be established
* Pre-existing condition exclusions for dependent children (under 19 years of age) are prohibited
* New health plan disclosure and transparency requirements are created

2011

Insurance Reforms:
* Uniform coverage documents and standard definitions are developed
* Minimum medical loss ratios are mandated

Medicare Reforms:
* Medicare Advantage cost sharing limits effective
* Medicare beneficiaries who reach the doughnut hole will receive a 50% discount on brand name drugs
* A 10% Medicare bonus will be provided to primary care physicians and general surgeons practicing in underserved areas, such as inner cities and rural communities.
* Medicare Advantage plans would begin to have their payments frozen.

Other:
* Employers are required to report the value of health care benefits on employees' W2 tax statements.
* Annual industry fee for pharmaceutical manufacturers of brand name drugs.
* Voluntary long term care insurance program would be made available to provide cash benefit for assisting disabled individuals to stay in their homes or cover nursing home costs. Benefits would start five years after people begin paying a fee for coverage.
* Funding for community health centers would be increased to provide care for many low income and uninsured people.

2012

* Hospitals, physicians, and payers would be encouraged to band together in "accountable care organizations."
* Hospitals with high rates of preventable readmissions would face reduced Medicare payments.

2013

* Individuals making $200,000 a year or couples making $250,000 would have a higher Medicare payroll tax of 2.35% on earned income —up from the current 1.45%. A new tax of 3.8% on unearned income, such as dividends and interest, is also added.
* Medical expense contributions to flexible spending accounts (FSAs) limited to $2,500 a year—indexed for inflation. In addition, the thresholds for claiming itemized tax deduction for medical expenses rise from 7.5% to 10% of income.
* Medical device manufacturers would have a 2.9% sales tax on medical devices; devices such as eyeglasses, contact lenses, and hearing aids would be exempt.
* Eliminates deduction for expenses allocable to Medicare Part D subsidy for employers who maintain prescription drug plans for their Medicare Part D eligible retirees.

2014

Coverage Mandates & Subsidies:
* Individual and employer coverage responsibilities are effective.
* Individual affordability tax credits are created and small business tax credits are expanded.

Health Insurance Exchange & Insurance Reforms:
* State individual and small group health insurance exchanges operational.
* Guaranteed issue, guaranteed renewability, modified community rating and minimum benefit standards (“essential benefits” plan) effective.
* Lifetime and annual dollar limits are prohibited for essential benefits.
* Pre-existing condition exclusions are prohibited.

Taxes & Fees:
* Addition of new taxes on health insurers

Medicaid and Medicare Reform:
* Medicaid expanded to cover low income individuals under age 65 up to 133% of the federal poverty level—about $28,300 for a family of four.
* Minimum medical loss ratio of 85% required for Medicare Advantage plans

2018

Taxes & Fees:
* Tax (“Cadillac tax”) imposed on employer sponsored health insurance plans that offer policies with generous levels of coverage.

2020

Medicare Reform:
* Doughnut hole coverage gap in Medicare prescription benefit is fully phased out. Seniors continue to pay the standard 25% of their drug costs until they reach the threshold for Medicare catastrophic coverage.

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Health Insurance Reform In Conclusion

2010-04-01T12:51:00.000-07:00

After more than a year of often contentious political debate, historic health insurance reform legislation was passed and signed into law last week. But the ink was not yet dry on the bill before 14 states filed a lawsuit challenging the new law, and everyone else began poring over provisions to determine exactly what it would mean for them. Time magazine concluded that health insurance premiums will continue to rise under the new law, and with more predictability. In a BusinessWeek magazine interview last week, Aetna Chairman and CEO Ron Williams agreed that premiums will continue to rise because health care costs were not adequately addressed. He added, however, that the nation still can get back to meaningfully taking on the drivers of rising health care costs in the next several years during the new law's implementation period. As stated in an Aetna news release issued last week, Aetna stands ready to help if that happens.

Federal

The President's signature on health care reform legislation March 23 and his signing on March 30 of the Reconciliation measure to "fix" the March 23 version starts the clock ticking for implementation of the biggest change to American health care in 45 years. Irrespective of policy position or political persuasion, two truths emerge from its passage: 1) Health care reform is now President Obama's health care reform, and he and the Democratic Party will have to defend it going forward for many years to come; and 2) The entire country (starting with health plans and insurers) needs to fasten its seat belt tightly and get ready for the most massive regulatory and implementation process since Medicare.

For the past three months, the House and Senate have been unable to agree on either a long-term "doc fix" (to permanently eliminate the 21 percent cut to Medicare doctors in 2010) or a COBRA fix (to provide a full 2010 calendar year extension of the right for certain COBRA recipients to receive a 65 percent government subsidy). The impasse has resulted in month-to-month extensions as neither Chamber has been able to get the other to agree to its version of a permanent extension. Just before the two-week recess (March 25 to April 12) the House once again did its part and passed an extension through April for each item. The Senate refused to play ping-pong this time and went home for recess without agreeing to the same month-long extension. This could prove both costly and administratively messy. CMS has already ordered a temporary halt on processing claims for the first days in April hoping to stave off the problems associated with letting a 21 percent cut go into place early in April only to retroactively unwind the cut within weeks. Whether Congress can figure out what to do and then do the right thing is at best a 50-50 proposition

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Individual Health Insurance Reform Future Proceedings Easy To Insure ME

2010-03-29T09:06:00.000-07:00

MARCH 26, 2010

This Week in Health Insurance Reform

Health care reform legislation passed the House this week on a party-line vote. Late Sunday night, House Democrats approved the Senate health care reform package, sending the legislation to President Obama for his signature. On Tuesday, President Obama signed the underlying bill into law, yet the House has yet to finalize the package of "fixes" that will alter the final implications of the legislation.

Health Care Reform Negotiations

House Democrats Pass Health Insurance Reform Package: The House of Representatives approved the Senate health care reform bill Sunday night by a vote of 219 to 212. The vote marks the climactic finale to a year-long debate over health care reform. In the final vote, 34 Democrats joined all House Republicans in voting against the measure. Shortly thereafter, the House also passed a package of "fixes," by a vote of 220-211, that was sent directly to the Senate for its approval through reconciliation. On Tuesday, President Obama signed into law the Senate health care reform bill, called the "Patient Protection and Affordable Care Act."

Republicans Force Senate to Send the Reconciliation Bill Back to the House: Shortly after the President signed the Senate bill into law, Senators began deliberations on the reconciliation bill. Reconciliation protocol restricts Senators to 20 hours of debate on the measure, but it does not limit the number of amendments that can be filed. In an expression of opposition to the bill, Republicans filed 29 amendments to the reconciliation package.

After 10 hours of continuous debate, Republicans were successful in eliminating two provisions related to college financial aid in the non-health care portion of the bill. The Senate parliamentarian ruled early Thursday morning that those two provisions violated the chamber's rules, sending the legislation back to the House for a new vote. As a result, on Thursday afternoon, the Senate voted on the reconciliation bill without those two provisions and sent the bill back to the House for a vote on final passage. The House vote will likely come Thursday evening.

What Does This Health Care Reform Legislation Mean: While the health care reform bill extends insurance coverage to 32 million more Americans by 2019, the legislation has other far-reaching implications that will be phased in sooner, during a multi-year implementation period.

Several features of the new health care overhaul bill that would take effect in 2010 under the measure passed Sunday include:

* New product requirements beginning 6 months after enactment, including:
o Coverage for dependents up to age 26
o No lifetime maximum benefit limits
o And no cost sharing on preventive care for certain policyholders
* Temporary federal high risk pools;
* Tax credits for small employers; and
* Prohibition on pre-existing condition exclusions for children (beginning 6 months after enactment).

Most Americans will have until 2014 to purchase insurance or pay a penalty. Other elements of the bill that will not take effect until at least 2014 include insurance marketplaces called "exchanges"; rules requiring insurers to accept all applicants regardless of pre-existing conditions, and an expansion of state Medicaid programs.

A number of experts question whether health care reform will really drive down insurance premiums. America's Health Insurance Plans ( AHIP), the trade group representing health insurers, outlines a series of concerns related to the legislation including a lack of provisions that address underlying health care costs, improve quality of care or ensure a stable risk pool. In addition, AHIP expressed concerns regarding new taxes on health coverage, which will likely increase premiums.

Additional Activities

Obama's Executive Order on Abortion Funding: On Sunday afternoon, prior to the final House vote on health care reform, President Obama agreed to issue an Executive Order that would uphold the ban on federal funding for abortion . In so doing, he secured about a half-dozen votes from anti-abortion Democrats, led by Rep. Bart Stupak (D-MI), who previously opposed the legislation. On Wednesday, President Obama signed the Executive Order banning the government from spending federal money to pay for abortions through plans offered on the insurance exchanges created under the measure.

States Filing Lawsuit to Fight Provision of Health Care Reform Bill: In response to the new health care reform legislation, states across the country have filed lawsuits asking the courts to declare the law unconstitutional and to bar its enforcement. On Monday,Attorneys General in 13 states, led by Florida, filed a joint lawsuit claiming that the new health care reforms violate state government rights in the U.S. Constitution and will force massive new spending on hard-pressed state governments. Joining Florida in the suit are Alabama, Colorado, Idaho, Louisiana, Michigan, Nebraska, Pennsylvania, South Carolina, South Dakota, Texas, Utah and Washington.

At the same time, the Attorney General in Virginia filed a separate suit contending that Congress has exceeded its power in mandating that people buy health insurance. Virginia Attorney General Ken Cuccinelli argues that the new law's requirement clashes with Virginia law that exempts citizens from federal fines imposed for not having health insurance.

Senate Voting to Extend COBRA Until May 5: Senate Democrats plan another short-term extension of unemployment aid this week, setting up a face-off with Republicans, who are vowing to fight the extension if the $10 billion cost isn't offset with spending cuts. The bill, currently set to expire on April 5, would extend a series of emergency programs - including funding for unemployment insurance benefits and COBRA health coverage for the jobless - and would hold off a deep cut in reimbursement rates for doctors who serve Medicare patients. The long-term extension has already passed in both the House and Senate, but the two measures are not expected to be reconciled and sent to the President's desk until after the Easter recess.

President Obama Heads to Iowa to Speak on Health Care: President Obama headed to Iowa on Thursday to increase support for his health care legislation. This was President Obama'sfirst trip out ofWashington since signing health care reform legislation earlier this week. He spoke at the University of Iowa, in the city where he first announced his health care proposal during the Presidential campaign.

Public Opinion

Most Americans Want Republicans to Fight Health Care Reform Bill: In a recent CBS News poll, 62 percent of Americans said they want congressional Republicans to continue challenging the bill, while 33 percent said they should not. Disapproval of the bill has remained steady, with 46 percent saying they disapprove, including 32 percent who "strongly" disapprove. A majority of Americans continue to say that they find the bill to be confusing and do not understand what it means for them or their family.

American's Split on Health Care Reform Passage: In a recent USA Today/Gallup poll, 42 percent of Americans said they were angry or disappointed with the recent passage of health care reform legislation. When asked to reveal party affiliation, 79 percent identified themselves as Republicans.

Polling Shows Support for State Lawsuits Against Government: National polling reveals significant opposition to the individual mandate. In a newly released Rasmussen report , 53 percent of those polled oppose the new mandate requiring every American to buy or obtain health insurance. Further, 49 percent of voters are in favor of their state suing the federal government to fight the mandate. Fifty-one percent say individual states should have the right to opt out of the health care plan entirely.

Looking Ahead

After this week's final health care reform vote, President Obama plans to travel the country in the next few months to discuss the new law. Republicans have begun their own discussions of the law, with an eye towards the November elections.

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Individual Health Insurance Reform Update Easy To Insure ME

2010-03-19T11:28:00.000-07:00

MARCH 19, 2010

This Week in Health Care Reform

This week, President Obama continued traveling outside of Washington to rally support for his health insurance plan. Meanwhile, Democratic leaders increased their efforts to pull together enough votes to push the package through the House of Representatives by week's end. House Speaker Nancy Pelosi (D-CA) needs to accumulate 216 votes to pass both the original Senate bill and the reconciliation bill of "fixes" before the Senate can take up the reconciliation bill next week.

Health Care Reform Negotiations

Democrats' "Deem and Pass" Process: On Monday, the House Budget Committee voted 21-16 in favor of advancing the health care reform legislation toward a final floor vote later in the week. Two Democrats sided with all 14 Republicans on the Committee in voting against the plan.

Meanwhile, the House Rules Committee spent much of the week waiting for the final scoring from the Congressional Budget Office (CBO), which would clear the way for committee members to pass the reconciliation bill. Once the bill is approved, Democrats must wait 72 hours in order to give all lawmakers a chance to review both the original Senate bill and the reconciliation bill.

On Thursday, the CBO released its final cost estimate of the health insurance reform bill. The bill would cost taxpayers $940 billion over 10 years, while trimming the federal deficit by $130 billion in the first 10 years, plus an estimated $1.2 trillion in the second 10 years.

With the November midterm elections looming, House Democrats are weighing multiple options for passing this health care reform legislation. One option Democratic leaders are currently considering would allow the House to " deem" the original Senate health care reform bill passed without actually voting on it. Instead, a so-called "self-executing rule " would deem the Senate's version of health care reform legislation approved so long as House members also vote on the reconciliation package. A vote on final passage is expected on the House floor this Sunday.

Kucinich Changes Vote to Yes on Health Care Reform: On Wednesday, Rep. Dennis Kucinich (D-OH) changed his vote on the health care reform legislation from no to yes, signaling a shift in votes and a chance for Democrats to win over former opponents of the bill. Members of the news media report that President Obama lobbied Rep. Kucinich both privately and publicly to vote in favor of the bill. Rep. Kucinich's decision signals the first Democrat who originally opposed the House legislation in November to change his vote, moving the party closer to the 216 votes needed by this weekend.

Abortion Issue Remains at Forefront of Debate: Rep. Dale Kildee (D-MI) announced on Wednesday that he will support the health care reform legislation and will not oppose it based on the abortion issue. Rep. Kildee, a strong ally of Rep. Bart Stupak (D-MI), says he is satisfied with the provisions in the Senate-passed bill that seek to limit the use of federal money for insurance coverage of abortion. This announcement gave a huge lift to House Democratic leaders, who have been working to assure abortion opponents that a vote for the bill would not reflect any change in policy on abortion.

President Obama Continues to Campaign for Health Care Reform: Throughout the week, the President has been working to garner increased support for health care reform through a variety of public forums. On Monday, President Obama traveled to Strongsville , Ohio, to build support for his health care plan. In his speech, the President cited rising costs, declining insurance coverage and the inability of millions of Americans to pay rising insurance premiums as reasons for overhauling the health care system.

On Wednesdayevening, the President appeared on Fox News to reiterate his stance for necessary and immediate reform. And on Friday , the President heads to the Patriot Center in Fairfax, Virginia, to hold his fourth and final rally on health care reform.

CBO Scoring of Reconciliation Bill: On Thursday, the Congressional Budget Office (CBO) and Joint Committee on Taxation (JCT) released their preliminary scoring of the House reconciliation proposal. Upon release of the legislative language in the proposal, the CBO will need to review that language and refine its estimate accordingly.

The CBO estimates that enacting the Senate and reconciliation bills together would result in a net reduction to the federal deficit of $138 billion over the 2010-19 period. The reconciliation bill itself would add $20 billion of net deficit reduction to the Senate bill's $118 billion net deficit reduction previously estimated by the CBO.

The Congressional Budget Office also estimated that the deficit reduction effect of the Senate and reconciliation bills together for the period 2020-29 would be approximately one-half percent of the GDP. However, the CBO states that this estimate is imprecise and has a great degree of uncertainty.

Public Opinion

Americans Continue to Oppose Reform: Opposition to the health care reform plan is still prevalent in national polling. In a newly released Rasmussen Reports survey , 53 percent of American voters continue to oppose the health care reform plan proposed by President Obama and congressional Democrats. Similar to the numbers last week, 55 percent of those polled believe health care costs will continue to rise, and 52 percent think the quality of care will go down. Further, 57 percent believe passage of the proposal currently working its way through Congress will hurt the economy.

In a recent Wall Street Journal/NBC poll, 48 percent of voters considered the health care reform bill a "bad idea" and 36 percent considered it a "good idea," when given a choice between those two answers. According to the survey, Americans are unhappy with the job Congress is doing, which is evident by their 17 percent approval rating. Further, 50 percent of those polled said they would vote every member of Congress out of office regardless of party affiliation.

Looking Ahead

Sunday's vote is expected to move the House closer to final passage of the two bills. And next week, Senate leaders await their chance to debate the reconciliation bill on the Senate floor.

Health Care Reform March 15 2010

2010-03-16T11:09:00.000-07:00

Week of March 15, 2010

The White House last week continued to rail against rising health insurance premiums to help build popular support for his health care reform package. But the effort to focus the blame for rising costs on insurers was questioned, in particular, by state insurance experts and economists quoted in a New York Times story last week. Insurance commissioners said that trying to hold down premiums before costs were under control would be very risky. This approach could mean solvency issues in some cases, they told the Times. To help educate Americans about the true drivers of rising health care costs, America's Health Insurance Plans, the industry trade association, last week launched a new national ad campaign. The ad demonstrates that health insurance company costs represent a small slice of the overall health care cost pie.

Federal

With a cadre of staff operatives searching for the right health insurance reform provisions among those previously discarded from the House, Senate and the President’s proposals, Democratic leadership has been relentlessly pursuing every possible pathway to pass a final bill. The expected process would have: 1) the House pass the Senate-adopted reform bill (which most House members hate), 2) the House passing a bill to "fix" all the things it hates using a reconciliation legislative vehicle, followed by 3) the Senate passing the very same reconciliation bill -- requiring only 51 votes in the Senate. The House Budget and Rules Committees are expected to start the review, hearing and mark-up process of the reconciliation bill this week. The Senate commitment to using reconciliation was made official in a scathing letter from Leader Harry Reid to the Minority Leader. Along the way the two Chambers will need to see the latest CBO "scores" on the bill before voting, and 216 House Democrats will have to resolve policy disagreements over abortion, federal health insurance rate review and authority, and other substantive issues. Additionally, the House will have to trust that the Senate can pass the reconciliation measure without changing one comma. Partisanship has blossomed into open hostility over health reform. Whether Congress can overcome these policy, process and political mine fields remains as murky as ever, but Democrats have chosen to try and will push for resolution by the Easter recess.

The Senate has passed Jobs Bill II and shipped it off to the House, where passage is not certain. Within the bill are two health-related items of note. First, the COBRA eligibility and subsidy program will be extended to the end of 2010. (These provisions are set to expire at the end of March.) Second, the bill contains a suspension until September 30, 2010 of the cut to physician Medicare reimbursements for the current calendar year. (This provision is also set to expire at the end of March.) Aetna urged Congress to apply the "doc fix" to next year's reimbursement as well, since insurers’ Medicare rates are based on what doctors are paid, but in the end Congress failed to make this change. Aetna and the industry will continue to find ways both to establish a more lasting, if not permanent, doc fix and to devise a legislative solution to the disconnect between doctor reimbursement and Medicare Advantage rates for 2011 and beyond.

States

ARIZONA: Budget issues remain front and center as the governor and Republican leadership proposed a plan they hope will close the $700 million deficit this year and reduce the anticipated $2.6 billion deficit in 2011. Righting the state's fiscal ship has become a very partisan exercise, with the Republicans supporting reductions in Medicaid and KidsCare, and the elimination of full-day kindergarten. As the special session on the budget is running concurrently with the regular session, no other bill hearings were held. The oral chemotherapy parity bill may be dead for this year as proponents did not meet the deadline for submitting amendatory language.

CALIFORNIA: The Assembly Accountability and Administrative Review Committee chaired by Assemblyman Hector De La Torre held a hearing last week to examine how the Department of Managed Health Care (DMHC) and the Department of Insurance (CDI) has handled issues surrounding the rescission of policies in the individual market. According to a report prepared for the committee by Bryan Liang, director of the Institute of Health Law Studies at the California Western School of Law, fewer than 300 of 6,000 former policyholders are participating in health insurers' agreements to settle such cases. Republican committee members were highly critical of this witness, while De La Torre was critical of the Departments. The DMHC reported that since their settlements were completed there have only been nine rescissions over the past two years, proof that the DMHC and the health plans have revamped their processes for rescission and have worked to address the problem.

COLORADO: A bill mandating maternity and contraceptive coverage in individual policies continues to receive significant attention in the Senate. The most recent amendment proposes requiring maternity coverage in at least three of the plans marketed by an insurer. It would also allow a current member of a plan without maternity coverage to switch to a plan with maternity coverage from the same carrier during the first trimester. The other major bill would require that second level appeals be performed by physicians who are actively involved in clinical practice. This measure is counterintuitive in the current economy, since it would result in outsourcing appeals and drive up costs for plan sponsors and their employees.

CONNECTICUT: A proposal that would require health insurance plans to cover oral chemotherapy in the same way that intravenous chemotherapy is covered made it through the legislature's Insurance and Real Estate Committee last week. Currently, many health plans treat the two kinds of cancer treatments differently. Chemotherapy treatments that come in pill form are often categorized as prescription drug benefits that can require patients to pay a larger share of the cost. Cancer patients, doctors and patient advocates spoke in favor of the bill, while insurers and the Connecticut Business and Industry Association opposed it, arguing that it would put a mandate on health plans that could raise costs and make it more difficult for employers to afford insurance.

GEORGIA: A bill restricting the use of rescissions in individual health insurance policies passed a Senate committee last week. Aetna continues to work with its trade organizations to educate legislators about the adverse effect of this type of legislation. Discussions also continue regarding legislation affecting the use of rental networks.

KANSAS: Roughly half way through the legislative session, several health care bills are still moving through the process. On the regulatory front, the Insurance Department has proposed a regulation that would mandate coverage of routine patient care costs while the insured is enrolled in a cancer clinical trial – a mandate that was rejected by the legislature in 2008. A hearing will be held on April 20, and Aetna will have an opportunity to present testimony on this issue. Bills still alive include mandates for autism and orally administered chemotherapy, legislation prohibiting dental contracts that require the dentist to follow a fee schedule for non-covered services, and a ban on "most favored nation" clauses by some insurers. Another bill would allow small employers to create individual HRAs to fund premium payments on individual policies, require administering insurers to offer employees the option of receiving health insurance coverage through a high-deductible health plan with an HSA, and requiring insurers who offer small group health plans to offer high-deductible health plans with HSAs, while authorizing tax deductions for health insurance premiums for individual insurance policies. Separate legislation would amend the definition of "eligible employee" to include part-time workers (currently less than 30 hours per week). Pending legislation concerning hospital charges would prohibit charging private-pay patients more than 25 percent of what the hospital's highest volume private payer would pay for the same goods or services. Legislation that died includes a telemedicine mandate and creation of a health care insurance database for employers.

KENTUCKY: Health issues that are being hotly debated by the legislature right now include an autism mandate, a dental bill that would not allow insurers to hold dentists, optometrists or ophthalmologists to a fee schedule for non-covered services, and a bill setting a reimbursement floor for chiropractic services. The chiropractic services proposal would allow chiropractors to bill, and would require insurers to reimburse, an evaluation and management (E&M) CPT code on each and every visit. In addition to billing for follow-up services for manipulations and other therapies, the chiropractor would be allowed to submit, and the insurer required to pay, for another E&M code on each and every visit. The legislation would also add a new mandated benefit to the Kentucky statutes. Currently, reimbursement for chiropractor visits is required only if the chiropractor performs a service already covered by the health benefit plan. Under the proposal, any service within the scope of practice of a chiropractor that is billed would become a mandated benefit. Finally, the bill would require health benefit plans to provide reimbursement without the chiropractor having to provide any documentation that the services were medically necessary. Each of these bills has, or is expected to, pass at least one chamber.

SOUTH DAKOTA: Several important legislative deadlines are approaching, resulting in a flurry of activity. Bills or resolutions not passed by the second chamber by March 9 died. But the Governor has already signed a bill that amends the premium rate-setting procedure for the high-risk pool so that rates for a given classification are 150 percent of the average actively marketed premium. The pool will have to offer three or more plan designs, remove coverage requirements for the plans (such as disease management) and remove set cost-sharing values. The bill was signed by the Governor on March 1 and will become effective on July 1, 2010. The Governor has also signed a bill prohibiting rating based on injuries caused by domestic violence and legislation requiring refunds of premiums for partial months, in the case of mid-month cancellations. Both chambers have passed legislation prohibiting contract language requiring dentists to accept a fee schedule for non-covered services, and the bill awaits the Governor's signature. Finally, the legislature passed a resolution opposing the federal health care reform proposals passed in the U.S. Senate and House.

The Week in Health Reform

2010-03-16T10:25:00.000-07:00

The Week in Health Reform—Federal Legislative Overview

The White House
On March 3, President Obama continued his push for Members of Congress to complete health insurance reform legislation within the upcoming weeks. He delivered a statement to a group of medical professionals in the East Room of the White House, in which he said that he has asked Senate and House leaders to finish work on health reform and schedule final votes in the next few weeks. The President went on to say that the issues have been debated thoroughly and that now is the time to make a decision. Although he did not specifically mention the budget reconciliation process, the President said that the American people deserve an “up or down” vote on health reform in the same way that welfare reform and tax cuts were approved by Congress in the past under reconciliation rules.

The President said that health insurance reform would change three things:

* End the “worst practices” of health insurance companies
* Give individuals and small businesses the same kind of choices members of Congress have
* Bring down health care costs for families, businesses and the government

The President made numerous references to the health insurance industry and stated that there is a fundamental disagreement between Republicans and Democrats about whether there should be more or less regulation of health insurance companies. The President concluded by emphasizing that he will do everything in his power to make the case for health reform in the coming weeks, and he also urged the American people to make their voices heard.

In addition, the President said he is open to exploring policy priorities identified by Republicans at the bipartisan summit such as:

* Conducting undercover investigations of health care providers that receive reimbursement from federal programs.
* Appropriating funds for state-based demonstration programs to test alternative approaches, including health courts, to resolving medical malpractice suits.
* Linking Medicaid eligibility expansions to higher Medicaid reimbursement for physicians.

* Clarifying that Health Savings Accounts (HSAs) may be offered through the proposed health insurance exchanges.

On March 4, Health Care Service Corporation President and CEO Pat Hemingway Hall attended a meeting at the White House, along with CEOs from other leading health insurance companies and officials from the National Association of Insurance Commissioners. The group met with Health and Human Services Secretary Kathleen Sebelius and President Obama to discuss premium issues in the individual market.

House and Senate
Congressional leaders are now focused intensely on developing legislative language that could be supported by a majority of members in both chambers. The President’s comments last week send a strong signal that such legislation, once finalized, would move through Congress under budget reconciliation procedures.

Under reconciliation rules, the House first would have to pass the Senate version of the health care reform bill, H.R. 3590, which passed on Christmas Eve last year. After that, the House would then be required to pass a separate “corrections” bill incorporating specific changes to that bill that will likely be negotiated among White House officials and House and Senate leaders. After the House passes the “corrections” bill, under budget reconciliation procedures, the Senate would need at least 50 senators to vote for the “corrections” bill. Under reconciliation rules, only a simple-majority vote of 51 votes are needed for passage (Vice President Joe Biden would be the 51st vote if only 50 senators vote for the bill) and filibusters are banned.

In order to meet the goal of sending a final health reform bill to the President’s desk before the Easter recess (which is scheduled to begin on March 29), congressional leaders would need to send legislative language to the Congressional Budget Office (CBO) for cost analysis in the very near future. On March 4, White House Press Secretary Robert Gibbs said that President Obama hopes the House of Representatives will pass the health reform bill by March 18, so the rest of the process can move swiftly.
Speaker Nancy Pelosi (D-CA) is now tasked with trying to corral votes in the House, while trying to assure those who are wary that the Senate will be willing to support the same measures. Some House members are worried about being left “holding the bag,” if the Senate decides it will not support some of the same legislative language.

In order to ensure the Democrats have enough votes, President Obama invited two groups of the Democratic Caucus to the White House on March 4 to continue to push for health reform passage. Members from the Congressional Progressive Caucus were:
Caucus Chairs Raúl Grijalva (AZ) and Lynn Woolsey (CA), Congressional Asian Pacific American Caucus Chairman Mike Honda (CA), Congressional Black Caucus Chairwoman Barbara Lee (CA), Congressional Hispanic Caucus Chairwoman Nydia Velázquez (NY), Reps. Dennis Kucinich (OH), Lucille Roybal-Allard (CA) and Jan Schakowsky (IL), as well as delegates Madeleine Bordallo (Guam) and Donna Christensen (Virgin Islands).

Afterward, Obama met with key members of the New Democrat Coalition. The New Democrats, like the Blue Dogs, are a group of fiscally conservative Democrats. Attendees of this meeting included: Reps. Jason Altmire (PA), Melissa Bean (IL), Lois Capps (CA), Joe Crowley (NY), Ron Kind (WI), Allyson Schwartz (PA) and Adam Smith (WA).

Overview: Extension of Physician Payment “Fix” and COBRA Provisions
On March 2, the Senate passed H.R. 4691, the “Temporary Extensions Act of 2010” and President Obama signed it into law. This legislation includes a one-month extension of the Medicare physician payment “fix,” premium assistance for unemployed workers with COBRA and state continuation coverage, unemployment insurance and several other legislative provisions that expired on February 28. Before voting on passage of the bill, the Senate first voted on an amendment by Senator Jim Bunning (R-KY) that would have offset the $10 billion cost of the “extenders” package. This amendment was defeated and therefore no further legislative action was needed. The bill was later signed by the President.

Overview: The “Health Insurance Industry Fair Competition Act” – H.R. 4626
In a letter dated March 3, 22 Democratic Senators wrote to Majority Leader Harry Reid (D-NV) urging him to bring H.R. 4626, the “Health Insurance Industry Fair Competition Act, to the Senate floor at its earliest opportunity. In the letter they state that “[this legislation] is an important step toward bringing competition to the health insurance market, and would ensure that anticompetitive abuses such as price fixing and monopolization are policed in the health insurance industry.” America’s Health Insurance Plans (AHIP) CEO Karen Ignagni maintains the position on the legislation saying, “The rhetoric surrounding repeal [anti-trust exemptions] does not match the reality of the situation. Health insurance is one of the most regulated industries in America at both the federal and the state levels. The Act is extremely limited in scope and has nothing to do with competition within the health insurance industry. In fact, a wide range of insurer activities, including mergers and many types of business practices, are and always have been subject to federal antitrust laws and to enforcement by the Department of Justice.”

This Week in Health Insurance Reform Easy To Insure ME

2010-03-05T12:23:00.000-08:00

MARCH 5, 2010

This Week in Health Insurance Reform

This week, President Barack Obama continued to pressure lawmakers to pass a final health insurance reform bill, calling for its passage through reconciliation, a process which only requires the support of a simple majority. Republicans continued to oppose the President's proposal , vowing to fight the expedited reconciliation process, while House Democratic leaders began intense internal discussions to rein in the needed votes.

Health Care Reform Negotiations

Health Care Summit Ends in Stalemate: Last Thursday , President Obama and congressional leaders spent nearly seven hours debating how to overhaul the U.S. health care system. Republicans argued against this new proposal, labeling it a government takeover and suggesting a more incremental approach. The philosophical differences between the parties were evident throughout the summit and remained unchanged at day's end. As predicted, no new agreement was reached, and Democratic leaders left the meeting determined to press forward with or without bipartisan support.

Tensions Increase Between the President and Congressional Republicans: After last week's health care reform summit, which displayed deep rifts between both Democrats and Republicans, the President sent a letter Tuesday to Congressional leaders. In the letter, the President offered to incorporate a handful of Republican ideas into his bill, including: the expansion of health savings accounts; increases to Medicaid reimbursements to doctors; the implementation of undercover investigations to combat fraud in the Medicare system, and increases in funding for grants to states to explore alternatives to resolve medical malpractice lawsuits.

Republicans rejected his proposal, calling his bill "unsalvageable," and asked him to listen to the American people and start the process from scratch.

President Obama Calls for Passage through Reconciliation: On Wednesday, the President stepped up the pressure, urging lawmakers to finish work on health care reform legislation. He encouraged them to ignore the politics of the issue, saying, "I do not know how this plays politically, but I know it's right."

Additionally, the President expressed his support for using the reconciliation process to prevent a Republican filibuster. The process would involve legislators in the Senate working with House members to develop a reconciliation package. This package of "fixes" would only require a simple majority vote in the Senate, as opposed to the 60 votes usually required to pass legislation. Democrats can no longer rely on the normally required 60 votes to pass the bill , due to the election last fall of Republican Senator Scott Brown.

Republicans continued to express strong opposition for the reconciliation tactic, saying that it was never intended for such important legislation; it raises the specter of unlimited amendments and challenges to the bill's provisions.

Democrats Work to Shore Up Votes: Democrats continued to work behind closed doors to garner enough votes to pass the Senate bill before the congressional Easter recess, which begins March 29, a deadline set by the President. A number of issues continue to present challenges for Democratic leaders, including Medicaid funding, immigration and abortion funding.

Abortion Issue Looms over Health Care Reform Bill: As final legislation begins to take shape, the debate around the use of federal funds for abortions continues to draw rancor from both sides of the issue.Currently, the new legislative package contains less restrictive language on federal funding of abortion, which diverges from the language included in the version passed by the House last fall. Rep. Bart Stupak (D-MI), a leader among anti-abortion Democrats, has intimated that this new language could cost House Speaker Nancy Pelosi (D-CA) the 10 to12 votes that she needs to pass the bill. On the other side, supporters of abortion rights fear the inclusion of more restrictive language.

Additional Activities

Jobs Bill Extends COBRA Coverage and Medicare Payments: This week, both the House and Senate passed bills giving unemployed Americans another month of health care coverage through COBRA and protecting physicians from a looming 21 percent cut in Medicare fees. This measure will now go to President Obama, as debate begins on a much broader bill that would extend the safety net programs through the end of the year.

House Energy and Commerce Committee Expands Investigation into Rate Increases: After recently examining the rate increases proposed by Anthem Blue Cross in California, House legislators signaled their intention to expand the investigation by summoning the chief executives of the nation's four largest for-profit health insurance companies to testify before the committee on the topic of preexisting conditions. The top executives at WellPoint, UnitedHealth Group, Humana and Aetna have been invited to appear before the Subcommittee on Oversight and Investigations on March 23.

White House Meeting with Insurers: On Thursday, five health plan CEOs and representatives of the National Association of Insurance Commissioners met with Health and Human Services Secretary Kathleen Sebelius at the White House to discuss insurance premium increases and rising health care costs. The President also stopped by the meeting.

Public Opinion

Americans Support Incremental Steps to Reform: In a newly released Rasmussen Reports survey , 52 percent of American voters continue to oppose the health care plan proposed by President Obama and congressional Democrats. Further, 63 percent of those polled believe that passing smaller, more targeted bills is a better strategy for achieving health care reform. In addition, just over half think that health care costs will rise if the current plan passes into law. Only 17 percent are convinced that the plan will decrease health care costs.

Editorials Point to Failed Massachusetts Health Care Experiment: Also this week, both the Wall Street Journal and Boston Herald featured opinion pieces pointing to the high costs of health care in Massachusetts, which passed its own version of universal care in 2006. Talk radio host Michael Graham in the Boston Herald pointed out that the Massachusetts plan is already $47 million over budget this year, saying, "It's killing us on costs: Average Massachusetts premiums are the highest in the nation and rising. We also spend 27 percent more on health care services, per capita, than the national average."

Looking Ahead

The next major step will be for Senators to send the reconciliation bill to the Congressional Budget Office (CBO) for a cost estimate, which could take days or even weeks to finalize. As Democratic leaders continue to lock down a strategy on the process, timing and substance of the bill, President Obama plans to travel to Philadelphia and St. Louis next week to discuss the importance of the bill's passage. www.easytoinsureme.com

Health Insurance Reforms Easy To Insure ME health insurance quotes

2010-02-26T12:27:00.000-08:00

President Obama's Health Insurance Bill

President Obama Releases New Health Care Proposal in Time for Health Summit: On Monday February 22, 2010, White House officials unveiled a new health insurance reform overhaul that builds on the Senate version passed last Christmas Eve, with some changes aimed at pleasing House Democrats who had concerns with the Senate bill. The President's proposal does not include the public option, despite the hopes of Senate Democrats, due to White House concerns that the provision will hinder passage in the Senate. President Obama ignored requests by Republicans to scratch the Democratic plan and start over. As such, Republican leaders questioned Democratic motives and labeled the bill as a massive government takeover of America's health care system.

Republicans Insist House Democrats Don't Have the Votes to Pass Legislation: Minority Whip Eric Cantor (R-VA) announced on Wednesday that Democrats don't have the necessary votes to pass the President's proposal in the House because of three new House vacancies and lagging support among some moderate Democrats. At issue for some Democrats are weaker abortion provisions in the President's proposal as well as the ongoing controversy over passing a bill by a simple majority, a process known as reconciliation.

Health Care Summit Preview

On Thursday, the President's Health Care Summit began at 10:00 a.m. with opening comments from the President, followed by remarks from both Republicans and Democrats. The discussion centered on four themes: controlling health care costs, overhauling the insurance market, reducing the deficit and expanding insurance coverage. Prior to Thursday, several top Republicans and some Democrats stated that expectations were extremely low for the Summit's success.

House Republicans arrived armed with their own version of a health care bill that encourages small businesses to join together to buy insurance, gives federal money to states to run high-risk pools for those unable to obtain private insurance and limits damages in medical malpractice lawsuits. The Republican plan would cost $61 billion and cover three million people over ten years. In contrast, President Obama contends his plan would cost $950 billion and cover 30 million people over the same time period. However, officials at the Congressional Budget Office (CBO) indicated they would not be able to officially score the President's proposal with just a summary - that legislative language is needed.

Note: A full summary of the results from the Health Care Summit will be included in next week's newsletter

Additional Activities

WellPoint Executives Defend Premium Increases: On Wednesday, the House Energy and Commerce Subcommittee on Oversight and Investigations held a hearing to examine the proposed health insurance premium increases by Anthem Blue Cross in California. Anthem, a WellPoint subsidiary, recently informed subscribers in California that premiums for individual insurance policies would be raised an average of 25 percent, with some rates going up as much as 39 percent. Angela Braly, president of WellPoint , said the premium increases were justified by soaring medical costs, and that pending legislation could make the problem worse, driving up costs further for young, healthy people.

"Raising our premiums was not something we wanted to do," Ms. Braly said . "But we believe this was the most prudent choice, given the rising cost of care and the problems caused by many younger and healthier policyholders dropping or reducing their coverage during tough economic times. By law, premiums must be reasonable in relationship to benefits provided, which means they need to reflect the known and anticipated costs they will cover."

In Sacramento , Leslie Margolin, president of Anthem Blue Cross in California, also testified before lawmakers, joined by vice president and general manager James Oatman. The focus of that hearing was also the proposed premium increase for California members in the individual market, with company executives pointing to the current economic climate and rising health care costs as reasons for the rate hikes.

U.S. House of Representatives Repeals Antitrust Exemption from Health Insurance Companies: On Wednesday, the House of Representatives voted 406-19 in favor of repealing a 65-year-old antitrust exemption from health insurance companies. Democrats said the repeal would lead to increased scrutiny of the industry. Yet, the non-partisan Congressional Budget Office said last year that repealing the exemption would not significantly reduce premiums because states already investigate health insurance companies.

In addition, industry executives pointed out that legislation could further hinder competition and the ability to share information to improve health care quality. "Health insurance is one of the most regulated industries in America at both the federal and the state levels," said Karen Ignani, president and chief executive of America's Health Insurance Plans (AHIP). "The real focus should be on addressing the rising cost of medical care, which is putting an unsustainable burden on families, employers and the federal budget," she said.

Public Opinion

Polling Suggest Health Care Reform is Still Key to Economic Recovery: Recent polling on health care reform shows mixed reaction among the public over the proposed legislation. According to a recent CNN poll, 48 percent of those questioned said lawmakers should work on an entirely new bill and 25 percent felt that Congress should stop work on health care reform altogether.

According to the monthly poll from the nonpartisan Robert Wood Johnson Foundation, 75 percent of Americans still think it's important that Obama include health care reform in addressing the nation's economic crisis, while many still harbor doubts about the legislation.

When asked how health care legislation relates to their economic situation:

* Nearly 31 percent said they thought the Democratic bills would make their personal financial situation worse, compared with 10 percent who said it would improve their family budgets.
* Forty-two percent said the nation's fiscal condition would suffer because of the legislation, compared with 26 percent who said it would get better.
* Americans were divided on whether the Democrats' approach would improve overall access to health care around the country, with 35 percent saying it would and nearly that many disagreeing.

Health Insurance Coverage Varies Widely Based on Age: Coming just before the President's Summit on Health Care Reform, a newly released Gallup Poll reinforces the wide degree of variability in health insurance coverage across U.S. population segments, especially when it comes to age. Eighty-four percent of 18-year-olds have health insurance, most likely because they are still covered under their parents' policies. By age 22, health insurance coverage reaches its lowest point, with just 66 percent maintaining coverage. From age 22 on, the percentage of Americans with health insurance begins to climb, albeit slowly, reaching the 95 percent level at age 65 when Medicare becomes an option.

Looking Ahead

Legislators need to determine next steps for health care legislation coming out of the President's Health Care Reform Summit. On Wednesday, Department of Health and Human Services Secretary Kathleen Sebelius invited executives from the top five insurance companies to meet at HHS to discuss their companies' insurance premiums.

Health Insurance Reform Weekly Easy To Insure ME health insurance quotes

2010-02-25T13:34:00.000-08:00

February 17, 2010

The Week in Individual Health Insurance Reform--Federal Legislative Overview

House and Senate
Things were quiet last week in Washington due to the 30 plus inches of snow the area received. On Feb. 9 House leaders announced that due to the heavy snow in the area they would suspend votes in the House for the remainder of the week. Congress will not be in session this week due to the President's Day recess and will reconvene the week of Feb. 22.

As a result of the congressional schedule, the timeframe for a floor vote on the McCarran-Ferguson antitrust legislation will be pushed back until the week of Feb. 22 at the earliest. Reports have stated that the antitrust bill is part of House Speaker Nancy Pelosi's (D-CA) strategy of moving smaller pieces of health insurance legislation quickly to help build momentum for a comprehensive health care reform bill. The Speaker also continues to urge House Democrats to pass the Senate bill as long as it is accompanied by a separate "reconciliation" bill that would “fix” key provisions in the Senate bill (e.g., raising the threshold for the Cadillac tax and dropping the Nebraska Medicaid provisions) to satisfy some members of her caucus.

The Senate remained in session last week, despite the weather, although Majority Leader Harry Reid (D-NV) stated that the Senate would not conduct any votes. On Feb. 11, Finance Committee Chairman Max Baucus (D-MT) and Ranking Member Charles Grassley (R-IA) released the highly anticipated “jobs bill” – The Hiring Incentives to Restore Employment (HIRE) Act.

Senators Baucus and Grassley issued a joint statement, emphasizing that this bill was drafted with bipartisan input. They further stated: “We also agree that, once properly reviewed, the package should be considered in a deliberate, but expeditious manner. Any efforts to needlessly delay Senate completion of consideration of this package through partisan means will undermine our goal of timely action in the current economic climate. Action on the expired provisions is long overdue. Timely action on incentives for economic activity and job creation also is needed.”
Hours after details of the “HIRE” legislation were released, Majority Leader Reid publicly stated that he was scrapping the bill. Reid told reporters that when the Senate returns from its recess on Feb. 22, “we will move to a smaller package than has been talked about in the press.” Reid went on to state that some of the tax provisions included in the legislation – key to garnering Republican support for the deal – “confuse” the bill. Reid went on to say that, “we don’t have a jobs bill. We have a jobs agenda.”

The draft “HIRE” legislation addresses a number of key health care issues:

* The bill extends, by three months, the eligibility period for premium subsidies for state continuation coverage and COBRA continuation coverage to include persons who are unemployed on or before May 31, 2010. The bill also clarifies that these subsidies are available to persons who are involuntarily terminated from their jobs after previously losing their employer-sponsored coverage due to a reduction in hours. The premium subsidies originally were enacted as part of the American Recovery and Reinvestment Act of 2009, also known as the “stimulus bill.”

* The bill provides for a seven-month Medicare physician payment fix (sometimes known as the “doc-fix”), maintaining physician payment rates at their current levels through Sept. 30, 2010. Under current law, in the absence of congressional action, physicians are scheduled to face a steep rate reduction on March 1.

* The bill provides for a one-year extension of both Medicare Advantage Special Needs Plans (section 626) and Medicare Cost Plans (section 627).

* The bill includes numerous provisions addressing Medicare fee-for-service reimbursement issues.
White House Health Care Reform Summit
In a pre-Super Bowl interview on CBS, President Obama said that he would like to host a televised health care summit with Republican and Democratic congressional leaders on Feb. 25. While specific details are not yet available, the summit represents the Obama Administration’s latest strategy to jumpstart the health care reform debate and seeks bipartisan cooperation following the loss of the Democrats’ supermajority in the Senate. Republican leaders expressed interest in the summit, and House Republican Leader John Boehner (OH) issued a statement saying that, "The best way to start on real, bipartisan reform would be to scrap those bills and focus on the kind of step-by-step improvements that will lower health care costs and expand access." In response, White House officials insisted that the President is not interested in starting from scratch on health reform.

This week Democratic and Republican congressional leaders also met with President Obama at the White House to discuss the jobs bill, health reform, energy, trade and other legislative priorities.

Following the meeting, the President spoke with reporters and he made the following comments about health reform: “I'm going to be starting from scratch in the sense that I will be open to any ideas that help promote these goals. What I will not do, what I don't think makes sense and I don't think the American people want to see, would be another year of partisan wrangling around these issues; another six months or eight months or nine months worth of hearings in every single committee in the House and the Senate in which there's a lot of posturing. Let's get the relevant parties together; let's put the best ideas on the table. My hope is that we can find enough overlap that we can say this is the right way to move forward, even if I don't get every single thing that I want.

Health Insurance Reforms from Easy To Insure ME health insurance quotes

2010-02-22T08:52:00.000-08:00

FEBRUARY 19, 2010

This Week in Health Insurance Reform

Although lawmakers left Washington this week for the President's Day recess, debate continued to amplify around the upcoming Health Care Summit. The Summit, scheduled for February 25th in Washington, D.C., is considered by members of the news media to be President Barack Obama's best attempt to salvage his health care reform agenda. Some Republicans view the Summit as political theater and a political trap for the GOP. White House officials insist, however, that the Summit is meant to find solutions to issues like soaring insurance premiums.

Health Insurance Reform Negotiations

President Obama Extends Invites to Health Summit, Lays Out Agenda: Last Friday, White House officials extended invitations to 21 lawmakers - Republicans and Democrats alike - to participate in the Health Care Summit. The list included the top leaders in the House and Senate, as well as the committees with jurisdiction over health legislation. In addition, the top four leaders of the House and Senate were each given the opportunity to invite four other lawmakers to the Summit. The meeting will ultimately be comprised of 20 Democrats and 17 Republicans.

Officials from the White House Office of Management and Budget, the Congressional Budget Office and the Joint Committee on Taxation have also been invited. President Obama did not invite House or Senate Budget Committee leaders, though, including Senate Budget Committee Chairman Kent Conrad (D-ND) and Ranking Member Judd Gregg (R-NH).

The invitation outlines the format of the event as follows:

* President Obama will offer opening remarks.
* A leading Republican lawmaker and a leading Democratic lawmaker will each comment.
* The President will then moderate a dialogue on: insurance reforms; cost containment; expanding coverage; and the impact of health legislation on the deficit.

Prior to the Summit, President Obama has asked House and Senate Democrats to resolve the differences between their bills and produce a final proposal. However, House Democrats said Thursday that a single plan might not be ready in time. President Obama also challenged Republicans to present a comprehensive reform package at the Summit. The President pledged to post the Democratic plan online before the 25th of this month. Members of the news media suggested that President Obama may also make his own health care reform proposal available.

Republicans Demand Halt on Compromise Bill: Last Friday, House Republican leaders sent a letter to Senate Majority Leader Harry Reid (D-NV) and House Speaker Nancy Pelosi (D-CA) in reaction to the Administration's request that Congressional Democrats merge the House and Senate bills as a starting point for negotiations. In the letter, House Republican leaders asserted that merging the bills would amount to a "backroom deal among the White House and Democratic leaders" and would undermine negotiations at the bipartisan Summit. The Republicans continue to demand that Democrats scrap the current proposals and start over.

Senate Democrats Ask for Public Option: Sixteen Democratic Senators, including Michael Bennet (D-CO), Sherrod Brown (D-OH), Jeff Merkley (D-OR) and Kirsten Gillibrand (D-NY) sent a letter on Tuesday to Senate Majority Leader Harry Reid asking him to bring the public option back up for a vote, while also making the case for using a process called reconciliation as a way to move the legislation forward. The Senators support this approach, citing the following reasons:

*
Cost savings achieved by including the public option
* Continued public support for the public option (citing a December 2009 New York Times/CBS poll which showed that 59 percent of Americans supported the public option)
*
Need for increased competition in the insurance market, and
*
Senate history of using the reconciliation process for health care reform

Democratic leaders have thus far resisted using reconciliation to bypass a Republican filibuster because it would appear too partisan (given that it only requires a simple majority of 51 votes in the Senate).

Additional Activities

Anthem Blue Cross Delays Rate Increase: On Saturday, Anthem Blue Cross in California agreed to postpone its rate increase from March 1 until May 1, 2010. This decision was made at the request of the California Insurance Commissioner in order to engage a third-party actuary to review the filing. This extra time will allow outside experts to review the complex and detailed data around the medical costs the company expects to incur. In response to criticisms, Anthem Blue Cross' parent company, WellPoint, Inc., held a press conference Thursday morning to address concerns and answer questions.

As the focus on insurance costs intensifies, Health and Human Services Secretary Kathleen Sebelius also held a news conference Thursday to discuss a new government report on rising insurance premiums across the country. She cited examples from Washington State to Maine in which insurers have sought premium increases for those buying coverage individually. Speaking on behalf of the industry, Robert Zirkelbach, a spokesperson for America's Health Insurance Plans, said that "the focus needs to be on the underlying increase in health care costs."

New Study - Excise Tax Will Fall Equally on Union and Nonunion Members: A new analysis regarding the controversial proposed tax on high-cost health insurance plans shows that the impact of the tax will fall equally on union and nonunion plans. The tax is a central component to the bill passed by the Senate in late December. The analysis was completed by Ken Jacobs, of the University of California at Berkeley Labor Center, and William H. Dow, professor of health economics at Berkeley and a member of President George W. Bush's Council of Economic Advisers.

State-By-State Approach Builds Steam: With the national-level debate on health care reform stalled until the Summit, the argument to leave health care reform to the states has built momentum over the past week. Proponents of a state-by-state approach, including Missouri State Senator Charlie Shields (R), believe that a national health care reform effort would ignore local variations in health care markets and politics. To this end, lawmakers in states including Colorado , California and Virginia have recently taken steps to develop their own reform legislation. In contrast, supporters of the national approach counter that states would not be able to implement substantial reform (given that they are currently cash-strapped and not in a position to launch new initiatives).

Tauzin Steps Down from PhRMA Head: Late last week, former Republican Louisiana Congressman Billy Tauzin announced plans to step down as head of the pharmaceutical industry's trade association, PhRMA, at the end of June. Mr. Tauzin helped to negotiate the $80 billion deal between drug makers and President Obama as part of the Administration's plan for health care reform. Members of the news media report that some of PhRMA's board members were concerned that more liberal House members will try to force the industry to commit to more deals. Some also felt that Mr. Tauzin conceded too much in the negotiating process, including spending up to $100 million on pro-reform advertising.

Public Opinion

Polling Suggests Americans Want to Start Over: The most recent polling suggests that while Americans want Congress to keep moving on health care reform, a majority think lawmakers should not rush through legislation.

A new Zogby International/University of Texas Health Science Center poll finds that 57 percent of respondents agree with the statement that lawmakers should start from scratch. When presented with a choice of approach:

*
Nearly 44 percent say Congress should start over.
*
Just over 25 percent say Congress should pass some sort of legislation and fix it later.
*
Only about 18 percent believe the House should pass the Senate bill alongside other legislation.

Another poll released by Franklin & Marshall College finds that while approximately 75 percent of Americans want health care reform, a majority of respondents (four out of five) are happy with their current health care. Only one in five says that the current system does not meet their personal needs. Further, the latest Quinnipiac University poll released last week shows that American voters still disapprove (54 - 35 percent) of President Obama's health care reform plan, but say (52 - 44 percent) they want Congress and the President to continue their efforts to reform the system.

In addition, a New York Times/CBS poll released this month shows that only 13 percent of Americans believe health care reform is the most important issue facing the nation. Rather, jobs and the economy topped their priority list. The study also finds that 56 percent prefer "smaller government, providing fewer services."

Looking Ahead

Both House and Senate lawmakers will return to Washington next Monday as Republicans and Democrats hash out their strategy for Thursday's upcoming Health Care Summit.

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Health Insurance Reform Weekly from EasyToInsureME health insurance

2010-02-18T13:15:00.000-08:00

February 17, 2010

The Week in Health Reform--Federal Legislative Overview

House and Senate
Things were quiet last week in Washington due to the 30 plus inches of snow the area received. On Feb. 9 House leaders announced that due to the heavy snow in the area they would suspend votes in the House for the remainder of the week. Congress will not be in session this week due to the President's Day recess and will reconvene the week of Feb. 22.

As a result of the congressional schedule, the timeframe for a floor vote on the McCarran-Ferguson antitrust legislation will be pushed back until the week of Feb. 22 at the earliest. Reports have stated that the antitrust bill is part of House Speaker Nancy Pelosi's (D-CA) strategy of moving smaller pieces of health insurance legislation quickly to help build momentum for a comprehensive individual health insurance reform bill. The Speaker also continues to urge House Democrats to pass the Senate bill as long as it is accompanied by a separate "reconciliation" bill that would “fix” key provisions in the Senate bill (e.g., raising the threshold for the Cadillac tax and dropping the Nebraska Medicaid provisions) to satisfy some members of her caucus.

The Senate remained in session last week, despite the weather, although Majority Leader Harry Reid (D-NV) stated that the Senate would not conduct any votes. On Feb. 11, Finance Committee Chairman Max Baucus (D-MT) and Ranking Member Charles Grassley (R-IA) released the highly anticipated “jobs bill” – The Hiring Incentives to Restore Employment (HIRE) Act.

Senators Baucus and Grassley issued a joint statement, emphasizing that this bill was drafted with bipartisan input. They further stated: “We also agree that, once properly reviewed, the package should be considered in a deliberate, but expeditious manner. Any efforts to needlessly delay Senate completion of consideration of this package through partisan means will undermine our goal of timely action in the current economic climate. Action on the expired provisions is long overdue. Timely action on incentives for economic activity and job creation also is needed.”
Hours after details of the “HIRE” legislation were released, Majority Leader Reid publicly stated that he was scrapping the bill. Reid told reporters that when the Senate returns from its recess on Feb. 22, “we will move to a smaller package than has been talked about in the press.” Reid went on to state that some of the tax provisions included in the legislation – key to garnering Republican support for the deal – “confuse” the bill. Reid went on to say that, “we don’t have a jobs bill. We have a jobs agenda.”

The draft “HIRE” legislation addresses a number of key health care issues:

* The bill extends, by three months, the eligibility period for premium subsidies for state continuation coverage and COBRA continuation coverage to include persons who are unemployed on or before May 31, 2010. The bill also clarifies that these subsidies are available to persons who are involuntarily terminated from their jobs after previously losing their employer-sponsored coverage due to a reduction in hours. The premium subsidies originally were enacted as part of the American Recovery and Reinvestment Act of 2009, also known as the “stimulus bill.”

* The bill provides for a seven-month Medicare physician payment fix (sometimes known as the “doc-fix”), maintaining physician payment rates at their current levels through Sept. 30, 2010. Under current law, in the absence of congressional action, physicians are scheduled to face a steep rate reduction on March 1.

* The bill provides for a one-year extension of both Medicare Advantage Special Needs Plans (section 626) and Medicare Cost Plans (section 627).

* The bill includes numerous provisions addressing Medicare fee-for-service reimbursement issues.

White House Health Care Reform Summit
In a pre-Super Bowl interview on CBS, President Obama said that he would like to host a televised health care summit with Republican and Democratic congressional leaders on Feb. 25. While specific details are not yet available, the summit represents the Obama Administration’s latest strategy to jumpstart the health care reform debate and seeks bipartisan cooperation following the loss of the Democrats’ supermajority in the Senate. Republican leaders expressed interest in the summit, and House Republican Leader John Boehner (OH) issued a statement saying that, "The best way to start on real, bipartisan reform would be to scrap those bills and focus on the kind of step-by-step improvements that will lower health care costs and expand access." In response, White House officials insisted that the President is not interested in starting from scratch on health reform.

This week Democratic and Republican congressional leaders also met with President Obama at the White House to discuss the jobs bill, health reform, energy, trade and other legislative priorities.

Following the meeting, the President spoke with reporters and he made the following comments about health reform: “I'm going to be starting from scratch in the sense that I will be open to any ideas that help promote these goals. What I will not do, what I don't think makes sense and I don't think the American people want to see, would be another year of partisan wrangling around these issues; another six months or eight months or nine months worth of hearings in every single committee in the House and the Senate in which there's a lot of posturing. Let's get the relevant parties together; let's put the best ideas on the table. My hope is that we can find enough overlap that we can say this is the right way to move forward, even if I don't get every single thing that I want.”

Health Insurance Reform from EasyToInsureME health insurance quotes

2010-02-17T08:19:00.000-08:00

Federal

Owing to multiple blizzards in Washington, Congress started its President's Day recess a full week early and conducted no official business last week. However, there was some legislative drama as Senate Majority Leader Harry Reid pulled the rug out from under Finance Committee Chairman Max Baucus by scrapping the Baucus jobs bill (without warning), which contained many health insurance items, and replacing it with a stripped down, narrow jobs bill. Whether the health items Baucus originally inserted with Republican help will make it back to the table remains fuzzy. Among the health items that have been dropped are: the COBRA eligibility extension (to May 31); the “doc fix” (to October, 2010) of Medicare reimbursement rates; and the favorable statutory direction to CMS to calculate the 2011 Medicare Advantage rates "as if" the doc fix were in place.

States

California health insurance The Office of Patient Advocacy released a report card on the state’s HMOs last week. Aetna received 3 out of 4 stars. The goal of the report card is to allow consumers to compare how well health plans use personal medical records and help address conditions such as asthma, arthritis and diabetes.

COLORADO: Governor Bill Ritter held a press conference to announce what he calls "the next round of reforms that represent common sense." His legislative package includes bills to preclude insurance companies from charging different rates due to a person's gender, ensure that women have access to breast cancer screening, assure plain language is used in insurance forms, standardize insurance applications and explanations of benefits, and encourage greater use of online tools to enroll people in public programs. Apart from the Governor's proposals, a bill that would establish a public option was also introduced.

CONNECTICUT: In a short legislative session of only three months, the Insurance & Real Estate Committee wasted no time in putting forth an agenda that includes many concept drafts for repeat legislation from previous sessions. These include prohibiting health insurance copayments for preventive care, limiting prescription drug copayments, prohibiting Social Security disability payment offsets, and exempting the Municipal Employees Health Insurance Plans from the premium tax on small group premiums. In addition, the committee reintroduced legislation that includes nearly a dozen new health benefit mandates. The Council for Affordable Health Insurance, an independent think-tank, says that health insurance mandates could increase premiums in Connecticut by more than 50 percent overall.

GEORGIA: A bill was proposed last week that would impose significant restrictions on insurers' ability to rescind health insurance policies. Aetna, through the Georgia Association of Health Plans and AHIP, met with the legislator sponsoring the bill to express concerns with the bill.

INDIANA: The legislative session is at halftime, and the insurance agenda is now limited. Most insurance issue bills are officially dead, including a bill that would have prohibited health plan provisions requiring a contracted provider to accept more than a certain number of patients; coverage for dialysis treatment regardless of whether the facility is contracted or not and without certain benefit restrictions; and a bill that would have allowed out-of-network assignment of benefits. However, Aetna is expecting that a bill requiring insurer and HMO annual reporting of premium cost composition, including administrative costs, may be resurrected. A bill that restricts dental insurers and HMOs from establishing fee schedules for non-covered services passed the Senate, with our amendment to accommodate most of the key concerns expressed by opponents of the bill. As the bill stands, dental insurance plans may impose fee schedules for covered services, regardless of whether the plan actually pays for the services rendered.

KANSAS: An amended version of S.B. 389 related to dental services passed the Senate Financial Institutions and Insurance Committee on February 11. The amended bill prohibits any contract between a health insurer that offers a health benefit plan and a dentist from containing a provision that requires the dentist to accept a fee schedule for services unless the service is a covered service. Committee amendments added to the definition of a “health benefit plan” the following: any subscription agreement issued by a non-profit dental service corporation; any policy of health insurance purchased by an individual; the state children’s health insurance plan; and the state medical assistance program under Medicaid. We will continue to update you as this bill progresses and hope to make favorable changes as the bill moves through the House.

MASSACHUSETTS: Governor Deval Patrick filed a 40-page bill that proposes giving the insurance commissioner the power to hold public hearings on rate adjustments and essentially cap health care price increases. Rate increases for individuals would be held to the rate of medical inflation; those sold to employers with 50 or fewer workers could not exceed one and a half times the level of medical inflation. The legislation would also impose a two-year moratorium on any new health benefit mandates. Legislative leaders praised the intent of the governor’s plan but declined to promise support. Strong opposition is expected from medical provider groups. The Governor simultaneously announced emergency regulations to take immediate effect that will require health insurers to submit proposed small business rate increases for review by the state 30 days before they take effect. Several other proposed provisions include a requirement that insurers offer at least one coverage plan with a limited network of health care providers costing at least 10 percent less than health plans with access to more physicians. The Massachusetts Association of Health plans is lobbying in support of a bill introduced by Senate Insurance Chair Richard Moore that would create a cheaper health insurance product for small employers by capping payments to providers at just 10 percent above Medicare rates. The Massachusetts Medical Society is against that proposal.

MISSOURI: An autism coverage mandate bill was amended and “perfected” by the Senate and then sent to the Government Accountability and Fiscal Oversight Committee from which it must emerge before returning to the floor of the Senate. In addition to two mandate-related amendments, a third amendment to the bill allowing for limited cross border sales of health insurance also passed. In its current form, the bill contains a mandated offering of the coverage in the individual market. Coverage is limited to treatment ordered by a licensed physician or psychologist whose treatment plan the carrier is entitled to review every six months. Coverage for applied behavior analysis (ABA) is limited to $52,000 annually (down from the $72,000 as introduced) for persons under age 21. Meanwhile in the House, a bill containing significant language relating to the credentialing of autism service providers also passed. The bill also contains a mandate to offer coverage in the individual market and to groups of fewer than 25. Groups of 25 to 50 would be entitled to an exemption from the mandate if they could demonstrate an increase in premiums tied to the mandate. The bill limits annual coverage of ABA ($36,000 for children ages 3-9; $20,000 for children ages 9-21). Aetna will continue to monitor the status of these mandates, but it appears fairly clear at this point that something will pass on the issue of autism.

NEW JERSEY: Last week Governor Chris Christie declared a fiscal state of emergency calling a special session of the legislature to lay out his plan for dealing with state’s current $2.2 billion budget shortfall. His plan calls for significant cuts or eliminations across 375 state programs and withholding $500 million of state education aid. Of note on the program side is a $12.6 million reduction in Charity Care funding to hospitals, which pays for care to uninsured residents. In legislative action, the Assembly Financial Institutions and Insurance Committee held a three-hour public hearing on out-of-network reimbursement. Much of the hearing focused on the markedly higher billing practices of ambulatory surgery centers and one non-par hospital. Aetna presented testimony regarding its experience with the non-par hospital, citing their disparate year-over-year increase in charges compared to other similarly situated hospitals. Chairman Schaer indicated the committee will work over the next several months to craft a solution.

NEW YORK: With Democratic Senator Hiram Monserrate officially expelled from the Senate, the Democratic majority (31-30) now faces an uphill battle getting the 32 votes needed to pass legislation. However, both the Senate and the Assembly moved forward with a public hearing on the Executive Budget proposal for health, including the section mandating the prior approval of rate adjustments. The Health Plan Association testified on behalf of the industry. If enacted, Governor Paterson's proposal for an 85 percent medical loss ratio and a prior approval hearing process for all rate adjustments would essentially amount to government control of health insurance, undermining the private health insurance market in New York. Price controls would weaken health plan solvency, hurt providers and virtually eliminate innovation and efficiency. At the same time, the proposal ignores the underlying cause of the increasing cost of health insurance -- the increase in the actual costs of health care services.

OKLAHOMA: The second session of the 52nd Oklahoma Legislature convened in Oklahoma City on February 1. Legislators quickly turned to the state’s $1.3 billion budget deficit described by Governor Brad Henry (D) in his eighth and final state of the state address and FY 2011 executive budget. During his address, the Governor focused on his plans for resolving the $1.3 billion budget deficit through precise budget cuts. His only reference to health insurance was to encourage the expansion of Insure Oklahoma, a program developed by the state in partnership with small employers to provide affordable health coverage. The legislature is scheduled to adjourn on May 28 but only after addressing a range of legislation including several bills of interest to Aetna.

SOUTH DAKOTA: A dental fee schedule bill (S.B. 108) unanimously passed the Senate Commerce Committee and is expected to be taken up by the full Senate early this week. The bill prohibits any contract between a health insurer that offers a health benefit plan and a dentist from containing a provision that requires the dentist to accept a fee schedule for services unless the service is a covered service. Aetna will continue to follow the bill's progress as it progresses.

TENNESSEE: Several bills have been proposed that would make changes to the state's external review law. Aetna and other industry representatives will be meeting with the Tennessee Department of Commerce and Insurance regarding its proposed changes to the external review law. The bill proposed by the TDCI most closely mirrors the model legislation proposed by the National Association of Insurance Commissioners.

UTAH: The Speaker of the House has introduced a health reform bill addressing health information technology, individual and small group market reforms and transparency. The overarching theme of the reforms is micromanagement of rates and rating factors, and a broadening of the Insurance Commissioner's authority. The transparency provisions apply plan designs and benefit descriptions submitted by carriers, and would require providers to make available, upon request, a price list for services on both an inpatient and outpatient basis.

Health Insurance Reform EasyToInsureME FEBRUARY 5 2010

2010-02-06T07:25:00.000-08:00

This Week in Health Insurance Reform EasyToInsureME FEBRUARY 5, 2010

Despite proclaiming to focus on other issues, such as the economy and jobs, President Barack Obama injected new energy into the health insurance reform debate this week.

On Monday, President Obama held a Q&A session via YouTube in which he responded to questions submitted during his State of the Union address. He commented that "it is my greatest hope" to have health care reform legislation "not just a year from now, but soon." He also responded to criticisms regarding the lack of transparency around the reform negotiations.

On Tuesday, at a town-hall-style meeting in New Hampshire, President Obama rejected the notion that health care reform was dead, saying "we've got to punch it through." Further, on Wednesday, he met with Senate Democrats reiterating his commitment to reform and encouraging lawmakers to press forward. He also suggested that Republicans play at least some role in negotiating a final bill.

Health Care Reform Negotiations

Democrats Look for Path Forward: Recent statements made by Rep. Charles Rangel (D-NY) are the first concrete signs that Democrats have started working to revive comprehensive health care reform legislation. Rep. Rangel indicated to the media that lawmakers have begun writing a compromise bill based on the legislation passed by the Senate last December. The bill will incorporate changes agreed upon last month by White House negotiators and members of the House and Senate.

Senate Majority Leader Harry Reid (D-NV) did not commit to a timeline for reform, but hopes that Democrats can agree to a path forward by next week. So far, he has been unable to identify compromise language that will win the needed 51 Senate votes.

At the same time, Speaker of the House Nancy Pelosi (D-CA) indicated that the House would vote on a small piece of the overall health care reform package next week. The proposed bill would overturn the insurance industry's exemption from federal antitrust laws. The Senate version of health care reform did not include this measure because Sen. Reid could not secure the 60 votes needed to include it; however, Sen. Reid indicated the Senate would reconsider the measure.

Additional Activities

President Obama's Budget Assumes Health Care Reform: On Monday, White House officials released a proposed $3.8 trillion 2011 budget including several measures aimed at improving health care:

· Hiring more fraud detectives to root out waste in Medicare and Medicaid

· Providing $25.5 billion to help state Medicaid programs swelling with enrollment due to unemployment

· Eliminating Congressional earmarks for building hospitals and other facilities, including $10 million for Alaska and $35 million for Mississippi

· Initiating or increasing funds for the following research projects:

o quality improvements for seniors with chronic conditions

o effective medical treatments for the costliest conditions

o expeditious ways to adopt electronic medical records

o medical fields such as genetic medicine that may provide breakthrough treatments.

Further, the budget assumes that some form of health care reform legislation will pass Congress. It includes a "reserve fund for health care reform" totaling $634 billion as a "down payment" for the legislation and also assumes that the reform effort will generate $150 billion in savings over 10 years.

States Begin Initiatives to Expand Coverage: With the fate of national health care reform in question, state legislators are pushing their own bills to expand coverage. Last Thursday, California's State Senate passed a measure to create a government-run health care system, ignoring a veto threat from Gov. Arnold Schwarzenegger. The measure is now with the State Assembly. Missouri legislators have introduced a similar bill to create a government-run plan whereas lawmakers in other states, including Virginia and New Jersey, are working to tweak existing state programs to expand coverage. Tight budgets in all of those states may hinder these efforts.

Virginia Senate Says No to Individual Mandates: On Monday, Virginia's Democratic-controlled State Senate passed measures that would make it illegal to enforce an individual health care mandate. This decision comes in direct conflict with the House and the Senate health care reform bills, both of which require all individuals to purchase health insurance.

Public Opinion

Majority of Americans Doubt Passage of Health Care Reform, but Growing Optimism: A survey released by the Pew Research Center on Wednesday shows growing optimism around the passage of health care reform. While the poll indicates that the majority of Americans (60 percent) do not believe health care reform legislation will pass this year, the figure is down from the 67 percent who said - just after a special Senate election was held last month in Massachusetts - that such legislation would not pass.

Poll Indicates Damage Done On Health Care Reform: A poll released Tuesday by Public Policy Polling shows that Republicans currently have the advantage over Democrats in the ballot races for Congress, regardless of the final outcome of health care reform. In general, the poll shows that 43 percent of voters surveyed would vote for a Republican, whereas 40 percent would vote for a Democrat. When asked about the implications of the health care overhaul.

* If health care reform passes, 45 percent would likely vote Republican and 40 percent would likely vote Democrat.
* If health care reform does not pass, 43 percent would likely vote Republican and 38 percent would likely vote Democrat.

The poll also shows that 36 percent of respondents support the President's health care reform effort, while 51 percent oppose it.

Looking Ahead

Currently there is no timeline for the development of a comprehensive health care reform package. However, Speaker Pelosi is moving forward with smaller pieces of the bill, starting next week with the repeal of the antitrust exemption for insurance companies.

This Week in Health Insurance Reform--Federal Legislative Overview

2010-02-03T14:17:00.000-08:00

February 3, 2010 EasyToInsureME Ez2InsureME

House and Senate
House and Senate Democratic leaders remain at an impasse on merging their respective health care reform bills. Senate Majority Leader Harry Reid (D-NV) stated that they will not move forward on any health care reform measures before Republican Scott Brown is sworn in as Massachusetts’ junior senator.

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Both party leaders decided to wait and hear what President Obama was going to say about health reform in his first State of the Union Address on January 27. In it, he urged Congress to continue its work on health care reform and outlined his agenda that focused heavily on reviving the economy to boost employment and reduce the budget deficit.

In an excerpt on health care reform from President Obama’s speech, he states, “Our approach would preserve the right of Americans who have insurance to keep their doctor and their plan. It would reduce costs and premiums for millions of families and businesses. And according to the Congressional Budget Office – the independent organization that both parties have cited as the official scorekeeper for Congress – our approach would bring down the deficit by as much as $1 trillion over the next two decades.”

The Republican response was given by newly-elected Governor Bob McDonnell at the Virginia State House. In an excerpt from his speech, McDonnell stated that “All Americans agree - we need a health care system that is affordable, accessible, and high quality. But most Americans do not want to turn over the best medical care system in the world to the federal government. Republicans in Congress have offered legislation to reform healthcare, without shifting Medicaid costs to the states, without cutting Medicare, and without raising your taxes.”

Health Care Reform Next Steps
Congressional leaders continue to consider options for moving forward on health reform legislation following President Obama’s State of the Union address. Serious consideration is being given to taking action – possibly as early as next week – on a number of narrowly focused bills, some of which may be structured with the goal of attracting bi-partisan support. Consideration of these bills is not intended to preclude action on comprehensive health reform at a later date.

One of the first bills likely to move to the House floor could be an antitrust bill that would repeal portions of the McCarran-Ferguson Act pertaining to health insurance issuers and medical malpractice issuers. This legislation was proposed last year in the Senate by Senator Patrick Leahy (D-VT) and in the House by Rep. John Conyers (D-MI) and is known as the Health Insurance Industry Antitrust Enforcement Act of 2009. It was ultimately included in the House health care reform bill, but not in the Senate reform bill.

As we reported last week, one of the potential options for Democrats to pass health care reform legislation was to use the budget reconciliation process. Democratic leaders are purportedly continuing to weigh a two-track process in which the House would clear the Senate health bill and then the Senate would use the filibuster-proof reconciliation process to incorporate a series of compromises with the House. Senate Majority Leader Reid said this week, “[Budget reconciliation is] something that we’re looking at, very closely. That’s where a lot of the procedural problems come in. It’s real tough to do it the right way, and we don’t know how to do that yet.”

In the meantime, the House will continue to focus on smaller health care bills. Speaker of the House Nancy Pelosi (D-CA) stated this week that her party will successfully complete their work on health care reform that they began last year. Pelosi said, “We’ll go through the gate. If the gate is closed, we’ll go over the fence. If the fence is too high, we’ll pole vault in. If that doesn’t work, we’ll parachute in. But we’re going to get health care reform passed for the American people.”

Federal Government Issues Interim Final Regulations on MHPAEA

2010-02-03T14:09:00.000-08:00

EasyToInsureME

On Friday, January 29, the Departments of Health and Human Services, Labor and Treasury jointly issued significant new interim final regulations for implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).

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The regulations are 154 pages long and will require detailed reviews of applicable plan documents and insurance policies, as well as current processes regarding management of mental health benefits, claims, and the relationship Plans have with outside organizations that provide and manage mental health and substance abuse benefits.

These are "interim” final regulations, meaning that they are essentially final but are nonetheless subject to later changes as the result of the official 90-day public comment period.

For purposes of enforcement, regulators have emphasized that they will take into account a health plan’s good faith efforts to comply with a reasonable interpretation of the statute for violations that may occur with implementations by the original Act deadline (plan year renewals on or after October 3, 2009). The interim final regulation generally applies to group health plans and health insurance issuers for plan years beginning on or after July 1, 2010. Collective bargaining entities have a different applicability provision to align with their agreements.

The interim final rules provide substantial clarification as to the definitions and tests that must be used in establishing parity between mental health and substance use and medical/surgical benefits with respect to financial requirements and treatment limitations, as required under MHPAEA.

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2010-01-31T06:07:00.000-08:00

JANUARY 29, 2010

This Week in Health Care Reform

Following the election of Republican Scott Brown to the Massachusetts State Senate last week and the resulting loss of Senate Democrats' supermajority, lawmakers continue to pave the way for health care reform - with limited progress. In addition, polls indicate that the public would rather lawmakers focus more on the economy than on health care.

State of the Union Address

President Obama Gives State of the Union Address: On Wednesday evening, President Barack Obama delivered his first State of the Union address before a joint session of Congress. Having hoped to have a health care reform bill on his desk prior to his address, the President instead used his speech to encourage Congress to push forward on health care reform. Yet, he did not give specific guidance as to how to proceed with the legislation. Instead, he made it clear that his primary focus would be on jobs and the economy.

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Health Care Reform Negotiations

Democrats Still Seek Way Forward: While vowing not to give up, Democratic Senate leaders indicated Tuesday that they no longer felt pressure to move quickly on health care reform; and, in the wake of the Massachusetts election and in reaction to public opinion, they shifted focus to jobs and the economy. Senate Majority Leader Harry Reid (D-NV) commented that there is "no rush" on health care and said that he and Speaker of the House Nancy Pelosi (D-CA) were working to map out a way to complete health care reform in the coming months. On Wednesday, Sen. Pelosi floated a two-pronged strategy to pass incremental changes now and pursue comprehensive reform later.

Some lawmakers have considered breaking up the legislation into smaller pieces that have bipartisan support. However, this option will prove challenging given the complexities and interdependencies of the measures. For example, lawmakers would like to include a measure that requires all insurance companies to insure those with pre-existing conditions; however, premiums will most likely increase unless there is an individual mandate.

Earlier this week, Democrats appeared to be coalescing around a different strategy through which Senate lawmakers would make changes to their bill to appease members of the House. The Senate would then pass the revised bill via reconciliation, which only requires 51 votes. Following that, the House would approve the revised bill, giving it to President Obama for his review. However, movement on this strategy stalled Tuesday when two centrist Senators, Sens. Evan Bayh (D-IN) and Blanche Lincoln (D-AK), indicated that they would oppose using reconciliation to bypass Republican support. Others, including Sen. Joe Lieberman (I-CT) and Sen. Dianne Feinstein (D-CA), have suggested a "time out" on health care reform until there is a clear path forward.

In the GOP response to President Obama's State of the Union address, Virginia Governor Robert McDonnell said that Republicans share the Democrats' desire for health care reform, but do not agree with their proposed solutions. Republicans suggest that Democrats scrap the current proposals and start over with more Republican input on issues such as medical malpractice reform and selling insurance policies across state lines.

Republicans Call for Transparency: On Wednesday, the House Energy and Commerce Committee marked up a resolution presented by Rep. Michael Burgess (R-TX) which requested that the administration divulge documentation regarding the health care reform deals made with trade associations and a labor union. Committee Chairman Henry Waxman (D-CA) said that while details remained to be worked out, he would support a narrowed version of the Republican request for White House records.

President Obama to Speak with House Republicans: President Obama will meet with House Republicans on Friday in response to an invitation to speak at their annual retreat in Baltimore that begins Thursday and ends Saturday. The meeting comes just after the President's State of the Union address, and members of the news media speculate that the meeting may spur more bipartisanship or potentially lead to even more tension between the two parties.

Interest Groups Call for Reform: With health care reform's fate in jeopardy, interest groups have voiced their support, encouraging Democrats to push forward with legislation. The AARP, American Cancer Society Cancer Action Network, Consumers Union, Families USA and Service employees International Union sent a joint letter last Thursday urging Congress not to abandon comprehensive health care reform. Further, the United States Conference of Catholic Bishops also sent a letter to Congress urging a push for reform.

Public Opinion

Polls Show Concern with Health Care Reform; More Focus on Jobs and Economy: Several polls were released this week that highlight the public's disenchantment with health care reform and anxiety around the struggling economy.

A new CNN/Opinion Research poll released Tuesday shows that only three in ten Americans say they want Congress to pass legislation similar to the bills currently being discussed in Congress. Forty-eight percent of Americans would like lawmakers to start again on a new bill, and 21 percent believe Congress should not work on bills that would change the current health care system. Further, a Wall Street Journal/NBC poll released Wednesday found that 51 percent of Americans believe President Obama has paid "too little attention" to the economy and that 44 percent feel he has paid "too much attention" to his proposed health care overall.

In addition, a new USA Today/Gallup poll released late last week finds that most Americans call for a more bipartisan effort in health reform. A 55 percent majority of Americans say that President Obama and Congressional Democrats should suspend movement on health care reform and consider alternatives that would increase Republican support.

A poll released last weekend by the Washington Post , Henry J. Kaiser Family Foundation and Harvard University's School of Public Health indicated that dissatisfaction with the direction of the country, including the Democrats' health care reform proposals, drove the outcome of the Massachusetts election. The post-election survey of Massachusetts state voters showed that overall 43 percent say they support the health care reform proposals advanced by President Obama and Congressional Democrats, while 48 percent oppose them.

A new poll released Monday from the Robert Wood Johnson Foundation found that fears regarding the health care reform package increased significantly in December as members of the Senate finalized their bill. Thirty-three percent of respondents said they believed their access to care would worsen if the legislation passed, up from 25 percent in November. Forty-two percent said the country's finances would suffer under reform, compared with 34.6 percent in November.

Looking Ahead

Next week, the President will present his Budget to Congress (which includes health programs), after which Congressional hearings will commence. We expect health reform to be discussed in these sessions. While there remains no clear path forward for health care reform, Congressional leaders will continue to work to find a solution.

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2010-01-28T09:07:00.000-08:00

Week of January 25, 2010

The sudden halt to health care reform's steady march forward came as a shock to many who saw an upset win by Republican Senator-elect Scott Brown in Massachusetts as all but impossible. But if many took delight in the election outcome's impact on health reform legislation, Aetna Chairman Ronald A. Williams made it clear in a New York Times story last week that the country still needs meaningful health care reform – reform that addresses access as well as affordability. Everyone benefits by health reform that gets at the factors driving soaring health care costs and the loss of coverage for so many Americans. While Congress thinks carefully about its next steps, Aetna will continue to support meaningful health care reform and continue to offer responsible solutions to legislative leaders.

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Federal

The election of Republican Scott Brown as the new senator from Massachusetts has derailed the Congressional health care reform train, less because Brown denies Democrats the 60th filibuster-proof vote, though that is certainly a major result, and more because it collapsed the Democratic political house of cards by highlighting the power of independent voters and the frustrated anti-incumbent mood of the electorate. Whether Democrats can regroup from this wake-up call will consume their leadership from now until the November off-year elections. How Democrats handle, and how Republicans respond to, health care reform in the short term and other key priorities – such as jobs, the economy, energy and security – over the rest of the session will underscore all Congressional decisions from now until the first Tuesday in November. In short, the 2010 elections started in earnest with Brown's victory.

Once Democrats get past the shock of losing Kennedy's seat, they will have to grapple with health care reform, one way or the other. The early favorites, including passing the Senate bill "as is" in the House, have been dropped for now as Democrats recognize the political cost of ramming through something unpopular propelled by political muscle only. Passing a smaller, less invasive and mostly Democratic bill has only a slightly better chance, as Republicans are not too likely to "crossover" quite yet. There is a growing interest in using reconciliation (the 51-vote tactic) down the road to pass a Democratic-only bill, once the House and Senate Democratic leadership can agree to a single bill. And, there is the outside chance that Democrats will see the Massachusetts election as an imperative to craft a bipartisan bill with Republicans that can secure 70-plus votes in the Senate. Wednesday’s State of the Union speech, followed by the party issues retreats later in the week, will go a long way toward determining which path will be pursued.

This Week in Health Insurance Reform EasyToInsureME.com

2010-01-28T06:05:00.000-08:00

January 27, 2010

This Week in Health Reform--Federal Legislative Overview

House and Senate
Republican Scott Brown’s victory over Massachusetts Attorney General Martha Coakley (D) in the January 19 special election to fill the seat of the late Senator Edward Kennedy (D) is proving to be a game-changer for the health care reform debate. It is now unclear what Democrats can do to pass President Obama’s most important legislative agenda item. Even though the Democrats held a majority in the House and Senate this year, they failed to coalesce around a strategy to pass this legislation. Initially after Brown’s win, there were two options under discussion for moving forward on the current legislation.

Have the House take up the Senate-passed bill and use the "reconciliation" bill process to "fix" several of the provisions the House finds unacceptable (e.g., the “Cadillac” tax, etc.). If the House passes the Senate bill, it will go directly to the President for his signature, with no further action needed in the Senate. A "reconciliation" bill, which would need only 51 votes in the Senate, could be passed either in tandem with the Senate bill or follow soon after.
.
Scale back the health care reform bill. A scaled-back bill could include health insurance reforms, exchanges, as well as several other provisions and possibly could attract bipartisan support. While many Democrats are likely to view this approach as a major lost opportunity, leadership may determine this is the most viable approach.

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However, Speaker of the House Nancy Pelosi (D-CA) publicly stated on January 21 that the House does not have the 218 votes needed to pass the Senate version of the health care reform bill, which takes option number one (above) off the table.

While numerous private discussions are reportedly being held on the matter, at the outset it seems that Democrats’ only option for keeping the current legislation alive is to reach across the aisle to their Republican counterparts, most notably, moderate Senator Olympia Snow (R-ME). That would mean a more conservative bill, which could anger rank and file Democrats who are supportive of the legislation.

Although no plans have emerged for how to move forward, it now looks like Democrats will have to modify their plans. On the night of Scott Brown’s win in Massachusetts, Rep. Anthony Weiner (D-NY) – one of the biggest proponents for a single-payer health care system – said: "The only way to go forward is to take a step back. If there isn't any recognition that we got the message and we are trying to recalibrate and do things differently, we are not only going to risk looking ignorant but arrogant. I don't think it would be the worst thing to take a step back and say we are going to pivot to do a jobs thing," and include elements of health care reform in it, he said.

Rep. David Camp (R-MI), Ranking Member on the House Ways and Means Committee, declared Democrats’ health care overhaul legislation “dead” and said that instead of full-scale change Congress should take a “first step toward comprehensive reform” of the nation’s health care system.

Issue Overview: Nebraska Medicaid Deal
While key elements of the health care reform legislation remain in flux, the Congressional Budget Office (CBO) released its cost estimate of the expansion of the State of Nebraska’s Medicaid Deal, negotiated by Senator Ben Nelson (D-NE) who then voted for the Senate’s Patient Protection and Affordable Care Act, HR 3590.

The letter responds to a request from Rep. Paul Ryan (R-WI)), Ranking Member, House Committee on the Budget, asking if the cost estimate of the Senate health reform bill would change if all states received the same level of federal assistance for Medicaid as Nebraska receives under the bill.

The CBO stated on January 21 that the net spending for the Senate legislation would increase by $35 billion over ten years if all states received the same level of assistance as Nebraska.

Under the Senate’s provisions, non-elderly individuals with incomes below 133 percent of the federal poverty level would be eligible for Medicaid beginning in 2014. The federal government would pay the cost of covering newly eligible enrollees through 2016; and federal spending would be about 90 percent by 2019. The Senate legislation states that it would pay all Medicaid expansion costs to Nebraska beginning in 2014.

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2010-01-23T06:34:00.000-08:00

JANUARY 22, 2010

This Week in Health Care Reform

After months of public debate and private negotiations, health care reform discussions stalled following Tuesday's Senate vote in Massachusetts. The Democratic Senate lost its 60th vote supermajority when Republican Scott Brown was elected to the United States Senate in the Massachusetts special election.

Health Care Reform Negotiations Post-Massachusetts Special Election

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Massachusetts Election of Senate Republican Recasts Debate: Following the election of Republican Scott Brown to the Massachusetts Senate seat Tuesday night, Democratic leaders have been scrambling to revive what could now be a dying bill. The loss of the Democrat's 60th vote in the Senate opens up the legislation to a Republican filibuster - something the Democrats have managed to avoid thus far in the debate.

House and Senate Democrats met this week to discuss how to move forward with the reform legislation in light of this election and promised Wednesday that they would push ahead. There are a number of options that Democrats are considering, but at this point they have not charted their course.

On Wednesday, Speaker of the House Nancy Pelosi (D-CA) attempted to rally House Democrats around a strategy to push the Senate bill through the House and onto President Barack Obama's desk so as to avoid the need to again secure 60 Senate votes. However, the Speaker indicated on Thursday morning that she did not believe she has the needed 218 House votes necessary to move forward. This option would have allowed lawmakersto then propose additional modifications to the approved legislation through a process called "reconciliation," which only requires 51 votes in the Senate.

Other remaining options:

1.
House and Senate Democrats could also quickly complete the merging of the two bills and vote on the combined package before Mr. Brown is sworn in.
2.
Democratic leaders could attempt to re-engage Sen. Olympia Snowe (R-ME), the only Republican who voted for the Senate Finance Committee's bill passed in October. Democrats would need to allow her to amend the bill so that she could support its passage and give Democrats the needed 60th vote; or,
3. House and Senate Democrats could essentially start over in their respective chambers and propose scaled-back versions of the bill under "reconciliation" procedures or regular order. Reconciliation procedures would greatly limit the scope of the legislation to issues only related to raising or spending federal funds; therefore, many provisions, such as creating new insurance exchanges and an individual mandate, might be excluded.

President Obama seemed to indicate that he favors having House and Senate lawmakers start over again and produce a scaled-back bill. In addition, more moderate Senate Democrats - hesitant to push through such a huge partisan bill in light of the Massachusetts election - urged leaders to slow down.
Sen. Jim Webb (D-VA) has called on Senate leaders to suspend voting on health care reform until Mr. Brown is sworn into office. President Obama and Senate Majority Leader Harry Reid (D-NV) have iterated this same message. Further, Sen. Joe Lieberman (D-CT) called for a bipartisan effort as the best way to achieve health care reform legislation.

Health Care Reform Negotiations Prior to Massachusetts Special Election

Senators Urge Guarantee of Government Savings: In a letter sent last Thursday to Sen. Reid, five Democratic Senators asked for the inclusion of a "fail-safe mechanism" in the final bill. This mechanism would give Congress "the tools to keep costs under control should the current savings estimates fail to materialize."

Both the Senate and House versions of the bill rely heavily on reductions in government spending, particularly around Medicare, to help pay for reform. Republicans and some nonpartisan analysts believe the government will not follow through on these spending reductions, which will lead to soaring costs.

President Obama Pushes for Less Protection for Biologic Drugs: Last Thursday President Obama pushed for a change in the health care reform legislation that would reduce the number of years that biologic drugs were patent protected from generic competition, previously set at 12 years. White House officials and Rep. Henry Waxman (D-CA) were negotiating for 10 years protection or less.

Members of the news media speculated that the move to reduce biologic drug protections could be a leverage point for President Obama to pressure the drug industry to increase contributions to pay for health care reform. In fact, the Wall Street Journal reported that Congressional Democrats had already asked drug companies to contribute an additional $10 billion or more, over and above the $80 billion which the industry agreed to early on in the reform negotiations.

President Obama Strikes Deal with Unions: Last week Democratic negotiators struck a deal with union officials and conceded to union demands to scale back a tax on high-end insurance plans. The deal would exempt union workers from having to pay the tax until 2018, five years after the tax would apply to other workers. While the deal would help gain union support for the bill, it would also reduce the amount of tax revenue generated by about 40 percent, to $90 billion. As such, Democratic leaders would need to find other sources of revenue to make up the difference.

Public Opinion

Exit Poll Indicates Health Care Reform as Hot Button Issue: As the ballot polls closed on Tuesday night's Massachusetts Senate election, an exit poll conducted by Frabrizio, McLaughlin & Associates indicated that 52 percent of voters said that they oppose the federal health care reform measure and 42 percent said they cast their ballot to help stop President Obama from passing this legislation. In addition, 48 percent said that health care was the single issue driving their vote.

Polls Show Discontent: The latest Wall Street Journal/NBC News poll indicated that almost half of Americans believe the health care reform bill in Congress is a bad idea (46 percent). This figure is up dramatically from April when only 26 percent believed the plan was a bad idea. Further, just 33 percent say the plan is a good idea. Nearly half of those surveyed (48 percent) believe that passing the current legislation would be a "step backward."

In addition, a new Quinnipiac University poll showed that public support for health care reform continues to decline. Thirty-four percent mostly approve, while 54 percent mostly disapprove. At the end of December, 53 percent of Americans mostly approved, while 36 mostly disapproved.

Looking Ahead

Currently, the path to health care reform is unclear. Democrats seek a way to secure the necessary votes to pass the legislation, and some now question the value of pushing such a large bill. President Obama had hoped to see a final bill prior to his State of the Union address, which has been scheduled for January 27; however, it appears this goal is likely out of reach.

This Week in Health Care Reform : EasyToInsureME Health Insurance

2010-01-21T07:57:00.000-08:00

This Week in Health Reform

Republican Scott Brown’s victory over Massachusetts Attorney General Martha Coakley (D) in the January 19 special election to fill the seat of the late Senator Edward Kennedy (D) might prove to be a game-changer for the health care reform debate. The loss of the 60th Democratic vote now robs Senate Democrats of a filibuster-proof majority. Last week, Democrats were rushing to wrap up a House/Senate agreement on the bill, likely due to reports that Coakley’s lead had diminished.

Congressional leaders are still aiming to have the controversial points in the health care reform bill settled as soon as possible, so they can send the compromised bill to the Congressional Budget Office (CBO) for scoring. The CBO will then need 12 days to analyze the legislation.

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In addition to Senate Majority Leader Harry Reid (D-NV) and Speaker of the House, Nancy Pelosi (D-CA), lawmakers participating in the White House meetings include: House Majority Leader Steny Hoyer (D-MD), House Majority Whip James Clyburn (D-SC), House Energy and Commerce Committee Chairman Henry Waxman (D-CA), House Ways and Means Committee Chairman Charlie Rangel (D-NY), House Education and Labor Committee Chairman George Miller (D-CA), Assistant Senate Majority Leader Richard Durbin (D-IL), Senate Finance Committee Chairman Max Baucus (D-MT), Senate HELP Committee Chairman Tom Harkin (D-IA), and Senate Banking Committee Chairman Christopher Dodd (D-CT).

A main point of contention between the two houses of Congress pertained to the
40 percent excise tax on high-cost health insurance plans passed by the Senate. Since many labor union members would be affected by the tax on high-cost health insurance plans, the House of Representatives was not supportive of this provision in the Senate bill. Union leaders have also been included in key negotiations on this provision, and on January 14, signaled that they are ready to support the merged legislation with the compromised provision.

The main revenue source for the Senate’s health care reform bill (H.R. 3590) would be from an excise tax – beginning in 2013 – on employer-provided, high-cost health insurance plans costing more than $8,500 for individuals and $23,000 for a family. The reported compromise on the legislation now makes the tax kick-in on policies costing $8,900 for individuals and $24,000 for families. The tax threshold would still rise at inflation plus one percentage point, as is currently written in the Senate bill. Additionally, dental and vision benefits would be removed from the calculation of threshold costs, and plans offered by state and local governments, as well as plans covered by collective bargaining agreements, would be exempted from the excise tax until 2018. This would allow current agreements to expire and allow for negotiation of new contracts.

In an effort to make up the lack of revenue from the modification of the excise tax provision, leadership will have to come up with new funding to finance the merged bill. Some reports have mentioned that the pharmaceutical industry has agreed to provide more money than the $80 billion they have already negotiated with the White House. Medical device companies could also face additional fees. Portions of the main revenue source in the House bill – a Medicare payroll tax on wealthy U.S. residents – could be added as well.

On January 14, Richard Trumpka, president of the AFL-CIO, said, “Union leaders approached negotiations with the White House and congressional leaders with one overriding goal in mind – getting a bill signed into law.” Gerald McEntee, president of the American Federation of State, County and Municipal Employees (AFSCME), said, “We do like the way it’s shaping up, but it’s still not finished. We’ve got to see a final product.”

There also has been significant discussion – but no resolution so far – about the question of whether to establish a single national health insurance exchange or allow each state to operate its own exchange. Blue Cross and Blue Shield of Texas continues to support a state-based approach to exchanges.

This Week in Health Insurance Reform : EasyToInsureME

2010-01-14T06:41:00.000-08:00

January 13, 2010

This Week in Health Reform

House and Senate
The Senate passed its health care reform legislation, the Patient Protection and Affordable Care Act of 2009 (H.R. 3590) on December 24, 2009. With both pieces of legislation now passed – the House legislation, the Affordable Health Care for America Act (H.R 3962), was passed on November 7, 2009 – House and Senate leadership must now reconcile the differences. Instead of moving into the conference committee to reconcile the bills, Democratic leadership has agreed to implement a “ping-pong” approach where the House will take up the Senate bill, amend it, and then send it back to the Senate for approval. Reiterating his commitment to signing health care reform legislation by the State of the Union address (the date of the Address has not been confirmed yet), President Obama has met with key Democrats multiple times during the last week and is supportive of this approach, which is said to be an easier procedural tactic and will take less time.

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Senate Majority Leader Harry Reid (D-NV) still has the challenge of maintaining the Democrats’ 60-vote majority for two procedural votes in the Senate. This first is a vote on a motion to proceed to debate the legislation and the second is a vote on cloture that will allow Senators to proceed to the vote itself. The final vote on the full legislation will only need 51 votes. Speaker Nancy Pelosi (D-CA) needs 218 votes in the House of Representatives.

While the “ping-pong” approach may seem easier than holding a formal conference committee, there are still numerous provisions in the Senate bill that might prove to be contentious issues for Democrats trying to marry the two pieces of legislation. One main priority is the way both bills are financed. The House Democrats prefer a tax on the wealthiest U.S. residents, while Senate Democrats want to tax high-cost “Cadillac” health insurance plans. It is suggested that a hybrid of the two is most likely to appease both groups. Among other provisions, many House Democrats are not supportive of either bill’s language on abortion, stating that they have a coalition of 41 members who will vote against the legislation if the abortion provisions are not amended. Other differences include national exchanges proposed in the House, while the Senate would like to see state-based exchanges; higher subsidies for the lowest-income Americans and an expansion of Medicaid in the House legislation.

The full Senate remains on recess until January 19.

Overview: NAIC Writes Speaker Pelosi and Majority Leader Reid
On January 6, The National Association of Insurance Commissioners (NAIC) wrote House Speaker Nancy Pelosi (D-CA) and Majority Leader Harry Reid (D-NV) to provide their input as the House and Senate begin to reconcile the differences in their prospective health care reform bills.

In its letter, the NAIC highlights important points about the need for a strong individual mandate, the implications of health care reform in non-guarantee issue states, concern over Federal rate approval processes and minimum loss ratios (MLR) at 80 percent for the individual market, as well as comments about the importance of Congress focusing on proposed effective dates for numerous insurance market reforms. Other issues discussed include high-risk pools and new vouchers programs.

This Week in Health Insurance Quotes Reform : EasyToInsureME

2010-01-08T11:30:00.000-08:00

JANUARY 8, 2010

This Week in Health Care Reform

While still technically in recess, members of Congress trickled back to Washington, D.C. this week to get a jump start on reconciling the health care reform bills passed by the House and Senate last year.

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On Tuesday, Democratic leaders began conversations around a final package, pledging to overcome differences and aiming to have a bill passed by the President Barack Obama's State of the Union Address, anticipated in early February. Members of the news media, however, have highlighted the difficult negotiations ahead, given some major differences in the proposed packages and the time pressure being imposed by President Obama.

We continue to encourage you and others to engage members of Congress during this debate by visiting the Health Action Network.

Health Reform Negotiations

Senate Passes Reform Bill: At 7:05 a.m. on Christmas Eve, Senate Majority Leader Harry Reid (D-NV), along with 59 other Senate members, voted to pass reform legislation that, according to the Congressional Budget Office (CBO), would expand health coverage to approximately 31 million people at a cost of $871 billion over 10 years. The bill passed on party lines (60-39), without a single Republican vote in favor. Republicans believe the bill would impose many regulatory and financial burdens on taxpayers and businesses while increasing government debt.

Reconciliation Poses Difficult Road Ahead: Before lawmakers can present a final health care reform bill to President Obama, the approved Senate bill needs to be merged with the House version passed in November 2009, which extends coverage to 36 million Americans at a cost of about $1 trillion. However, the bills have some major differences that will need to be addressed as lawmakers shape the final package, including:

* Insurance market reform and exchanges - Both bills would bar insurers from denying coverage to those with pre-existing conditions and from dropping coverage for those who get sick. Both would also create insurance exchanges through which small businesses and individuals could shop for insurance. The Senate bill would create state-based exchanges, however, whereas the House bill would create a national exchange with an option for states to run state-based programs if they meet certain requirements.
* The government-run plan - A government-run plan was a central component to the House bill. The Senate bill would instead direct the U.S. Office of Personnel Management to contract with private insurance companies to offer policies on the exchanges. Despite much commotion over the need to include the public option, House leaders conceded Tuesday that they may be willing to agree to a bill without a public option if other parts of the bill fulfill the same goals, with the hope of expanding available subsidies.
* Reform financing - Members of the House would pay for the reform effort - which carries a price tag of about $1 trillion - through a 5.4 percent surtax on individuals making more than $500,000 a year and couples making more than $1 million and by imposing a 2.5 percent excise tax on medical devices. Members of the Senate, on the other hand, plan to pay for their $871 billion plan through several measures:

- a 40 percent excise tax on high-cost health insurance plans;
- an increase in payroll taxes for Medicare on individuals making more than $200,000 a year and couples making more than $250,000 per year;
- fees on insurers, medical device manufacturers and drug companies;
- and, a 10 percent tax on indoor tanning salons.

On Wednesday, President Obama expressed his preference for the insurance tax contained in the Senate bill, but the excise tax is strongly opposed by labor unions.

* Coverage Mandates - Both bills require that individuals obtain health insurance and impose a penalty on those who do not. The House bill also includes an employer mandate for companies with payrolls above $750,000. The Senate bill does not include this mandate but would require companies with more than 50 employees to pay a fine if employees obtain federally subsidized coverage on the insurance exchange.
* Medicaid expansion - Both bills expand Medicaid. The Senate bill makes Medicaid available to those with incomes up to 133 percent of the poverty level, whereas the House allows for coverage for those with incomes up to 150 percent of the poverty level.
* Abortion - While both bills bar the use of federal funds for abortions, the House bill includes stricter language requiring anyone seeking abortion coverage to buy separate insurance riders. The Senate bill would let the states choose whether or not to include plans with abortion coverage in the insurance exchange and would require those with abortion coverage to write a separate check for this insurance.

President Obama Pushes Swift Action: In a meeting at the White House Tuesday, President Obama encouraged House Speaker Nancy Pelosi (D-CA) and House Majority Leader Steny Hoyer (D-MD), as well as Senate Majority Leader Harry Reid and Sen. Dick Durbin (D-IL), who participated via phone, to bypass the traditional conference committee used to negotiate reconciliation, in the interest of time. The move, which creates a three-way negotiating construct involving top Democrats in the House and Senate and the White House, will exclude Republican lawmakers from the debate and reduce their ability to delay the voting.

Further, President Obama indicated that he would be taking a hands-on approach to the final stages of the negotiations. The President held another meeting with leading Democrats on Wednesday to help iron out differences between the House and Senate bills. Democrats also held a noon meeting and conference call on Thursday to discuss how reconciliation will proceed and some of the priorities for the final bill.

Additional Activities

C-SPAN Calls for Transparency: Noting that President Obama mentioned several times during his campaign that health care negotiations would be transparent and broadcasted on C-SPAN, Brian Lamb, C-SPAN CEO, sent a letter to House and Senate leaders on December 30 asking for negotiations to be opened up for public viewing. Republicans pointed out that the most critical discussions on health reform have taken place behind closed doors so far. Top House Democrats deflected the C-SPAN request, saying the process has been highly transparent through more than 100 public hearings held by the House. They pledged to make the final stages transparent in part via the Internet.

Opponents Question Constitutionality: On Wednesday, December 30, Republican attorneys general in 13 states - including Colorado, Florida, Idaho, Michigan and Virginia - sent a letter to Sens. Nancy Pelosi and Harry Reid stating that Congressional leaders must remove the amendment exempting Nebraska from having to pay for the state's Medicaid expansion. The prosecutors are calling the deal unconstitutional and threatened legal action. Members of the news media report that South Carolina Attorney General Henry McMaster and Oklahoma top prosecutor Drew Edmondson are asking attorneys general across the country to call on Sens. Pelosi and Reid to remove the provision.

In addition, a contingency of legal scholars as well as many Republican lawmakers are calling the measures passed by both the House and the Senate unconstitutional , primarily due to the inclusion of an individual mandate. "In the history of this country, the federal government has never required every American to enter into a contract with a private company," said Randy Barnett, a professor of constitutional law at Georgetown University Law Center.

Looking Ahead

Formal sessions in Congress are scheduled to begin January 19, 2010. Sen. Pelosi, however, plans to continue to work with key committee chairs and other Democratic leaders prior to the official sessions..

Buying Individual Health Insurance EasyToInsureME

2009-12-26T10:44:00.000-08:00

Making Health Insurance Shopping Easier

Buying individual health insurance on the EasyToInsureME site is very simple. When individuals and families get quotes on the site they will be provided with every carrier available in the U.S. and all the plans that come with them. This includes full brochures and documentation of each and every plan along with a search tool for participating doctors. To apply, an apply button is next to each plan and this will forward the shopper directly to the carrier’s website to submit an application. EasyToInsureME cannot view your private information it is secured with the carrier. (Read the rest of Buying individual health insurance here)

Cobra Health Insurance Subsidy Continued EasyToInsureME

2009-12-24T17:33:00.000-08:00

COBRA, state continuation subsidies extended

On December 19, 2009, President Barack Obama signed an extension of the COBRA subsidy program originally introduced under the American Recovery and Reinvestment Act of 2009 (ARRA).

ARRA provides for a federal subsidy of 65 percent of the COBRA continuation coverage premiums for qualified beneficiaries receiving COBRA continuation coverage due to involuntary termination of employment between September 1, 2008, and December 31, 2009. These individuals, referred to as "assistance-eligible individuals" or "AEIs," were entitled to receive the subsidy for up to nine months.

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Under the new COBRA subsidy extension provision:

* The end date of eligibility for the premium subsidy changes from December 31, 2009, to February 28, 2010.
* The ARRA premium subsidy period expands to 15 months, increased from current nine months.
* Those who have lost their subsidy by completing their nine months in November or later are grandfathered in under the new law and may receive six additional months of the subsidy.
* Employees who are involuntary terminated on or before February 28, 2010, are eligible for the subsidy, regardless of when their COBRA eligibility period begins. This addresses a congressional oversight in the original bill pertaining to December 31, 2009, qualifying events.
* Additional notices will be sent regarding the amendments to assistance-eligible individuals, as well as those who qualify for COBRA due to termination of employment.
* The provision also allows a period for the retroactive payment of premiums for assistance-eligible individuals whose subsidy period expired on November 16, 2009, and who failed to continue to pay their premiums.

* The same refund and credit rules under the original ARRA bill apply to any assistance-eligible individual whose subsidy expired in November and who has since paid the full COBRA premium.

Impact on state continuation coverage:

* The premium subsidy program also applies to group health plans subject to state continuation "mini-COBRA" requirements that are regulated by state departments of insurance.
* The subsidy period for state continuation will vary by state but cannot exceed 15 months regardless of state continuation rules.

Health Insurance Exchange Reform Weekly EasyToInsureME

2009-12-24T07:33:00.000-08:00

DECEMBER 23, 2009

This Week in Health Reform

Senate Majority Leader Harry Reid (D-NV), may just reach his goal of getting a health care reform package approved by the Senate by Christmas. This past week, Sen. Reid clinched the 60th vote needed to pass the legislation. As of this communication, he has scheduled the final Senate vote for 7 a.m. on Christmas Eve day. In an effort to shore up votes, Sen. Reid and his colleagues struck deals to overcome hot-button issues such as abortion funding.

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Senate Negotiations

Senate Eyes Finish Line: After weeks of rancorous debate and more than 20 straight days and nights spent negotiating on Capitol Hill, Senate lawmakers cleared all three major procedural hurdles prior to a final vote on the legislation.

* The first procedural motion passed on a 60-40 vote early Monday morning , ending debate on Sen. Reid's proposed amendments, called the "manager's package," and cutting off a Republican filibuster. The "manager's package" represented a series of last-minute deals and compromises to shore up support for the legislation.
* The second procedural motion to approve the "manager's package" passed 60-39 on Tuesday morning.
* The third motion came Wednesday and ended debate on the final legislation in a 60-39 vote, setting up the reform bill for a final vote just in time for Sen. Reid's Christmas deadline.

Sen. Reid Carves Out State-Specific Deals to Secure the 60 Votes: On Saturday, Sen. Reid secured the 60 votes needed to pass the historic legislation, winning over Sen. Ben Nelson, (D-NE), with an amendment to prevent federal subsidies from being used for abortions. Under the new abortion provisions, states can opt out of allowing coverage for abortion. If states do offer coverage, enrollees must pay for abortion coverage separately - a compromise that has sparked criticism from both sides of the abortion divide. Sen. Nelson also secured other benefits for the state of Nebraska, including:

* Millions of dollars from the federal government to pay for the proposed cost of the Medicaid expansion in his state; and
* An exemption for Blue Cross Blue Shield of Nebraska from an annual fee on insurers.

Throughout his amendment package, Sen. Reid included several other state-specific deals to secure the 60 votes. Such last-minute deals have been criticized by Republicans, including:

* For Sen. Max Baucus, (D-MT), the package included a provision to help 2,900 residents of Libby, Mont., sign up for Medicare benefits. Many residents have asbestos-related illnesses;
* For Sen. Christopher Dodd, (D-CT), it included a measure to provide $100 million for the construction of a hospital at a public university;
* Sen. Patrick Leahy, (D-VT), negotiated for $600 million in additional Medicaid benefits for his state over 10 years;
* Sen. Bernie Sanders, (I-VT), got a $10 billion increase for community health centers over a number of years;
* Sen. Mary Landrieu, (D-LA), procured at least $100 million in 2011 from the federal government for help with Medicaid; and
* For Sen. Bill Nelson, (D-FL), the package included a measure allowing some 800,000 Florida senior citizens currently enrolled in private Medicare Advantage plans to keep their extra benefits.

Sen. Reid's negotiations also included:

* The removal of a 5 percent tax on elective cosmetic surgeries, and the inclusion of a 10 percent tax on indoor tanning services;
* 12 years of patent protection for the makers of brand-name biotech drugs;
* An increase in the Medicare payroll tax percent of an additional 0.9 percent of income for those making $200,000 as an individual and $250,000 for couples;
* An exemption from taxes on high-value insurance plans for those with certain professions, such as firefighters, policemen, construction workers, emergency first responders and longshoremen;
* A provision allowing for doctors and hospitals in Montana, North Dakota, South Dakota, Utah and Wyoming to get paid more than providers elsewhere; and
* About $1 billion extra in Medicaid payments for visiting nurses and other in-home or community services.

CBO Updates Estimates on Health Care Bill's Impact: In a letter sent to Sen. Reid, the Congressional Budget Office (CBO) said that it had over-estimated the latest Senate health care bill's impact on deficit reduction during the second decade of enactment. The original estimate indicated the overhaul would yield deficit reductions by one-half percent of GDP; the revised estimates indicate a reduction of between one-quarter and one-half percent of GDP. The CBO confirmed that its estimate over the first 10 years remains accurate, reducing the deficit by up to $132 billion by 2019.

However, in a Wednesday letter to Sen. Jeffery Sessions, (R-AL), the CBO indicated that the current Senate bill may potentially double count the savings from Medicare as a means to pay for the Senate health care bill. In the letter, CBO Director Doug Elmendorf writes: "The key point is that the savings to the (Hospital Insurance) trust fund under the (Patient Protection and Affordable Care Act) would be received by the government only once, so they cannot be set aside to pay for future Medicare spending and, at the same time, pay for current spending on other parts of the legislation or on other programs." Republicans quickly jumped on the letter as proof that the Senate's bill will not decrease the federal deficit over time, but rather add to it.

Late last week, the CBO estimated that the revised Senate bill will cost $871 billion over the next decade to extend coverage to the uninsured. It would dramatically expand Medicaid and offer federal subsidies to those who lack affordable coverage through employers. The nation will pay for the overhaul with about $400 billion in new taxes and about $500 billion in cuts to programs such as Medicare.

Sen. Snowe Indicates "No" Vote: Despite many weeks of negotiations with Republican Sen. Olympia Snowe of Maine and several one-on-one meetings with President Barack Obama, Sen. Snowe indicated that she will vote against the Senate's legislation without significant changes. Sen. Snowe has been a pivotal figure in the health care reform debate as the only Republican to have voted for the Senate Finance Committee's bill, which passed in October. The loss of Sen. Snowe's support comes as a blow to Democratic leaders who were hoping to achieve some level of bipartisan support.

Other Activities

AMA, AHA, AARP and FAH Show Support; AHIP Opposes: On Monday, both the American Medical Association (AMA) and the American Hospital Association ( AHA) sent letters to Sen. Reid indicating support for the latest version of the Senate health care bill, while highlighting requests for changes. The AMA, for example, hopes to see changes to the independent board that would be created to slow the growth of Medicare costs. Among other adjustments, the AHA requested a change that would lower Medicare payments to hospitals with high readmission rates. Endorsements also came from AARP and from the Federation of American Hospitals (FAH). In contrast, a statement Friday from America's Health Insurance Plans (AHIP) voiced opposition to the bill, citing cuts to Medicare Advantage programs and caps on insurers' administrative costs as problematic.

Public Opinion

December Polls Show Americans Disapprove: As a final vote on the Senate's health care reform package nears, Americans are increasingly wary of its impact. The December Kaiser Health Tracking Poll found that:

* Only 35 percent of Americans said they would personally be better off if health care reform passes - down from 42 percent last month;
* Only forty-five percent of voters said the country would be better off with health reform - down from 54 percent last month.

The latest poll results released Tuesday from Quinnipiac University show that:

* Americans "mostly disapprove" (53 percent to 36 percent) of the Senate's plan;
* A majority (56 percent to 38 percent) disapprove of President Obama's handling of health care reform;
* Voters oppose (72 percent to 23 percent) using any public money in the health care overhaul to pay for abortions;
* Americans support (56 percent to 38 percent) giving people the option of coverage by a government health insurance plan; and
* A majority (64 percent to 30 percent) support allowing younger people to buy into Medicare.

As a volatile year in health care reform comes to a close, an average of monthly polls since April shows that 82 percent of Americans say an overhaul of the nation's health care system is important for recharging the economy. However, in the most recent Robert Wood Johnson Foundation poll taken in November, 60 percent said an overhaul will not affect their personal access to health care or their family finances, and only about 40 percent said a revamping will improve access to care in the nation overall. Further, only about 30 percent believe health care reform will help the county's financial status.

Looking Ahead

Senate lawmakers are expected to vote on their final health care reform legislation early Thursday morning, setting the stage for reconciliation with the House bill passed in November. When lawmakers return from holiday break in January, the conference committee between the two chambers is expected to begin discussions about merging the two bills. Leaders of the House and Senate had hoped to have a final bill approved by Congress and sent to President Obama before the State of the Union address, scheduled for late January or early February. However, White House officials now indicate that given January's tight legislative calendar, this timeframe is unlikely.

Health Insurance Quotes Reform Final Vote EasyToInsureME

2009-12-22T07:59:00.000-08:00

In the past week, the Senate’s health care reform legislation has run the political gauntlet, with Republicans trying to filibuster other legislation to create a roadblock, liberal Democrats complaining loudly about the loss of some favorite provisions, and independent-minded Democrats forcing some significant changes. But the holiday break and the President’s stated goals have given Senate Democrats powerful motivation to get health care reform to a vote this week. Regardless of what happens in the Senate this week, the House has adjourned, which means that the health reform debate will certainly carry over into 2010. Conference committee deliberations between House and Senate leaders are expected to be difficult. (Read the rest of Health Insurance Quotes Reform Final Vote here)

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Individual Health Insurance Reform EasyToInsureME

2009-12-18T07:43:00.000-08:00

December 17, 2009

It appears that the U.S. Senate will vote to close debate on its version of federal health care reform as early as this weekend. Whether or not you have contacted your senators previously, now is the time for you to consider contacting both of your senators and encourage them to continue debate and to improve the legislation.

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It is difficult to overstate the negative implications of Senate Majority Leader Harry Reid's (D-NV) proposal. According to the Congressional Budget Office, this legislation - if enacted - will have a significant, negative impact on the cost and nature of coverage for our customers. The administration's chief actuary for Medicare and Medicaid Services has determined that if the Senate health care bill became law, it would increase national health care spending more than if we did nothing. Our own analysis concurs with these assessments and further indicates that Sen. Reid's proposal will likely lead to higher premiums for many of our customers without reducing the growth in underlying health care costs.

A new Washington Post-ABC News poll indicates that 53% of Americans understand that their personal costs will increase under this proposal and only 37% believe that their personal health care will improve under this legislation. The Senate needs to set aside this version of health care reform and construct a proposal that has broad and deep public support.

Throughout the health care reform debate, our company has sought to partner with our elected leaders in both parties to pursue responsible, sustainable reform that lowers costs and increases access. The current legislation does not meet these goals and Congress needs to hear from individuals who are concerned about the consequences of well-intended but flawed reforms.

While we continue to support health care reform, we cannot support reform that fails to address the cost and quality issues in our health care delivery system and undermines the bipartisan consensus for responsible and sustainable reform.

The holiday season is a busy time for all. Now is the time to get involved today.

The Senate needs to hear from you and time is short.

Health Insurance Quotes Reform Weekly EasyToInsureME

2009-12-17T13:32:00.000-08:00

Week of December 14, 2009

Health care reform provisions are changing fast as the Senate considers numerous amendments on the floor, and there is no better example of how fast than the much-reported government plan option. Senate leaders announced last week that a deal had been struck to remove the public plan from the bill in favor of a not-for-profit private insurance option and an expansion of Medicare to allow people 55 or older to buy in. The deal was quickly lauded by the White House and others, but concerns soon emerged about the new approach from various sectors of the health care system. A day or two later, the Associated Press reported that Senate Democrats were changing the "breakthrough" provisions in response to those concerns. The anticipated impact of the reform bill (especially its raft of proposed health care sector taxes and fees) on costs continues to be the focus of most critics, from labor unions to hospitals.

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Federal

The Senate last week barely moved forward on health care reform. Although the Senate focused on health care issues the entire week, there were no votes past Tuesday and the key amendment of the week (reimportation of cheaper drugs from Canada and overseas) is in limbo though the amendment clearly has majority support. Off the floor the action is more intense and meaningful. Earlier in the week Majority Leader Harry Reid announced a "deal" on the public plan. As it turned out the deal was among 10 Democrats only, and no details of any consequence were released. Reid himself was closed-mouthed claiming everyone had to wait until the CBO had a chance to "score" this newest iteration of health reform. The deal is in three parts: 1) use of the Federal Employee Health Benefit Plan model in which a federal agency would administer a national plan with private carriers in the mix; 2) triggering a true public plan if too few carriers participate in this national plan; and 3) allowing seniors 55 to 64 years old to buy in to Medicare. Even before the CBO score is back we already know that Senator Joseph Lieberman (D-CT) is opposed to the Medicare piece alone, if not the rest, and would filibuster the overall bill; Senator Ben Nelson (D-NE) is not far behind. And, if the score is bad and turns away additional moderate Democrats, Reid may have to go back to the drawing board for yet another twist to the never-ending saga of health care reform.

States

FLORIDA: A final draft of the voluntary compact regarding coverage for cancer clinical trials was circulated to interested parties late last week by legislative leadership. Aetna has been working with leadership, both directly and through the Florida Association of Health Plans, to assure the language follows current coverage guidelines. Aetna anticipates being a signatory to the compact.

MASSACHUSETTS: The Massachusetts Joint Health Care Financing Committee held a hearing on legislation requiring every full-and part-time college student in Massachusetts to have at least the basic level of health insurance required under the state's 2006 health reform law. If enacted, the new law would require students to carry the minimum credible coverage to be considered insured. Universities and colleges that fail to carry out their "responsibilities" to ensure student compliance would be fined a penalty of $1 per student for every day their "failure" continues. The bill also would require the Division of Insurance to issue regulations establishing procedures for implementation and monitoring of compliance. Massachusetts' existing individual mandate applies to students age 18 or older who pay in-state tuition rates for themselves at a Massachusetts community college, state college, or university.

MISSOURI: The pre-filing of bills for the second regular session of the Missouri 95th General Assembly began on December 1, and several new bills concern federal health care reform. Several pre-filed bills that failed to pass in the first regular session included an autism spectrum disorder mandate as well as a bill to amend the current prompt-pay statute. Both are expected to continue to be debated again in 2010. New to the Assembly are bills to pursue a constitutional amendment to prohibit compelling a patient, employer or health care provider to participate in any government- or privately run health system and to prohibit banning a person or employer from paying directly for legal health care services. Another new bill would pursue a constitutional amendment to penalize a political subdivision for participating in a health insurance option sponsored by the federal government. New also is a bill to provide premium refunds for consumers with cancelled long-term care and/or Medicare supplement policies and to make it an unfair trade practice to engage in certain practices when selling Medicare products. Aetna will continue to monitor the pre-filing of bills through the start of the next legislative session in January 2010.

NEW YORK: In a press release issued last week, Governor David Paterson is calling for the reinstatement of prior approval of insurance premium rates. The Governor introduced a bill during 2009 that would have given the Superintendent of Insurance sole authority to approve rates at his or her discretion, but that bill failed to pass. Given this latest press statement, it is expected that the Governor will ask the legislature to re-introduce his program bill for 2010. The Governor tied his support for the prior approval of rates to plans' dividend requests. The dividend requests were $800 million from Oxford (18.7 percent of 2008 New York premiums), $200 million from Empire (2.5 percent) and $134 million from Aetna (16 percent). The state's insurance lobby, the HPA, responded that the dividends reflect multiple years' earnings, and the plans' margins are in the 2 percent to 3 percent range.

OHIO: Resolutions continue to be introduced in Ohio with respect to implementation of anticipated federal health care reform. Specifically, a new resolution was recently introduced requesting all members of the General Assembly to support the public plan option as part of national health care reform. This resolution adds to other pending resolutions on health care reform, such as one supporting rights for people to enter into private contracts with health care providers for health care services and to purchase private health care coverage; and another to amend Ohio's Constitution to prohibit a law or rule from compelling a person, employer, or health care provider to participate in a health care system. They are not expected to pass, as the legislature continues to focus mainly on budgetary matters.

OKLAHOMA: While testifying at a hearing before the House Appropriations and Budget Subcommittee, the Oklahoma State Auditor and Inspector suggested eliminating all health insurance options except for “HealthChoice” to cut $100 million in state employee benefits costs. Currently state employees can enroll in one of eight health insurance plans offered by four HMOs through the Employees Benefits Council or one of the HealthChoice plans offered by the Oklahoma State and Education Employees Group Insurance Board. Employees receive an allowance to offset the costs of the plans. According to state law, the allowance is calculated based on the average cost of the high-option health insurance plans, plus the average of the dental plan costs, plus the cost of life insurance, plus the cost of disability insurance, plus 75 percent of the dependent health costs, if applicable. Steve Burrage said the current arrangement creates a situation of "adverse selection" where healthy, younger employees purchase the less expensive health insurance policies offered by the HMOs, and less healthy, older employees buy the more expensive HealthChoice policies. However, both employees receive the same benefit allowance. In his FY2009 executive budget, Governor Brad Henry proposed adjusting the benefit allowance formula by giving the HealthChoice high-option plan a 40 percent weight. The proposed adjustment did not make it into the final budget.

WISCONSIN: Proposed legislation is circulating in the Senate that would create explicit statutory authority for the Wisconsin Office of the Commissioner of Insurance (OCI) to oversee operation of self-funded plans serving public-sector employees, resolve consumer complaints, and monitor reserve and reinsurance levels. Additionally, the bill would apply state minimum coverage requirements, such as mammograms, chiropractic care, diabetes education and care, and require a governmental body that provides a self-funded health plan to provide reports and replies to requests for information to the OCI as they relate to the plan. This bill is aimed at self-funded plans offered by cities, towns, villages, counties and school districts.

Week in Health Insurance Reform EasyToInsureME

2009-12-17T10:05:00.000-08:00

December 16, 2009

This Week in Health Reform—Legislative Overview

Senate
The Senate this week continued debate on its health care reform legislation, H.R. 3590, “The Patient Protection and Affordable Care Act”. The two most controversial issues continue to be the public option and abortion, with both issues being discussed at length last week. On December 9, Senate Democrats blocked an amendment, 54-45, by Ben Nelson (D-NE) and Orrin Hatch (R-UT) that would tighten restrictions for funding of abortions. The amendment’s language mirrored what was in the House legislation that passed last month to the opposition of many Progressive Democrats. Majority Leader Reid (D-NV), voted down the amendment stating that the language in the existing Senate bill already adequately states that insurance plans (public or private) in the new exchange would be restricted from using taxpayer money for abortions.

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Democrats Ben Nelson (NE), Bob Casey (PA), Kent Conrad (ND) and Byron Dorgan (ND), Ted Kaufman (DE) and Mark Pryor (AR) all supported the amendment. An outspoken opponent on abortion, it is unclear whether or not Nelson will support a final bill without the amendment. If he does not, then Reid has the additional task of ensuring that at least one Republican Senator votes in favor of his bill to secure the 60 votes needed to block a filibuster.

In order to break the bottleneck in the Senate over the public option last week, a group of ten moderate and liberal Democrats negotiated a compromise agreement that they said would appease both moderate and liberal Democrats – and perhaps interest some moderate Republicans. The re-formatted public option would create a national insurance plan, run by nonprofit private insurance companies, and supervised by the Office of Personnel Management. The program is said to be modeled after the Federal Employee Health Benefits Program (FEHBP), which currently covers more than eight million federal employees, including members of Congress. To appease the liberal base of the Democratic Party, the compromise also reportedly created an expansion of Medicare to individuals between the ages of 55 to 64.

Senator Joe Lieberman (I-CT), an Independent who often caucuses with the Democrats, has been an outspoken opponent of the Medicare expansion provision and publicly stated that he would not vote for any bill that includes it. While Senators still remain quiet on the details of the legislation, stating that they are waiting to receive a cost analysis from the Congressional Budget Office (CBO) before discussing it publicly, it looks like the Medicare expansion provision has been removed from the pending legislation.

Reid is still aiming to have a vote on the Senate’s portion of the health care reform bill ahead of the Christmas holiday.

House
Last week Speaker Nancy Pelosi (D-CA) publicly stated that she would not discard the option of keeping House members in Washington for part of Christmas week – if it means that they make progress in passing health care reform legislation. Pelosi reiterated both her support for President Obama’s top domestic priority – health care reform – and her enthusiasm for seeing the Senate’s version of the bill.

Overview: NFIB Opposes Senate Health Care Reform Bill
On December 8, the National Federation of Independent Businesses (NFIB), an association that represents small and independent businesses, publicly stated its opposition to the Senate’s “Patient Protection and Affordable Care Act” (H.R. 3590).

See below for excerpts from the letter:

* The letter states that “the most recent Congressional Budget Office (CBO) study detailing the effect that H.R. 3590 will have on insurance premiums reinforces that, despite claims by its supporters, the bill will not deliver the widely-promised help to the small business community. Instead, CBO findings report that the bill will increase non-group premiums by 10 to 13 percent and result in, at best, a two percent decrease for small group coverage by 2016. These findings tell small business all it needs to know – that the current bill does not do enough to reduce costs for small business owners and their employees.”

* “Despite the inclusion of insurance market reforms in the small-group and individual marketplaces, the savings that may materialize are too small for too few and the increases in premium costs are too great for too many. Those costs, along with greater government involvement, higher taxes and new mandates that are disproportionately targeted at small business and are being used to finance H.R. 3590, create a reality that is worse than the status quo for small business.”
* “...the excessively tight age rating (3:1) in H.R. 3590 will increase more costs than it will decrease, and make coverage unaffordable for the very populations that are most beneficial to the insurance pool – the young and the healthy. Independent actuaries have analyzed the negative impact of such tight bands and have indicated that there will be devastating effects to the long-term viability of a pool without action to correct this rating imbalance.”

Health Insurance Quotes Reform Weeklys EasyToInsureME

2009-12-11T12:15:00.000-08:00

DECEMBER 11, 2009

This Week in Health Reform

This week Senate lawmakers continued to debate numerous proposed amendments to Senate Majority Leader Harry Reid's (D-NV) health care reform bill.

An updated analysis by our parent company shows that, with the proposed health care reform legislation, across- the-board premiums will increase significantly for younger and healthier people who purchase insurance on the individual market or through small employer groups.

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Senate Negotiations

Senate Continues Debate on Health Care Reform Bill: As Senate lawmakers continued to debate through the weekend and voted on proposed amendments, President Barack Obama encouraged this effort by visiting Capital Hill on Sunday and urging lawmakers to put aside their differences and pass the historic legislation. While the President did not mention abortion or the government-run option specifically, those issues remain particularly divisive and at the center of debate on the Senate floor:

* Abortion - On Tuesday the Senate rejected (54-45) an amendment proposed by Sen. Ben Nelson (D-NE) that would have imposed restrictions on coverage of abortion services for people who received subsidies to buy insurance. Sen. Nelson has indicated that he will not support a health care reform bill that does not include language restricting abortion coverage. Tuesday's vote puts into question whether Sen. Reid has the 60 votes necessary to pass the reform package.
* Government-Run Option - On Tuesday night a group of 10 appointed Democratic Senate lawmakers announced a tentative agreement in regards to the public option. In an effort to remove a major hurdle to passing legislation this year, the group of negotiators offered an alternative program to the government-run option that would create several national insurance plans administered by private companies but negotiated by the Office of Personnel Management, which oversees health policies for federal workers. The negotiators said that a government plan would only be created if private firms were unable to deliver acceptable national policies.

The agreement would allow individuals to buy into Medicare starting at age 55, and insurance companies would face new regulations, including a requirement that they spend at least 90 cents of every dollar collected in premiums on medical services for customers.

In response to the agreement, the American Hospital Association, the American Medical Association, the American Federation of Hospitals - along with other health care companies, including insurers and drug makers - expressed concerns over the proposed Medicare expansion. Some also voiced concerns that the agreement simply represents another form of a public option. Those in opposition cite potential cost increases, low Medicare reimbursements and greater government control over parts of the health care industry. Hospital representatives said an expansion of Medicare would violate a deal they reached with the White House this year to give up $155 billion in Medicare payments over the next decade. Furthermore, The National Federation of Independent Business, a small-business association, released a statement opposing the legislation as an inadequate response to rising costs.

Currently Sen. Reid has only released a few specific details about the agreement, and lawmakers are hesitant to endorse the plan until it is better understood. Sen. Joe Lieberman (I-CT) has indicated that the inclusion of a public option trigger may be a possible deal breaker. Sen. Reid presented this new agreement to the Congressional Budget Office (CBO) to be analyzed and is currently waiting for the CBO costs estimates.

In addition, on Wednesday Senate lawmakers debated an amendment offered by Byron L. Dorgan (D-ND) that would allow for the importation of prescription drugs from other countries. Should it pass, the measure could threaten the pharmaceutical industry's support for President Obama's health care reform. The pharmaceutical industry strongly opposes allowing prescription drug imports, indicating that the risk for counterfeit drugs would increase. While the amendment was supposed to come to a vote on Wednesday, an agreement was not reached and debate continued on Thursday.

Other Activities

Federal Insurers Warn of Higher Premiums: The Association of Federal Health Organizations , which includes federal employee-sponsored health insurance companies and Associate Member Blue Cross and Blue Shield Association, is starting to make waves on Capitol Hill with information released in a November 25 report to the Office of Management and Budget. The report indicates that health insurance premiums could go up and benefits could be hurt due to impending fees on the insurance industry and the excise tax on premiums above a certain amount.

Drug Makers May See Increased Fees: Media reports indicate that the bill emerging from the Senate may include fees on the pharmaceutical industry that are greater than the $80 billion originally discussed in June. Given that the House bill would cost drug makers about $140 billion, the eventual House-Senate bill is likely to include fees exceeding $80 billion.

Public Opinion

Americans Oppose Reform Plan: As special interest groups express concern over the latest Senate proposal, polls continue to show that Americans are increasingly worried about the impact of reform. The most recent Quinnipiac University Poll indicates that Americans disapprove (52-38 percent) of the health care reform proposal under consideration in Congress. Furthermore, a Bloomberg National Poll indicates that 62 percent of Americans say they are mostly pessimistic that they would benefit from the bill.

Looking Ahead

Senate lawmakers will continue working around the clock and weekends to debate and vote on the proposed amendments. Sen. Reid is still pushing to have a final Senate reform package put together by Christmas.

Health Insurance Quotes Reform EasyToInsureME

2009-12-10T08:12:00.000-08:00

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.

This Week in Health Reform EasyToInsureME

2009-12-10T08:10:00.000-08:00

December 9, 2009

This Week in Health Reform —Legislative Overview

Senate
Less than two weeks after the debut of official legislative language, the Senate began official debate on its $848 billion health care reform bill “The Patient Protection and Affordable Care Act” (H.R. 3590) on November 30. The bill, which is estimated to cover 94 percent of Americans, passed its first hurdle before the Thanksgiving holiday when Senate Democrats received the needed 60 votes on the “motion to proceed” to debate.

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More than 60 amendments have been filed to the Senate health care reform legislation in its first week of debate. Some of the notable amendments include one by Senator Barbara Mikulski (D-MD), which was adopted by a vote of 61-39. The amendment would eliminate co-payments for many preventive services for women – and would require that insurers provide full coverage for breast and cervical cancer screenings. Senator David Vitter (R-LA) also included a stipulation to the amendment that would preclude the most recent controversial recommendations on breast cancer screenings by the U.S. Preventive Services Task Force from being used for insurance coverage determinations. Additionally, Senator Ben Nelson (D-NE) and Senator Orrin Hatch (R-UT) are crafting an abortion-related amendment that will mirror the one passed in the House version of the bill last month. The amendment would prohibit the use of federal funds for abortions.

Senator Thomas Carper (D-DE) is leading efforts in the Democratic caucus on the creation of a public health insurance option that is built around a state-by-state “trigger” option. Carper has spent weeks working with members of the Democratic caucus, as well as some moderate Republicans on the amendment that he is hoping will appease a broad range of individuals concerned about the government-run health insurance plan, also known as the “public option”.

Majority Leader Harry Reid (D-NV) still has significant work to do in uniting his divided Democratic caucus. Reid has stated that he will keep Senators in Washington on weekends throughout December to ensure that key legislative issues are worked out before a final bill can be brought to the Senate floor. As detailed above, Reid will have to balance trying to appease the progressive members of his party with a robust government-run health insurance plan with corralling the moderate and conservative Democrats who have been vocal on issues such as abortion and cost-containment measures.

House
The House of Representatives remains quiet on health care reform legislation after passing its portion of the bill in November. Its main focus during the next few weeks before the holiday recess will be on a financial regulation package to be brought up by the House Committee on Ways and Means.

Health Insurance Quotes Reform EasyToInsureME

2009-12-04T11:37:00.000-08:00

DECEMBER 4, 2009

This Week in Health Care Reform

On November 21st Senate lawmakers voted along party lines to move ahead with a floor debate over Senate Majority Leader Harry Reid's (D-NV) proposed health care reform legislation. Negotiations began in the Senate this week following the Thanksgiving recess.

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WellPoint believes the Senate legislation will have a significant, negative impact on the cost and nature of coverage for our customers. We believe it will cause more problems and have outlined several reasons why employers, employees, and consumers should be concerned about this legislation.

If these points concern you as well, we encourage you to engage your Senators thru visiting the Health Action Network.

House and Senate Negotiations

Senate Debates Health Care Reform Bill: As the debate began Monday, discussions highlighted many contentious issues including cost-containment, the public option, illegal immigrants, Medicare cuts and abortion funding. In the coming weeks each side will be offering dozens of amendments that will be debated and voted on. On Wednesday, lawmakers agreed to vote on amendments addressing two of this week's main issues , centering on women and seniors:

* One proposed amendment, co-sponsored by Sens. Barbara Mikulski (D-MD) and Olympia Snowe (R-ME), would increase insurance benefits for women, mandating that policies include an annual health screening. While the amendment does not specifically lay out what preventive services will be covered, the measure gives the Health and Human Services Secretary authority to make these determinations. Debate on the amendment in part focused on the controversial recommendations last month that women undergo fewer mammograms and Pap smears to test for cervical cancer. The Congressional Budget Office said the amendment would cost $940 million over a decade. This amendment passed by a vote of 61-39.
* Another proposed amendment was filed by Sen. John McCain (R-AZ) and would remove from the bill $400 million in Medicare cuts to home health providers, hospitals and private providers of Medicare Advantage plans. This motion failed by a vote of 58 to 42.

AARP Backs Medicare Cuts: As Senate lawmakers prepare to vote on controversial Medicare funding amendments to the reform legislation, AARP said in a letter on Wednesday that the organization supports Medicare cuts.

Medical Groups Oppose Senate Bill: A coalition of the American College of Surgeons and 18 other medical societies representing surgeon specialists indicated Wednesday that they could not support the proposed Senate bill given that it inadequately addresses Medicare's doctor payment system. In addition, the California Medical Association joined a number of other state medical associations , including Florida, Georgia and Texas, in opposition to the bill being discussed in the Senate. The California Medical Association cites increases in costs of services and restrictions in access to care for elderly and low-income people as reason for the opposition.

CBO: Premiums Could Rise for Individuals: According to a new analysis from the Congressional Budget Office (CBO) released Monday, the Senate's health care reform bill may increase premiums for individuals purchasing insurance, unless they qualify for government subsidies. The report also indicates that employees from large companies would see premiums decrease, while those from small firms would see premiums remain largely unchanged. On Tuesday, The Wall Street Journal editorial page made the case that, according to the CBO, employer-sponsored insurance costs would remain roughly in line with the status quo; a result tantamount to failure, considering the overall cost-cutting goals of reform.

Abortion Continues to Take Center Stage: Abortion-rights groups held a lobby day on Wednesday as part of a national "week of action" to fight language in the House health care bill, which would impose greater restrictions on access to the controversial procedure. The Senate's reform bill currently does not include the same level of restrictions. However, the language from the House bill is expected to come up during the debate.

Other Activities

Pfizer CEO Backs Reform: Pfizer, Inc . CEO, Jeffery Kindler, said Tuesday that he supports Congress' efforts to reform the health care system. However, he is specifically opposed to anything that could lead to price controls - such as giving the government the ability to directly negotiate with drug makers for products under the Medicare Part D drug benefit program. Mr. Kindler also stated that the $80 billion that the pharmaceutical industry has agreed to contribute to help pay for the health care system overhaul exceeds any benefit that the industry would receive from additional patients due to extended coverage.

Public Opinion

Americans Lean Against Health Care Reform: The latest USA Today/Gallup Poll released Monday shows that Americans currently skew against passing health care reform legislation. Forty-nine percent of Americans say they would advise their member of Congress to vote against the bill, while 44 percent say they would support it. A Robert Wood Johnson Foundation poll conducted just before Thanksgiving indicates that most Americans do not expect health care reform to affect their lives directly. However, for those who do expect a change, a larger number believe that there will be more negative affects than positive ones. Interestingly, however, another poll released Monday by the Robert Wood Johnson Foundation Center for Health Policy (UNM-RWJF Center), Latino Decisions and impreMedia shows widespread consensus among the Latino/Hispanic electorate about the importance of health care reform, indicating significant support for expansion of coverage.

Americans Support Malpractice Reform: An Associated Press poll released just before Thanksgiving shows that 54 percent of Americans favor making it harder to sue doctors and hospitals for medical errors, while 32 percent are opposed to the idea.

Looking Ahead

Negotiations on proposed amendments to Sen. Reid's reform bill will continue in the coming weeks. Sen. Reid hopes to have a health care reform bill passed by Christmas but has warned Senators to plan on working weekends to get this done.

This Week in Health Reform—Federal Legislative Overview

2009-11-23T09:59:00.000-08:00

Senate
Former President Bill Clinton visited Senate Democrats on Capitol Hill this week, urging them to quickly pass health care reform by the end of the year. Senate Leadership continues to work pulling its final merged bill together and Majority Leader Harry Reid (D-NV) says that he will introduce the legislation on the Senate floor the week of November 16th.

Under Senate rules, a 60-vote majority is required to move the bill forward before official debate can begin. It is likely that Democrats will receive the 60-votes needed to move the bill to the Senate floor, but it remains to be seen whether Reid has the full 60 votes to overcome a filibuster for bill’s official passage. Reid is still aiming to pass the legislation by the Christmas holiday.

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House
After passing its health care reform legislation, the “Affordable Health Care for America Act” (H.R. 3962), the House of Representatives was quiet this week.

Overview: Medicare Payroll in Senate Health Care Reform Legislation

The Senate’s health care reform legislation has still not yet been unveiled, but there are reports that an analysis from the Congressional Budget Office has found the bill to be more costly than expected, so Senate Democrats are already considering new ways to pay for the bill.

One of the options is an increase to the Medicare portion of the payroll tax on individuals making $250,000 per year or more. Currently, workers and employers each pay a 1.45 percent payroll tax for Medicare and the new proposal would increase that to 2.5 percent payroll tax bracket for those making $250,000 per year or more.

By including this new approach, it would allow the Senate to either reduce or eliminate altogether the controversial excise tax on “Cadillac” or high-cost insurance plans, passed in the Senate Finance Committee’s bill last month. Under legislation (S 1796) approved by the Senate Finance Committee, individual insurance plans costing more than $8,000 and family plans costing more than $21,000 would face a 40 percent excise tax on any amount above that level.

EasyToInsureME This Week in Health Reform: November 20, 2009

2009-11-23T09:48:00.000-08:00

This week focused on the unveiling of Senate Majority Leader Harry Reid's (D-NV) proposed health care reform legislation.

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House and Senate Negotiations

Reid Unveils Senate Bill: Senate Majority Leader Harry Reid unveiled his version of health care reform legislation on Wednesday night after receiving cost estimates from the Congressional Budget Office (CBO). With a price tag of $849 billion over ten years, the bill will reduce the deficit by $127 billion over a decade and cut Medicare spending by $500 billion, while increasing taxes by $500 billion. In addition, the bill will:

* Provide coverage for 31 million Americans who currently lack health insurance - accounting for 94 percent of eligible Americans
* Offer a government-run option of which states can opt out
* Expand Medicaid
* Require most Americans to carry health insurance, providing subsidies for those who cannot afford it and imposing weak penalties for violations
* Bar insurance companies from denying coverage based on pre-existing conditions or dropping coverage for those who become sick
* Impose penalties on medium and large sized employers for not providing health insurance to employees
* Increase the Medicare payroll tax on higher-income workers
* Imposes fees totaling $101.9 billion on insurance companies, drug makers, and medical device manufacturers over ten years
* Impose a tax on high-cost health insurance plans provided by employers to their employees.

While Democrats remain committed to passing the legislation, it is not certain that Reid has the 60 votes needed to bring the measure to the floor for debate. Several moderate democrats, including Sens. Mary L. Landrieu of Louisiana, Blanche Lincoln of Arkansas and Ben Nelson of Nebraska have expressed concerns over the inclusion of a government-run plan. Sen. Sherrod Brown (D-OH), however, expressed in a meeting Monday night with Reid that liberal lawmakers had conceded enough ground on the government-run plan and that he should push forward with the bill.

Members of the Senate will convene on Saturday for a rare weekend session to hold a procedural vote, deciding whether or not to bring the legislation to the Senate floor for debate.

Immigration and Abortion Remain Central to the Debate: Access to care for illegal immigrants will continue to be contentious as lawmakers work to reconcile the health care legislation passed by the House and pending in the Senate. Under the bill approved by the House, illegal immigrants would not be barred from using their own money in the newly-created insurance exchanges. White House officials and members of the Senate Finance Committee, however, pledged that undocumented workers be barred not only from receiving subsidies but also from buying insurance through federally sponsored exchanges - even with their own money.

As Senate Majority Leader Harry Reid works to finalize the legislation, he will also need to address the question of federal funding for abortions, an issue that has proved starkly divisive. Because of pressure from the Catholic Church and anti-abortion groups, the House-approved bill restricts the use of taxpayer funds for abortions, a decision that has sparked a heated debate among pro-choice and pro-life advocacy organizations. In contrast, the Senate's proposed bill would allow the use of federal funds for abortion in cases of rape and incest, requiring insurers that cover elective abortions to segregate money from Americans who get government subsidies.

Public Opinion

Polls Continue to Show Deep Divisions: A new Washington Post-ABC News poll shows that Americans are deeply divided over the current health care proposals and that the majority believes costs will rise. Forty-eight percent say they support the proposed changes to overhaul the health care system, whereas 49 percent are opposed. In addition, 52 percent say an altered system would probably make their own care more expensive, and 56 percent see the overall cost of health care in the country going up as a result of the reform.

Furthermore, a recent Associated Press (AP) poll shows that Americans are split (43 percent opposed; 41 percent support) over the health care plans being discussed in Congress. The AP poll also suggests that the public is becoming more attuned to the details of the proposals, including the cost implications and the public option. And, according to a Quinnipiac University poll released Thursday, 53 percent of voters disapprove of President Barack Obama's handling of health care reform.

However, a new CBS News poll shows that only one in four Americans prefer to have no health care legislation at all, while 51 percent support a bill with a public option.

Other Activities

CMS Report Indicates Costs Would Rise Under House Bill: According to a report issued by Richard Foster, the chief actuary at the Centers for Medicare and Medicaid (CMS), overall spending on health care would rise as a result of the legislation approved by the House. Specifically, the measure to reduce more than $500 billion from future Medicare spending would sharply reduce benefits for some seniors and may jeopardize access to care for millions of others.

Drug Makers Increase Price, Anticipating Health Reform: The media has reported that the drug industry has been raising prices at its fastest rate in years, in anticipation of the costs associated with health care reform. These costs include the $80 billion in fees over the next decade that the industry agreed to in order to help pay for coverage of the uninsured.On Wednesday, Democrats in Congress asked for two separate investigations of drug industry pricing.

Economists Endorse Health Care Reform Bill: Twenty-three high profile economists from universities and think tanks sent a letter to President Obama on Tuesday to support four important elements of health reform legislation critical to its success: deficit neutrality, an excise tax on high-cost insurance plans, an independent Medicare commission, and delivery system reforms.

Looking Ahead

The Senate will convene on Saturday for a procedural vote, deciding whether or not to bring the legislation to the Senate floor for debate. Debate could continue throughout the weekend.

Individual Health Insurance Reform EasyToInsureME

2009-11-19T09:14:00.000-08:00

Week of November 16, 2009

The Business Roundtable released a report late last week that found key components of existing health care reform legislation could slow the growth of health care costs and offer real savings for companies and their employees. The results were immediately welcomed by the White House. Yet, the report goes on to warn that certain provisions within the legislation could actually accelerate costs. "The report also shows that reform done wrong won't work and could make a bad situation much worse," said Antonio M. Perez, Chair of Business Roundtable's Consumer Health and Retirement Initiative. Aetna, a supporter of bipartisan health care reform, has expressed similar concerns. Specifically, the report notes changes that threaten to increase health care spending include failure to implement a strong individual mandate, increases in the cost of health care to individuals from changes to consumer spending accounts, and increased cost shifting to the private sector from reduced reimbursements to providers and the public plan option.

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Federal

The Democratic leadership continues to play an "inch-by-inch" game on health care reform. In the House, Speaker Pelosi is fully aware of the fact that the very bill she managed through the House would very likely not pass a second time because of the abortion issue. But she succeeded in inching the bill forward, which was the plan all along. In the Senate, Majority Leader Harry Reid continues weaving policy substance with political reality in order to create a mosaic that can inch forward to the next milestone, which is getting the 60 votes needed to allow the Senate to proceed to debate. He has yet to release the final "merged" bill; Senator Reid is going one-on-one with the Senate to sort out the combination of provisions that will allow him to get past the next hurdle. The abortion issue is the latest stumbling block, as at least one Senator is saying "no" to proceeding without this very provision. To jump start the process, Senator Reid is using the first of myriad procedural tactics to get the bill to the Senate floor. But if Republicans stand their ground, Senator Reid probably can't get to that next step (the "motion to proceed") until Friday. That would leave only enough time to make a few introductory speeches and go home for Thanksgiving.

On Thursday, the House is expected to proceed to debate and possibly pass a permanent "fix" to the perennial problem of what to do about scheduled cuts to physician reimbursement in Medicare. The House leadership wants to spend $210 billion (with no good funding source) to eliminate the upcoming 21 percent cut in 2010, along with all future cuts. The Speaker needs to make the gesture, given the AMA's support for her health care reform bill. It is unclear whether this measure will pass in the House; however, it is clear that such a measure will have a more difficult time in the Senate. For one, the Finance Committee reform bill already contains a one-year "fix" costing $10.9 billion, which is the best Chairman Max Baucus thinks is currently possible. The Senate already tried two weeks ago to pass a permanent fix, and Senator Reid was soundly rebuffed in the effort.

States

ILLINOIS: A leader in the Senate has prefiled a bill to amend Illinois' HIPAA law with a proposal that group and individual health insurance carriers be prohibited from imposing any pre-existing condition exclusions. Current limitations imposed by state law would be deleted. While the issue is being discussed on the federal level, this issue has had a lot of traction with both House and Senate Insurance Committee members for the past six months. As amended, the current proposal may not meet current federal HIPAA requirements. The bill will not be considered until January 2010.

MICHIGAN: The Office of Financial and Insurance Regulation (OFIR) has scheduled a hearing on November 23 to review Blue Care Network's proposal to buy Physicians Health Plan. In late September, Blue Care Network, a Michigan nonprofit HMO, filed a statement with OFIR regarding its intention to acquire control or merge with Physicians Health Plan of Mid-Michigan-Family Care and PHPMM Insurance Company. OFIR has 90 days to review the statement. Various parties have requested that OFIR conduct public hearings before making a decision on the sale, due to concerns raised regarding the size of the Blue Cross Blue Shield of Michigan.

NEW JERSEY: The governor has directed state departments and agencies to collectively cut $400 million from the state budget due to state revenue collection falling well short of budget projections. Furthermore, the Governor requested that the legislature not pass any spending bills during the upcoming "lame duck" session. This nearly half-a-billion dollar shortfall, coupled with a projected $8 billion budget deficit for next fiscal year, puts the state in dire fiscal straits. With options limited for making up the lost revenue, businesses operating in the state will be closely monitoring this developing situation.

NEW YORK: The legislature has passed a bill that prohibits all subrogation (collateral source or third party) recoveries by an insurer for medical expenses. The former collateral source rule eliminated the potential windfall of double recoveries by plaintiffs who receive medical benefits and win recoveries from defendant payments. The old rule of law allowed insurance companies to offset potential premium increases to consumers by authorizing them to recover medical costs from payments made to an injured plaintiff from a jury award or settlement. With that option no longer available, insurance premiums in New York will be further stressed. In addition, Governor Paterson and the hospital sector are proposing that the current Patient Services Assessment (PSA) of 9.63 percent be increased by 0.25 percent to generate an additional $54 million as part of the Governor's second Deficit Reduction plan (DRP) for 2009. The hospitals are advocating for this insurance tax increase to offset some of the governor’s proposed Medicaid cuts on hospitals. The $800 in insurance taxes adopted this year already includes an increase in the PSA, and the new proposal would make the latest increase retroactive to November 1, clearly not included in premium increases for 2010. The legislature is set to return to the Capitol for two more special session days to address the DRP.

OKLAHOMA: Two Republican State Senators are sounding the alarm bell regarding both U.S. House and Senate versions of health care reform, charging that either would devastate at least one new health care facility in Oklahoma City and cost Oklahoma County and surrounding environs more than 500 jobs. State Sen. Jim Reynolds and Sen. Harry Coates say both bills would financially devastate many top-quality health care facilities, including Oklahoma Heart Hospital’s $98 million South Campus, which is set to open soon. The bills would financially undermine the facility by denying the facility federal reimbursement for services such as Medicare and Medicaid. A joint venture of Mercy Hospital, Midwest City Regional and a group of local physicians, the facility will serve much of southeast Oklahoma County along with hundreds of active-duty military and veterans. Both Sen. Coates and Sen. Reynolds say they will ask Gov. Brad Henry to intercede quickly to remove the onerous provisions.

UTAH: The Department of Insurance is circulating a draft bill to amend the state's uniform electronic standards law to require insurers to provide coverage eligibility and detailed coordination of benefits information to physicians. Aetna will be submitting comments, including the fact that an insurer is not the repository of each member's applicable insurance coverage information and that a July 1, 2010, effective date does not allow sufficient time for implementation.

EasyToInsureME Health Insurance Quotes Reform Weekly

2009-11-16T10:30:00.000-08:00

This Week in Health Reform: November 13, 2009

This week's debate focused on last Saturday's approval of health care reform legislation by the House of Representatives. Some members of the media have raised concerns over the costs associated with the Democrat version of health care reform, highlighting the challenges Democrats might face politically as health care reform legislation evolves in Congress.

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House and Senate Negotiations

House Passes Health Care Reform Legislation: Late last Saturday, the House narrowly passed its health care reform package with a 220-215 vote, which included opposition from 39 Democrats. One Republican, Rep. Joseph Cao (R-LA), voted in favor of the bill. President Barack Obama visited Capitol Hill on Saturday morning to encourage House Democrats to pass the legislation.

The $1.1 trillion legislation passed by the House would extend coverage to an estimated 36 million Americans, vastly expand Medicaid, establish a government-run option, and create individual and employer mandates. It would also bar insurers from denying coverage based on pre-existing conditions or from dropping coverage for those who become sick. To pay for the expansion, the House passed measures including a $400 billion cut in Medicare spending over the next 10 years and new taxes on the wealthy. While the Congressional Budget Office (CBO) estimates that the bill will reduce the federal deficit by about $104 billion over a decade, the bill's longer term impact remains unclear, and some Democrats are still raising concerns over its costs.

In order to secure enough votes for passage, House Speaker Nancy Pelosi (D-CA) agreed to hold a vote on an amendment that would specifically bar the public plan from covering abortion and prohibit those who receive insurance subsidies from using the subsidy to purchase private plan options that cover abortion. The amendment was approved 240 to 194, with 64 Democrats in favor. Abortion rights supporters, however, vowed to oppose the final legislation if it remains in the amendment, highlighting the difficult road ahead.

AARP and AMA Back House Bill: The House reform legislation received a boost last Thursday, winning the support of two highly influential lobbies - AARP and the American Medical Association (AMA). The announcements came at a critical time as the House Speaker was working to shore up the last votes needed to pass the reform legislation.

Small Businesses Voice Concern: Groups and coalitions representing small businesses showed their opposition to the health care reform late last week, sending letters to lawmakers urging them to vote against the House health care reform bill. In a statement Saturday, Susan Eckerly, Senior Vice President of the National Federation of Independent Business, said, "With unemployment at a 26-year high, the punitive employer mandates and atrocious new taxes will force small business owners to eliminate jobs and freeze expansion plans at a time when our nation's economy needs small business to thrive."

Obstacles Remain for Senate: While Senate Majority Leader Harry Reid (D-NV) waits for the CBO to review the Senate's health care proposal, many hurdles remain before securing the 60 votes needed for it to pass. These obstacles include the incorporation of a public option, issues associated with federal funding for abortion, and how to pay for the health care overhaul. Recent reports indicate that Sen. Reid is favoring an increase in payroll tax on the wealthy to help pay for reform. In addition, U.S. drug makers, medical-device manufacturers and insurers are gearing up for another opportunity to reduce proposed industry fees in the Senate version of reform legislation.

With continuing pressure from White House officials to pass health care reform legislation by the end of the year, Sen. Reid has indicated that he will bring the reform package to the Senate floor for debate as early as Monday. However, Senators have indicated that, more realistically, voting will take place before Christmas, with the final passage in mid-January. In an effort to spur on Senate Democrats, Former President Bill Clinton - whose health care reform efforts failed 15 years ago - told the senators over lunch last Tuesday that "passing health care reform is not only a moral issue but also an economic imperative."

Public Opinion

American Support Slips for Passing a Health Care Reform Bill: A new Gallup Poll released last Monday shows that Americans have moved in a more negative direction on whether or not a new bill should be passed into law. Thirty-eight percent of Americans now say they would advise their member of Congress to vote against a new health care bill this year, while 29 percent would advise their member to vote for it. In addition, 41 percent say a new health care bill would make the U.S. health care system better in the long run, while 40 percent say it would make things worse.

Other Activities

Republicans Mobilize to Increase Opposition: In an effort to drum up opposition to the Democratic health care reform bills, Senate Republican Conference Chairman Lamar Alexander (R-TN) indicated that Republicans are "quietly" planning approximately 50 in-person and telephone town hall gatherings over the next three weeks.

Looking Ahead

CBO estimates of the cost of the Senate health care reform package are expected late this week or early next week, which will clear the way for Senate Majority Leader Harry Reid to bring the legislation to the Senate floor for debate as early as Monday.

EasyToInsureME Individual Health Insurance Reform Weekly

2009-11-12T09:51:00.000-08:00

Week of November 9, 2009

Given that the Senate is expected to require much more time than the House to vote on a health care bill (see below), it is likely there is not enough legislative time left in 2009 to wrap up a bill for Christmas delivery to the White House. Senate Majority Leader Harry Reid fueled concerns about the schedule last week when he refused to commit publicly to passing an overhaul bill this year. This makes a "conference" between the House and Senate MORE likely in January 2010 THAN IN 2009, and that could require some time since the current House and Senate versions are vastly different on several key provisions. If the Conference pathway proves too contentious, House Speaker Nancy Pelosi and Reid could play legislative "ping-pong," whereby each Chamber makes a modest change and ships if off to the other, back and forth, until they both approve the same language.

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Federal

Late Saturday night the House of Representatives approved its version of health care reform by the slim margin of 220 to 215 (218 was the minimum needed). The core of the approved House bill remained unchanged from the version the Speaker introduced a few weeks ago and includes: an employer mandate to provide and pay for coverage; a fairly strong individual coverage requirement; a public plan option set up by government that would pay "negotiated" rates to providers; and insurance reforms, including guaranteed issue and modified community rating. It does not include the "Cadillac" plan tax or the insurer tax provisions currently in the Senate bill. The House bill would be paid for in part with cuts to Medicare Advantage and a surcharge on the "wealthy."

On the Senate side, Majority Leader Reid is waiting for the revenue score from CBO on several different Senate Bill scenarios, given that several Senators have publicly stated opposition to going forward without a hard and fast number on both cost and impact on bending the spending curve. He also needs this time to win over the 60 votes needed to even proceed with consideration of the bill, let alone the 60 needed to cut off debate once the debate begins; he may not have either right now. The earliest the Senate could start debate would be the week of November 16, but a date in December seems more likely. Approval of the House bill will surely put increased pressure on the Senate to move forward but to do so cautiously, given the slim voting margin in the House, as the issue moves closer to the finish line.

Bills to extend and expand COBRA have been introduced in both the House and Senate and could well be part of the final push on health care reform. Both versions extend the Special COBRA subsidy program from end of 2009 to June 30, 2010 and maintain the government's 65 percent subsidy. The Senate version increases this subsidy to 75 percent, and the House extends basic COBRA eligibility from 18 to 24 months. Given the unemployment numbers, it seems likely that, whether as part of health reform or on its own, a COBRA extension (including the subsidy) will be enacted in 2009.

States

ARIZONA: Governor Jan Brewer and legislative leaders have reached a tentative agreement to reconvene to address the projected 2010 budget shortfall, which ballooned from $1 billion in early September to $2 billion by the end of October. Although the governor favors a temporary tax increase to boost revenue, she is unlikely to float that idea this time around to help limit the length of the session. Governor Brewer is expected to announce her candidacy for re-election. Although the former lieutenant governor is now the incumbent and has never lost an election, she is viewed as vulnerable by some Republicans because of budget concerns and her continued focus on obtaining additional revenue through taxation.

CALIFORNIA: California’s state budget deficit could reach $7 billion for the current fiscal year in part because of recent court decisions blocking state funding cuts. For example, a federal judge recently blocked the state's plans to cut $80 million from its budget for In-Home Supportive Services, and Insurance Commissioner Steve Poizner has filed a suit to block the sale of part of the State Compensation Insurance Fund, which was projected to generate $1 billion. Some analysts project that the state’s budget deficit will range from $10 billion to $20 billion in the upcoming fiscal year. In other developments, Lt. Governor John Garamendi won a special election to fill the Congressional seat vacated by U.S. Representative Ellen Tauscher (D). Garamendi was elected lieutenant governor in 2006 after 16 years in the legislature and two terms as insurance commissioner.

COLORADO: Senator Betty Boyd, President Pro Tem and Chair of the Health and Human Services Committee, met with insurer representatives to highlight the issues likely to get attention in the upcoming session. A proposal to prohibit the use of gender in rating individual policies has a high likelihood of passing, she said. Senator Boyd also advised that efforts will be made to ensure that the Cover Colorado program remains solvent, as it has potential to be used as the state’s public plan option. Speculation has it that Colorado could become one of the first states to act on federal health care reform if it is enacted. Finally, she expressed a strong interest in authorizing the DOI to establish standardized policy forms.

DELAWARE: Department of Health and Social Services Secretary Rita M. Landgraf has issued an update to existing statutes adding virtual colonoscopy as an approved colorectal screening modality. Delaware law requires coverage for colorectal screening modalities and empowers the Secretary to add modalities as recommended by the Delaware Cancer Consortium. Accordingly, all contracts for health insurance issued, delivered or renewed after December 1, 2009 must include coverage for virtual colonoscopy for colorectal cancer screening.

DISTRICT OF COLUMBIA: Newly passed legislation requires individual and group health plans to provide coverage for orally administered chemotherapy medication in a manner no more restrictive than intravenously administered treatment or injected cancer medications. In other business, the Council of the District of Columbia confirmed Acting Commissioner Gennet Purcell as Commissioner for the District of Columbia Department of Insurance, Securities and Banking (DISB). Commissioner Purcell, who served as DISB’s Deputy Commissioner since 2008, is an attorney and member of both the State of Maryland Bar and the Commonwealth of Virginia Bar. As deputy, her primary responsibilities included oversight of the agency’s core functional areas, including the divisions of Insurance, Securities, Banking, Fraud Enforcement and Investigation, and Risk Finance.

GEORGIA: A meeting was held last week between health insurance representatives and the Chairman of the Senate Insurance Committee to discuss legislation for 2010 that would restrict rental networks. The Medical Association of Georgia also was represented. Aetna has committed to work with all interested parties on the legislation.

ILLINOIS: A fall veto session concluded at the end of October, and three health insurance bills of import passed both chambers. The first bill creates external review requirements for all commercial insurance products, rather than just HMOs, effective July 1, 2010. The bill also establishes committees to create a uniform small-employer group health status questionnaire and an individual health statement for use on January 1, 2011. The legislation also requires insurers to semi-annually prepare and provide the Department of Insurance a statement on aggregate administrative expenses and other information. It is a good compromise versus what was originally proposed. In addition, both chambers passed an orthotics and prosthetics mandate on health carriers and HMOs for policies amended, delivered, issued, or renewed six months after the effective date of the amendatory act. The third bill changed the requirements to obtain a producer license. The Illinois General Assembly is not expected to reconvene until January 2010.

MISSOURI: The Secretary of the State recently approved a ballot initiative proposal for the November 2010 ballot that would essentially eliminate network-based health care delivery in Missouri. The move follows unsuccessful efforts to enact an any-willing-provider bill in past legislative sessions.The petition effort behind the ballot initiative appears to have been spearheaded by a local surgical practice that has been excluded from the medical staffs of local hospitals. Any willing provider is only one portion of the proposal. It would apply to health carriers and health benefit plans, including Medicare and Medicaid, and facilities. It would, for example, prohibit carriers from: Imposing on a beneficiary any co-payment, fee, or condition that is not equally imposed on all other beneficiaries in the same benefit category, co-payment level, or class; prohibiting or limiting a provider from the opportunity to participate in the network if that provider is willing to accept the carrier’s operating terms and conditions, fee schedule, covered expenses, utilization and quality standards. The State Auditor is preparing an assessment of the fiscal impact of the proposed measure as well as a brief summary of the fiscal impact for the petition. Legal challenges to the ballot initiative are permitted. A group of stakeholders, including Aetna, are discussing strategy.

NEW JERSEY: Health insurance issues were front and center in a bitter battle for the governor's office, which ended last week when Republican candidate Chris Christie defeated Democratic Governor Jon Corzine. The governor-elect has publicly supported greater flexibility for carriers to make health coverage more affordable via mandate-free plan designs and interstate sales of health policies. The Democrats remain in firm control of the legislature, which will make the governor-elect's agenda an uphill battle. Also, the Department of Banking and Insurance (DOBI) adopted a regulation standardizing the information and format on health identification cards. Additionally, DOBI initiated a meeting with the state's major health plans seeking guidance as to how the state might proceed in limiting plans,’ and members,’ exposure to exorbitant out-of-network provider charges. This is one in a series of meetings aimed at developing consensus on an appropriate fee schedule or other mechanism for non-par provider charges. Lastly, the NJ Department of Health & Senior Services (DHSS) has launched a six-month Hospital Newborn Pilot Program. Nine hospitals throughout the state are participating in a pilot to ensure no newborn leaves the hospital without health insurance. The participating hospitals are expected to submit data to the DHSS.

NEW YORK: Governor David Paterson is calling for a special session to address the current state budget deficit. The Governor’s two-year, $5.2 billion Deficit Reduction Package would have a current-year impact of $3.2 billion in 2009-10 and a recurring impact of $2 billion in 2010-11. The components include across-the-board spending reductions and a tax penalty forgiveness program. The Governor indicated that his agenda will include a bill that would completely prohibit all subrogation (collateral source) recoveries on any insured or self-insured plans. The existing collateral source rule eliminates the potential windfall of double recoveries to plaintiffs who receive benefits and make recoveries from both their insurance coverage and defendant payments, while still ensuring that uncompensated losses are fully compensated. This subrogation legislation passed the Senate earlier this year, but it has not passed the Assembly. In other business, State Sen. Eric Schneiderman, chairman of the Codes Committee, and Sen. Neil Breslin, chairman of the Insurance Committee, introduced a bill known as "Ian's Law," which is named after a patient with muscular dystrophy. The proposed legislation would prohibit non-renewal of group policies and would require heath plans to get state Department of Insurance approval before discontinuing a class of insurance. The bill also would require plans to continue covering a totally disabled policyholder for 18 months, even if the plan gets state permission to cancel an entire class of policies.

EasyToInsureME Health Insurance Quotes Reform Weekly

2009-11-06T13:13:00.000-08:00

This Week in Health Reform: November 6, 2009

As we near the end of a busy week in Congress, WellPoint sent a letter to Congressional Members highlighting the detrimental impact of current legislation on our health care system. The letter focuses on the potential impact of the Affordable Health Care for America Act (HR 3962) currently being debated in the House of Representatives.

WellPoint also provided Congress with a point-by-point response to the White House Blog's criticism of its actuarial analyses released late last week.

And, earlier this week, The Wall Street Journal published alead editorial highly critical of House Speaker Nancy Pelosi (D-CA) and the House bill. In addition, House Republicans proposed their own health care reform legislation.

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URGENT ACTION IS NEEDED

On Saturday, November 7, the House of Representatives is scheduled to vote on health care reform legislation that would force individuals to purchase coverage through the government health care exchange. Section 202(c) of HR 3962 prohibits individual coverage from being sold outside of the government health care exchange.

Forcing individuals to purchase coverage through the exchange reflects a sharp departure from the current system, and we believe Americans should have the choice of not buying coverage through the government exchange if they choose not to do so.

We encourage you to take action and contact your Congressional Member today.

House and Senate Negotiations

House Republicans Offer Health Care Reform Plan: On Tuesday, House Republican Leader John Boehner (R-OH) described key aspects of the newly proposed health care reform bill that focus more on controlling health care costs than on expanding coverage. The proposed bill will:

* cap medical malpractice damages;
* increase incentives for people to open health savings accounts;
* allow insurance companies to sell insurance across state lines;
* allow trade associations and guild members to band together to purchase group insurance , and
* create state-based, high-risk insurance pools for individuals who have difficulty obtaining health care coverage.

The bill does not bar insurance providers from denying coverage based on pre-existing conditions, nor does it create individual or employer mandates. It also does not raise taxes. The media suggest that Republicans may galvanize around their newly introduced bill. However, the media also speculate that the proposed legislation may make Republicans more vulnerable to criticism. Late Wednesday, the Congressional Budget Office (CBO) indicated that the bill would only cover 3 million additional people at a cost of $60 billion through 2019.

Biofuel Tax Credit Restrictions Added to House Health Care Reform Legislation: A measure introduced by Rep. Chris Van Hollen (D-MD), a member of the House Democrat leadership, would save the federal government $24 billion in biofuel tax credits over 10 years.

The measure would restrict the paper industry from claiming tax incentives for use of a fuel known as "black liquor." The tax credit savings could be used to offset costs of the health care bill, Van Hollen said.

Abortion and Immigration Issues May Imperil House Legislation: As House Speaker Nancy Pelosi works to shore up 218 votes for the House health care reform legislation introduced last week, two key contentious issues remain at the center of debate - funding for abortions and coverage for illegal immigrants . This week, anti-abortion Democrats circulated legislation to strengthen prohibitions in the bill against federal funding of abortion. It is also still up for debate as to whether or not illegal immigrants would be allowed to shop for insurance within the new exchange.

Senate Leader Signals Delay: Senate Majority Leader Harry Reid (D-NV) signaled Tuesday that Congress may fail to meet the end-of-year deadline for health care reform imposed by President Barack Obama. Senators are currently waiting for CBO cost estimates on their health care reform proposal, which may not come until late next week. Given this timeline and the upcoming Thanksgiving holiday, a bill may not reach the Senate floor until December.

Public Option Developments

CBO Indicates House Bill Would Attract Less Healthy: According to the CBO, the House health care reform legislation would attract less healthy enrollees in its version of the public option and would subsequently result in higher health care costs. In addition, the CBO predicted that of the 30 million Americans likely to purchase insurance through the insurance exchanges, one fifth would purchase insurance from the public option.

Looking Ahead

President Obama indicated that he will visit Capitol Hill late this week to address House Democrats and encourage a final push towards health care reform legislation. While House leaders plan to hold a rare Saturday vote on their proposed measure, Senate leaders still await a CBO cost estimate.

EasyToInsureME Individual Health Insurance Reform Weekly

2009-11-05T08:02:00.000-08:00

Week of November 2, 2009

That the bill going to the floor of the House contains a government plan option is no surprise. But Senate leadership's decision to pursue a government plan option in defiance of the Senate Finance Committee's preference is something of a surprise (see below), given it was perhaps the most bitterly argued reform issue of the summer's town hall meetings. The path ahead in the Senate will not be an easy one, as Connecticut Senator Joseph Lieberman's opposition makes clear. Lieberman is a former Democrat who still caucuses with Senate Democrats and had been counted among a potential 60 filibuster-proof majority. As the issue heats up, expect more debate and media attention on the real ramifications of this controversial provision.

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Federal

Several discrete events occurred this past week that have bearing on the health care reform (HCR) debate. First, Majority Leader Harry Reid boldly moved where he was not expected to go: He announced that a relatively strong form of the public plan, the "opt-out" version, would be in the bill he brings to the Senate floor. Most observers thought Reid would pick a "lighter" form of public plan. However, he clearly wants to keep the Democratic left on board while he works to secure votes on the right, rather than the other way around. Second, within 24 hours, Senator Joseph Lieberman (I-CT) broke ranks publicly and stated flat-out that he would filibuster against Reid's bill because of the government plan option. The Senate is expected to take a week longer to merge its two Committee bills and secure a score from the Congressional Budget Office, which is likely fine with Reid who probably does not have the 60 votes needed to bring the bill to the floor or end a filibuster. The Senate Floor debate is likely to begin around Veteran's Day. On the House side, Speaker Nancy Pelosi has unveiled the merged House bill (1990 pages, $894 billion in costs and rising), setting the stage for an expected vote -- with no real debate and no amendments allowed -- on the House floor late this week. The Speaker likely would not let the bill come to the floor unless she knows she has the votes or she believes can get them.

On related fronts, in order to get the HCR bill below the $1 trillion mark, the Speaker purged it of a $200+ billion item by deleting the Medicare physician reimbursement fix provision and introducing this as a freestanding bill, which has no "pay fors," i.e., it would add to the federal deficit. The Senate has already rejected this freestanding bill approach, which means Congress still has no solution for the impending slashing of 21 percent in doctor Medicare fees in 2010. Separately, Congressman McDermott (D-WA) has introduced a bill to neutralize ERISA's preemption protection by allowing state law causes of action for claims disputes to be processed under state liability law. Aetna would oppose either measure should it gain traction.

States

COLORADO: Governor Bill Ritter has unveiled another plan to shore up the state’s ever-widening budget shortfall by using federal stimulus dollars as a short-term stop gap. Although $1 billion has been trimmed from the budget since last year, a deficit of $271 million remains. Additional revenue through tax increases is being discussed, but health insurers have not been a part of the discussion.

FLORIDA: The Senate Health Committee and Senator Gaetz have asked the health insurance industry to sign a voluntary compact regarding coverage for cancer clinical trials. The compact would be similar to those signed in Georgia and New Jersey, to which Aetna was a signatory. A preliminary meeting was held last week at which concerns were raised. Aetna will continue to be engaged in these discussions.

KANSAS: Four state lawmakers announced last week that they are co-sponsoring a "Health Care Freedom Amendment" in the form of a Senate concurrent resolution that would add a new article to the Kansas Constitution to "preserve the right and freedom of Kansans to provide for their health care." Essentially the resolution is the first step toward trying to opt out of any potential federal health care legislation. The co-sponsors expressed opposition to a federal health care plan, stating that Washington is ill suited to manage health care. If passed, the resolution will be on the ballot in the fall of 2010. The legislators expressed confidence that they have the votes to pass the measure, but they conceded that many members had yet to be contacted.

MICHIGAN: As the state's budget crisis continues, legislators and engaged groups at the capitol are actively looking for ways to find revenue. Legislators and the Michigan Hospital Association have raised the issue of a 1.8 percent tax on all insurance claims paid, including disability and workers' compensation. There have also been discussions about taking the life, health, and property & casualty guarantee fund(s) reserves, but no concrete proposal has been floated to date. In addition, Public Employee Health Care Reform Committee hearings continue regarding the consolidation of purchasing benefits for public employees in Michigan. To date, over 30 organizations have asked to make public comments. The Speaker said that the proposal is still evolving but that he expects it to expand to include vision, dental and disability/workers' compensation benefits. Approximately $900 million in savings have been projected from administrative savings, economies of scale, "better benefits" and lower costs.

MISSOURI: The Missouri Speaker of the House, Ron Richards, has appointed an Interim Committee on autism spectrum disorders. The Committee will evaluate the impact autism spectrum disorders are having on families in the state. The committee's goal is to identify a solution that considers medical, educational and insurance changes to improve the lives of families dealing with autism. Aetna was very involved with last session's debate over an autism mandate and will continue to have a voice in this interim committee's work. The next Missouri legislative session begins in January 2010.

OHIO: Two bills concerning physician/insurer relationships are moving in the Ohio legislature. A bill that passed out of the House on October 21 specifies that a material amendment to a health care contract does not become part of the contract unless agreed upon by both parties. A different bill passed the House Health Committee on October 14, and its companion bill had sponsor testimony on October 27 in the Senate Insurance, Commerce & Labor Committee. The bill would place various requirements on health insurers that operate a system for physician designations to assign a grade or rating for certain physicians. This bill includes what must be considered in the evaluations, disclosure requirements, appeal rights and legal remedies against an insurer if a provider is adversely affected by a violation of the requirements. It is sponsored by the Ohio State Medical Association. Aetna opposes both measures and continues to discuss what may be agreeable language for physician designation programs.

WISCONSIN: The Office of the Insurance Commissioner (OCI) is working on several regulations and bulletins regarding recently passed laws. The OCI has issued a revised bulletin summarizing the provisions of the 2009-2011 state budget that impact insurance, including: establishing a uniform application for individual major medical policies; expanding independent review rights to adverse findings regarding coverage denial determinations, including preexisting condition exclusion denials and rescissions; requiring an insurer to provide coverage for an unmarried child dependent who is not eligible for other group coverage and is under age 27 or a full-time student regardless of age; and requiring coverage for autism spectrum disorders and contraceptives. Related to implementation of the budget bill, OCI published an emergency rule on September 30, 2009 related to the coverage of treatment for autism spectrum disorders that is effective on Nov. 1, 2009.On issues unrelated to the budget bill, OCI has issued two regulations. First, OCI issued emergency rules providing for eligibility for continuation of coverage under the American Recovery and Reinvestment Act of 2009 (ARRA) for individuals whose group coverage is terminated. Second, the OCI recently issued a proposed rule intended to expand the eligibility requirements for guarantee issue of Medicare supplemental policies and bring Wisconsin rules more closely in line with the NAIC Medicare Supplement Model Regulation. The proposed regulations establish two new categories of eligible individuals for Medigap guaranteed issue; modify current regulations pertaining to Wisconsin's "Plan M and N" look-alike plans to more closely follow corresponding NAIC model regulations; and reintroduce a high-deductible Medigap option.

EasyToInsureME Health Insurance Quotes Reform Weekly

2009-11-01T08:08:00.000-08:00

Oct. 30, 2009

This Week in Health Care Reform

This week, lawmakers fine-tuned their reform proposals and, once again, the public option became the central issue of the health care reform debate.

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Senate and House Negotiations

Senate Majority Leader Announces Senate Bill that Includes Public Option: On Monday, Senate Majority Leader Harry Reid (D-NV) announced that the health care reform package from the Senate is expected to include a public option with an opt-out provision should a state choose to not participate in the government plan. While liberal Democrats cheered the inclusion of the government-run plan, some moderates - including Sens. Joe Lieberman (I-CT), Blanche Lincoln (D-AR), Evan Bayh (D-IN) and Mary Landrieu (D-LA) - all voiced concerns.

Sen. Lieberman said that he would vote to block the passage of the Senate health care reform bill in Sen. Reid's proposed form. In addition, Sen. Olympia Snowe (R-ME), the only Republican to vote in favor of any health care reform legislation to date, stated that she is "deeply disappointed" with the inclusion of the public option.

This backlash comes as a blow to Sen. Reid and calls into question whether he has the 60 votes needed for final passage of the bill without an anticipated Republican filibuster. Sen. Reid has delivered a variety of proposals to the Congressional Budget Office (CBO) for cost estimates as he works to finalize the legislation.

Pelosi Unveils House Health Reform Bill: On Thursday, following weeks of negotiations to merge three bills passed by House committees last summer, House Speaker Nancy Pelosi (D-CA) unveiled the House's 1,990-page health care reform legislation.

The merged legislation includes a version of the public option, favored by moderate Democrats, that uses reimbursement rates negotiated with private insurers rather than the option favored by liberal Democrats that pegs rates to Medicare. The bill also includes:

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Mandates for individuals and employers to purchase coverage (with some exemptions)
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Subsidies to help lower-income individuals purchase insurance
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An expansion of Medicaid eligibility to include individuals and families with incomes of up to 150% of the federal poverty level
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Taxes on the wealthy of 5.4% for individuals who earn more than $500,000 and for couples who earn more than $1 million
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Significant insurance market reforms
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Fees collected from the medical device industry totaling $20 billion

The House bill does not include the "Cadillac Tax," a controversial tax on high-end insurance plans. And, House Democrats indicated that party leaders have yet to resolve long-standing disagreements regarding coverage for abortion and illegal immigrants.

This bill is estimated to cost just under $900 billion over the next 10 years. However, the legislation does not address Medicare physician payments and instead moves this portion of the proposal to a separate bill, which is anticipated to increase the U.S. budget deficit by more than $200 billion over 10 years.

Senate and House Propose Lower Medical Device Industry Fees: In the bill originally passed by the Senate Finance Committee, fees collected from the medical device industry would have totaled $40 billion over 10 years. Lawmakers from both the Senate and the House are proposing lower fees. In the emerging Senate legislation, Sen. Reid is expected to adjust the fees to between $15 and $20 billion over 10 years. By comparison, the House version includes a tax that would be imposed at the point of sale, thereby spreading its impact across manufacturers, wholesalers and distributors, and would yield $20 billion between 2013 and 2019.

Additional Activities

U.S. Business Group Opposes Public Option: On Wednesday, The Business Roundtable, comprised of chief executives at Verizon Communications, JPMorgan, General Electric, Wal-Mart and other companies, said the federal government is inefficient and would underpay providers while driving up costs for employers and their workers.

Public Opinion

American Opinion on Public Option Remains Steady: The October Kaiser Family Foundation poll found that 55% of Americans believe that it is now more important than ever to take on health care reform, while 41% say the country cannot afford it, results that are unchanged from the previous month. Other findings include:

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Americans' support for taxing the wealthy to pay for reform decreased slightly in October, while support for taxing insurance companies increased.
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Americans still worry about the potential impact of the reforms on measures such as wait times, cost and choice of providers.
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Most Americans believe that health care reform will deliver changes immediately. About half of Americans believe that if Democrats pass health care reform legislation, help for the uninsured and consumer protections in the insurance market will begin within a year. In actuality, however, most of the reform provisions will take years to kick in.

Looking Ahead

Sen. Reid awaits CBO financial estimates to finalize the Senate bill before bringing it to the Senate floor. The House bill will be submitted to the full House for debate as early as next week.

EasyToInsureME Individual Health Insurance Reform Weekly

2009-10-30T10:35:00.000-07:00

Week of October 26, 2009

While Aetna and the rest of the insurance industry continue to focus on important health care reform issues, some members of Congress and The White House appear unwilling to stop or even slow the political attacks against insurers. Even as yet another analysis released last week showed real concerns persist that current proposals will worsen, rather than alleviate, rising health care costs, the House Judiciary Committee used its powers last week to try to punish the industry for speaking out (see below). Actually, the industry remains committed to seeing meaningful health care reform passed this year, a view made clear in a Washington Post op-ed authored by the President of America's Health Insurance Plans. The reactions on the Hill continue to largely side-step the specific cost concerns raised in the past two weeks. But Aetna remains hopeful that the dialogue may yet return to substantive issues before bills are brought to the floor of the House and Senate in the next several weeks.

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To ease the burden of a scheduled 21-percent pay cut for Medicare doctors in 2010, Senate Democrats tried to pass a stand-alone bill that would have wiped out both next year's cut and all future cuts. Eliminating the cut for one year would cost $10.9 billion -- such a provision is in the Finance Committee version of health care reform and would be fully funded. To totally wipe out the fee cuts for all years would cost $245 billion. Without a "pay for" such a bill would add close to a quarter-trillion dollars to the deficit. This is precisely the bill Majority Leader Harry Reid brought forth. Senator Reid needed 60 votes; he got 47 as all Republicans and 13 Democrats voted against cutting off debate. Senate Democrats had hoped to gain physician support for health care reform by providing relief from the cuts. But the results should serve as a "wake-up" call to the Democratic leadership that health reform will not be a walk in the park. The strong vote could also embolden moderate Democrats to band together and make "hard votes" on health care reform as well.

In the House, legislative activity for the week came down to passage in the Judiciary Committee of a bill that Democratic sponsors describe as repeal of the health insurer antitrust immunity known as the McCarran-Ferguson Act. The bill more accurately can be described as codifying various court interpretations of the Act, all of which the industry lives with day in and day out. The bill specifically says health insurers (and MedMal insurers) can't hide behind McCarran-Ferguson to price-fix, bid-rig or engage in market allocations with competitors. Insurers can't do that now. Thus, the bill is much more of a vehicle for some in Congress to further demonize a well thought-out piece of legislation with positive policy underpinnings. Whether this item gets added to a health care reform bill or progresses on its own remains to be seen.

The timing for floor debate on health care reform will likely ebb and flow for several weeks, but the current thinking is that this process may take all of 2009 and possibly into 2010 to complete. The House merging process is all but done along with the CBO review of the House bill. The House bill could be released this week, go to the Rules Committee on Thursday/Friday and on to the House floor the first week of November. This schedule requires that everything fall into place and that the Speaker be willing to begin floor debate before the Senate, which seems to be the case. On the Senate side, merging the HELP and Finance Committee bills seems to be picking up speed, particularly with reports of an emerging public plan compromise. But the process will not be finished until later this week, which would bring the bill to the floor the week of November 2 at the earliest. There is a real chance that too many variables will get in the way and neither Chamber will get to the floor until December, which, if true, would translate into a January Conference.

States

COLORADO: The Colorado Health Care Task Force has voted several bills out of committee, including: a prohibition on the use of gender in developing rates for individual policies; a maternity coverage requirement in individual policies; and a requirement that the Department of Insurance develop standardized formats for such things as policy forms and explanations of benefits. Aetna will provide comments.

GEORGIA: Commissioner Oxendine signed the regulation allowing health insurers to utilize health status at renewal when underwriting small groups (2-50). Aetna has worked with the Georgia Association of Health Plans for some time to help enact this regulation. The Commissioner has also scheduled a meeting with health plan representatives to discuss his 2010 legislative agenda, which will include a bill similar to one defeated this year that would have regulated rates for individual policies.

ILLINOIS: The legislature last week completed the first week of a two-week veto session and took on two insurance-related issues. One bill would create external review requirements for all commercial insurance products, rather than just HMOs, effective July 1, 2010. The bill also would establish committees to create a uniform small-employer, group-health status questionnaire and an individual health statement for use beginning January 1, 2011. Lastly, the bill would require insurers to semi-annually prepare and provide the Department of Insurance a statement on aggregate administrative expenses and other information. Surprisingly, Chairman of the Executive Committee Mary Flowers stated that she was not going to allow the bill to be called for a vote until she had an opportunity to question the sponsor. Thus, no vote was taken, even though there was no opposition. It appears the bill will be moved for a vote this week in a different committee. Also, negotiations have begun on an insurance mandate bill for prosthetics and orthotics. The General Assembly has indicated that when they adjourn late this week, they will not return again until January.

PENNSYLVANIA: Governor Ed Rendell signed spending, revenue and fiscal code bills earlier this month, ending the 101-day budget standoff. But negotiations continue over the unresolved issue of expanding legalized gambling to include table games. Of primary interest, one bill signed into law embraces an extension of the 5.9 percent gross receipts tax on Medicaid MCOs as an alternative to the Administration’s proposed 2 percent health insurance tax as the basis for federal matching Medicaid funds. The final bill also dropped the proposed “trigger provision,” which would have authorized the Department of Public Welfare to abrogate its Medicaid MCO contracts if the Centers for Medicare & Medicaid Services were to disapprove the GRT approach for fund matching.

UTAH: The Health Reform Task Force has drafted two proposals to recommend to the 2010 legislature. The first, under the guise of administrative simplification, would establish procedures to be followed for coordination of benefits for dependents subsequent to a divorce, superseding the provisions in the applicable insurance contract. The second proposal would require the DOI to develop standards for the use and electronic exchange of uniform claim forms, billing and claim codes, eligibility and coverage information and coordination of benefits.

Health Insurance Reform EasyToInsureME

2009-10-22T08:30:00.000-07:00

October 21, 2009

The Week in Health Care Reform

Federal Legislative Overview
Senate
On Tuesday, October 13 the Senate Finance Committee approved Chairman Max Baucus’ amended “America’s Healthy Future Act” by a vote of 14-9. Olympia Snowe (R-ME) was the only Republican who joined all 13 Democrats in supporting the bill. After the vote Snowe stated, “Is this bill all that I want? Far from it. Is it all that it could be? No. But when history calls, history calls. And I happen to think the consequences of inaction dictate the urgency of Congress to take every opportunity to demonstrate its capacity to solve the monumental issues of our time.” She went on to say, “My vote today is my vote today, it doesn’t forecast what my vote will be tomorrow,” quelling any predictions for what her vote will be on the Senate floor.

The legislation has now moved to Majority Leader Harry Reid’s (D-NV) office, who will work hand-in-hand with key Democratic leadership in the Senate, as well as the White House, to craft a single bill. This process will likely take weeks and we do not expect it to reach the Senate floor until November.

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House
Speaker Nancy Pelosi (D-CA) continued to say this week that the merged bill in the House of Representatives will have a “robust” public plan – meaning that provider reimbursement rates will be tied to Medicare. This is the opposite of the agreement made in Henry Waxman’s (D-CA) Energy & Commerce Committee with Blue Dog Democrats, in which payment rates would be negotiated.

Interestingly enough, Rep. Mike Ross (D-AR), the leader of the Blue Dogs’ Health Care Task Force, who was vehemently against a public health insurance option during reform debates in July, came out this week saying that he supported the idea of opening Medicare to those under 65 without insurance. He later backpedalled and said, "I do not endorse this idea, as it was just one of many ideas we, as legislators, have brought up and discussed in the numerous, ongoing negotiations and discussions we have had on healthcare reform over the past several months." Ross has changed his mind numerous times during this debate. After he negotiated the deal in the Energy & Commerce Committee in July he faced significant opposition from conservative constituents during the August recess. He then returned from recess stating that he couldn’t support a public option. Ross’ statements show how difficult the push and pull will be in the upcoming weeks over key provisions in the health care reform bills.

Individual Health Insurance Reform Weekly EasyToInsureME

2009-10-22T08:24:00.000-07:00

Week of October 19, 2009

Inside-the-Beltway politics were in full swing last week as the insurance industry came under heavy fire from some members of Congress and the media for releasing a PricewaterhouseCoopers report prior to the Senate Finance Committee's scheduled vote on its health care reform proposal. The report found that the Committee's reform package would drive up the cost of private insurance coverage for individuals, families and businesses. As a result, the industry was openly accused of trying to scuttle health care reform, even though America's Health Insurance Plans (AHIP) stated clearly in a press release and a letter to key Senate leaders that the industry was simply fulfilling its responsibility to bring to light serious flaws in the bill. The industry still intends to work toward bipartisan reform. By the time the furor died down, no one had seriously refuted the substance of the report. In fact, just a day later a new report from Oliver Wyman arrived at very similar conclusions. Regardless of these reports, Aetna has consistently warned that meaningful health care reform must address rising costs and that insurance market reforms must be linked with a strong individual coverage requirement to work effectively. Aetna will continue to deliver this message and help others understand how the market works.

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Federal

While there was some drama, the actual outcome of the Senate Finance Committee's vote to approve its health care reform bill was never really in doubt. By a vote of 14 to 9, the Committee approved the bill with all Democrats and one Republican, Olympia Snowe of Maine, saying yes. The drama was two-fold: a) would Snowe agree or hold her powder dry until the floor debate to improve her ability to bargain for changes; and b) would Ron Wyden (D-OR) and/or Jay Rockefeller (D-WV) vote no or hold their vote to protest the absence of the public plan. Neither possibility materialized, but the "drama" could merely have shifted from the Committee to the Senate floor. The Finance Committee approval of health reform set in motion the next step in the process, as the Senate Democratic leadership began the process of melding the Finance and HELP Committee bills. Majority Leader Harry Reid is working with Finance Chairman Max Baucus, HELP Vice-Chairman Christopher Dodd and Chairman Harkin to hammer out a single bill, and three issues appear the most contentious: the Finance Committee's weak individual mandate vs. HELP's stronger one; a HELP public plan vs. the co-op approach from Finance; and the HELP employer mandate vs. no mandate from Finance.There are hundreds of subordinate issues as well, all of which translates into a contentious merging process that will likely delay debate on the floor to late October/early November.

Senate Democrats, led by Senator Stabenow (D-MI), will likely vote this week on a stand-alone bill to eliminate a scheduled 21 percent cut in physician Medicare reimbursement on a permanent basis. The one-year cost of this doctor "fix" in the current Senate Finance Committee bill is $10.9 billion; the permanent fix (buried in the House reform bill) would cost upwards of $250 billion. The idea behind this maneuver is to pull out a costly item from the health reform bill, which is supposed to be deficit-neutral, in order to free up more money to spend on other items or to reduce the total cost of health reform, e.g., the House Democrats want to get their bill under $1 trillion. While most agree that the payment level for physicians should be much more aligned to quality and performance, the debate will likely turn on whether Democrats can shift to the deficit another $250 billion in money for doctors without stirring up the American public.

States

COLORADO: The Colorado Division of Insurance adopted amendments revising the state's early intervention services (EIS) benefit mandate in accordance with newly adopted legislation. Individual and group policies or contracts that include dependent coverage are required to cover EIS delivered by qualified providers to eligible children through age 3. The new law modifies this mandate by requiring, among other things, an increase in the reimbursement rate for EIS by carriers, if the base rate for state-funded EIS increases by more than the cost-of-living adjustment. The amended rule was effective October 1. The DOI also adopted amendments establishing standards for the sale of limited benefit plans by HMOs. This legislation allows HMOs to offer access to basic health care services through limited benefit plans to employer groups that have not offered health coverage to their employees for the previous 12 months and to individuals who have been uninsured for the previous 12 months. HMOs are prohibited from offering limited health benefit plans in Colorado counties with a population of more than 25,000 people.

ILLINOIS: The Department of Insurance (DOI) has taken the position that carriers cannot require, in their contracts, that claims for proceeds on a life insurance policy be made “in writing.” The insurance industry has requested that the DOI reconsider its position. The DOI maintains that the only required documents for a life insurance claim are the insured’s death certificate and a copy of the claim check. The insurance industry believes that this interpretation of the law runs contrary to generally accepted claim procedures that were put in place to confirm that coverage was in force, that a covered loss occurred, and that there are no exclusions or limitations that affect the claim payment. Illinois statute directs a life insurer to settle a death claim within two months of the receipt of due proof of the insured’s death and places no limit on what an insurer may reasonably require during the statutory period to assure proper verification of the insured’s death, as well as verification that claim proceeds are being correctly paid to the proper claimant.

KENTUCKY: Last week the Department of Insurance held a public meeting at which it briefly discussed its proposed 2010 legislative package, approved by the Governor's office, for the upcoming session. The proposals include updating state laws to incorporate federal changes with respect to mental health parity, Michelle's law, HIPAA clarifications; updates to the limits under the life and health guaranty model; and uniformity changes to the producer licensing law. Also discussed was the possible elimination of the requirement that insurers offer a standard benefit plan under the Kentucky Access law.

MASSACHUSETTS: The Commonwealth Health Insurance Connector Authority is proposing amendments to the Minimum Credible Coverage (MCC) regulations, with a public hearing on the matter scheduled for Nov. 17. The MCC regulations set the standard for minimum benefits Massachusetts residents must carry in order to be considered insured and avoid penalties. The proposed regulation changes were approved by the Connector Board and filed with the Secretary of State. They would: make prescription drugs one of the categories of services/benefits that are considered “core services” under minimum creditable coverage, thus prohibiting the imposition of dollar caps on its prescription drug benefit; require a health benefit plan covering dependents to provide coverage to all “broad range of medical benefits” as provided to subscribers in order to ensure that maternity benefits are extended to pregnant dependents; and allow employer groups to pair a high-deductible health plan with a Health Reimbursement Arrangement (HRA), as an alternative to a Health Savings Account (HSA). There likely will be some push back on the additions to the MCC standard. However, some version of the amendments is expected to pass. If enacted, the prescription and dependent benefits amendments would be effective in 2011; the HDHP/HRA amendment would take effect on 1/1/2010.

NEW JERSEY: The state has launched a database designed to track autism cases and direct affected families to health care and other services. The New Jersey Autism Registry requires psychiatrists, psychologists, neurologists and medical professionals to register children diagnosed with autism and birth defects such as Down's Syndrome, cleft palate, and heart or muscular defects. The registry is confidential and will be used to enable officials to better assist New Jersey's families with autism and other special needs. Access to the database is restricted to medical professionals.

NEW YORK: Governor David Paterson last week proposed a new two-year, $5 billion deficit-reduction package (DRP) that will fill the $3 billion (and growing) gap in the 2009-2010 spending plan and have a recurring impact of $2 billion in 2010-11. The new proposal does not include new taxes or assessments, a reflection of the extraordinarily high taxes already imposed on health plans in the main '09-'10 budget. The Governor's new DRP focuses on across-the-board Medicaid cuts, a $14.7 million cut in the managed long-term care program, a $14 million reduction in the Child Health Plus program, and a $7 million reduction in section 332 assessment sub-allocation, which includes both the Healthy New York and Timothy's Law programs. The budget announcement was sharply criticized by the hospital industry and hospital workers' union SEIU/1199. Assembly Democrats have already scheduled two hearings on the Governor's proposed DRP for Wednesday, October 21st, in Albany and Friday, October 23rd in Syracuse.

OREGON: The state Insurance Department has issued a second bulletin regarding legislation that established a premium assessment on health insurers. The primary purpose of the new bulletin is to provide information about the approved manner of calculating premium increases to offset the cost of the new assessment. The bulletin states that the law limits the amount carriers are allowed to increase premiums, as a result of the assessment, to one percent. The amount derived from dividing premiums by .99 is greater than one percent and is therefore illegal. Any insurers that calculated the increase in the .99 manner and have already collected premiums are required to issue refunds.

TEXAS: The Department of Insurance held a stakeholder meeting last week to discuss implementation of the new "Healthy Texas" program, legislation that passed in May. The program is modeled after Healthy New York and will offer state re-insurance for up to 80 percent of the claims corridor of $5,000-$75,000 for an insurance product, which can be sold only to small groups that have been uninsured for at least a year and have at least 30 percent of their employees' salaries at a maximum of 300 percent of the federal poverty level. The employer must agree to pay at least 50 percent of the premiums, and at least 60 percent of the employees must enroll. The legislature provided $17.5 million dollars annually to fund the program for the next 2 years. TDI and the Texas HHSC have been awarded almost $5 million a year for the next five years in HRSA grant money to assist with costs of actuarial contracts, marketing contracts and additional staff to help fully implement the program. They have posted informal rules to implement the program and plan to adopt a formal rule by the end of 2009. They would like to see members enrolled in qualifying plans by June 1, 2010, at the latest. Aetna has been involved with the drafting of legislation for this program from the beginning and will continue to be involved throughout the rulemaking process.

WASHINGTON: The state Office of the Insurance Commissioner has released its legislative agenda for 2010. The OIC proposals include; 1) new and extended grace periods for individuals to take up conversion coverage -- 31 days after a person has received notice of termination of coverage; 2) a revised definition of emergency services and the elimination of a requirement that the covered health care services are provided in a hospital emergency department; and 3) a health care reform proposal that would cover catastrophic medical costs over $10,000 per year and limited preventive care for all state residents. The catastrophic health plan was also proposed in 2009 but failed to gather much attention in the legislature.

Health Insurance Quotes Reform Weekly EasyToInsureME

2009-10-16T12:41:00.000-07:00

Oct. 16, 2009

This Week in Health Care Reform

This week, Senate Finance Committee members voted on the committee's health care reform bill, and the conversation shifted to how to reconcile the bill with pending legislation from the House.

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Senate Negotiations

Senate Finance Committee Passes Bill: On Tuesday, after months of negotiations, the Senate Finance Committee passed its $829 billion health care reform package with a 14-9 vote. One Republican, Sen. Olympia Snowe (R-ME) voted with Democrats on the committee. The proposal would expand coverage to 29 million uninsured Americans while reducing deficits by $81 billion over 10 years. The bill includes insurance market reforms, an individual mandate to purchase coverage that appears reduced when compared with prior versions, an expansion of Medicaid, a cut in future Medicare spending, new fees and taxes on employers, and billions in new fees on health insurance and other sectors of the health care industry. The bill also includes seed funding for state cooperative plans and subsidies for other state coverage programs.

Shortly after the vote, labor unions and large business organizations requested changes to the Finance Committee bill primarily because it omitted a public option . The swift feedback from interest groups underscores the difficult road ahead for Senate Majority Leader Harry Reid (D-NV), who will work to merge the Finance Committee bill with the Senate Health, Education, Labor and Pensions (HELP) bill passed last summer. Unions and lawmakers such as Sens. Chuck Schumer (D-NY) and Jay Rockefeller (D-WV) have criticized the legislation for not including a public option . At the same time, insurance companies, medical device makers and others in the health care industry are voicing strong concerns about the increased premium costs of the proposed legislation.

House Activities

Legislators Look to Reconcile Health Care Measures: House leaders indicated that negotiators have trimmed costs for its proposed health care reform bill to President Barack Obama's goal of $900 billion, down from $1.2 trillion. Aides said the final bill will include slightly lower subsidies for copayments and deductibles for people who buy coverage through the new insurance exchanges that be would established for those who can't access affordable employer coverage. A provision preventing doctors who see Medicare patients from having their fees cut was excluded, while a surcharge tax on incomes of individuals ($500,000 or more) and families ($1 million or more) was included. House members will consider including more low income families in Medicaid instead of the insurance exchange market, and adopting tax increases featured in the Senate Finance Committee bill, including a profit tax on health insurers. They have, however, rejected the tax on "Cadillac" plans.

Additional Activities

Insurance Industry Study Indicates Higher Costs: On Sunday, the insurance industry trade association, America's Health Insurance Plans, released a study indicating that the proposed Finance Committee legislation would raise the price of a typical policy. The study, completed by PricewaterhouseCoopers, projected that family premiums could be $4,000 higher and individual premiums could be $1,500 higher in 2019. The report details that a weak individual mandate, measures preventing insurers from barring people with pre-existing conditions, taxes on high-cost health care plans and new taxes on some health care industry sectors will rapidly raise costs.

On Wednesday, another study conducted by Oliver Wyman Inc. and sponsored by the Blue Cross Blue Shield Association indicated that the proposed legislation would raise premiums 50% for individual and 19% for small group policies. Premium increases would likely be a result of a weak individual insurance mandate over the next five years.

Looking Ahead

Following the Senate Finance Committee vote, health care reform legislation negotiations will continue behind closed doors. Sen. Reid will merge the Senate Finance and the HELP Committee bills. He has indicated that the full Senate will begin debating the merged legislation the week of October 26.

House leaders are expected to vote the first week of November.

Individual Health Insurance Reform Weekly EasyToInsureME

2009-10-15T08:55:00.000-07:00

Week of October 12 , 2009

A new report from PricewaterhouseCoopers made headlines this week in pointing out that the Senate Finance Committee's health care reform proposal, as currently outlined (approved by a 14-9 margin on October 13), would increase the cost of private insurance coverage for individuals, families and businesses above what these costs would be in the absence of reform. Specifically, the report says that four provisions could significantly increase costs: a weak coverage requirement coupled with insurance market reforms, a new tax on high-cost health plans, cost shifting as a result of Medicare cuts and new taxes on several health care sectors. While the Committee is scheduled to vote on its reform package this week, the new report demonstrates much work remains to be done before any bill can appease growing cost concerns and claim broad consensus.

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Federal

The Senate Finance Committee's health care reform efforts were buoyed last week by news from the Congressional Budget Office, in the form of a preliminary analysis that found the Committee's health reform mark-up would reduce the number of uninsured nationally by about 29 million while reducing the federal budget deficit by about $81 billion over the 2010-2019 period. The projected budget impact made many Democrats jubilant, since the President has made it a condition that no reform bill add to the deficit if it is to get his signature. But the initial euphoria over the score started to evaporate within 24 hours as Republicans and some Democrats have questioned the numbers. Aside from the numerous political issues still in play, the CBO identified some significant caveats to its analysis that were not widely reported. The CBO analysis points out that once the reform proposal is converted into actual legislative language, significant changes could be necessary to its estimates. Also, federal spending that would be funded by future appropriations, such as implementation costs for Medicare operations, is not reflected in the estimates. The Senate Finance Committee approved the bill this week, but the legislative path ahead will not be easy.

A glimpse into one of hundreds of subordinate issues connected to health care reform points out how difficult it will be to actually enact legislation. Late last week, Aetna participated (as the only invited insurer) in a discussion among a cross-section of key players in the health care debate: the trial bar, employers, unions, and an insurer. The convening authority was the senior staff from all three key House Committees. The issue is whether the House bill should include a trial bar-supported provision to deny insurers (and union plans) the right to recover, from the insured, health care payments when the insured member has already received payment for the very same expense from a court award or settlement. The staff and the trial bar want this provision, while insurers, employers and the unions strongly oppose any change. The discussion pointed out (a) how a bill this big will surface myriad subordinate issues that will cut numerous ways and force strange bedfellow allies while pushing traditional friends far apart, and (b) how difficult it will be for Congressional leadership to cobble together a passable piece of legislation.

States

CALIFORNIA: Governor Arnold Schwarzenegger has signed legislation prohibiting the use of gender as a rating factor in the individual market but vetoed all new mandated coverage requirements, including a measure that would have required all individual policies to include full maternity coverage. The governor has not yet released his decision on the two rescission bills that were on his desk, although he vetoed similar legislation last year.

KENTUCKY: The Interim Joint Committee on Banking and Insurance is reviewing continuity of care issues related to a contract dispute between Anthem and Norton Healthcare that resulted in the filing of new legislation. The bill would require contracting agreements between a managed care plan and a hospital to be for a term of not less than three years, with at least six months notice by the acute-care hospital to the managed care plan and the Insurance Department when terminating or not renewing a contractual agreement. The managed care plan and the hospital must develop procedures for a covered person's access to care under continuity of care requirements established by law. The bill also would require mediation or binding arbitration in any dispute between the managed care plan and the hospital regarding a covered person's access to care under the continuity of care provisions.

MINNESOTA: The Neighborhood Health Care Network has received $832,768 federal funding in to expand and upgrade electronic health records systems in community health clinics that serve economically and ethnically diverse populations in the Minneapolis-St. Paul metropolitan area. The award will support the implementation of a shared Electronic Health Records (EHR) system with three member clinics: Freemont, Indian Health Board and West Side. Prior funding for this project from the Minnesota Department of Health and the Healthier Minnesota Community Clinic Fund enabled the early phases. The new funding will help support clinic-specific costs associated with “going live” in the months ahead. Network membership includes 14 independent, non-profit community health centers with clinic locations in Minneapolis, St. Paul and Stillwater.

Health Insurance Reform EasyToInsureME

2009-10-15T07:55:00.000-07:00

October 14, 2009

The Week in Health Reform

Federal Legislative Overview

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Senate
The long-awaited cost estimate of the Senate Finance Committee’s health care reform proposal, “America’s Healthy Future Act,” was released this week by the Congressional Budget Office (CBO).

The CBO concluded that the proposal would cost $829 billion over 10 years – an increase from the previous $738 billion estimate of the revised Chairman’s Mark – and would cover 94 percent of Americans. A more detailed overview of the CBO cost estimate is discussed in the next section of this article.

The Senate Finance Committee waited to vote on its health care reform proposal until the CBO completed its work. On Tuesday October 13, the Finance Committee voted 14 to 9 to approve the legislation. Senator Olympia Snowe (R-ME) was the only Republican who voted in support of the measure. This now paves the way for Democratic leadership to begin merging the Senate Finance legislation with the Senate HELP bill (S 1679). Senators Max Baucus (D-MT), Christopher Dodd (D-CT) and Majority Leader Harry Reid (D-NV) will lead those efforts, working alongside the White House. The blended legislation could potentially be on the Senate floor the week of October 19.

House
House Speaker Pelosi and other Democratic leaders in the House of Representatives continue to meld its three pieces of health care reform legislation into one bill, while aiming to cut its total cost by another $200 billion. Although Pelosi has publicly stated that she will not consider a “trigger option” for the public plan, nor health care cooperatives, she has seemingly become a bit more open to the idea of the creation of a public plan that would be allowed to negotiate provider reimbursement rates, an idea that has more commonly belonged to conservative Democrats in this debate.

This past week, more than 150 House Democrats wrote a letter to Pelosi (D-CA) urging her “to reject proposals to enact an excise tax on high-cost insurance plans that could be potentially passed on to middle-class families.” This letter was in reference to the Senate Finance Committee’s health care reform proposal that includes a 40 percent excise tax on insurers that exceed certain cost thresholds, also known as a tax on “Cadillac plans”. Beginning in 2013, the threshold for individual plans will be $8,000 and $21,000 for family coverage. It is clear that more than half of House Democrats recognize that insurers will be forced to pass on these proposed new taxes to consumers – undermining the shared goal of ensuring affordable health coverage for all Americans.

Overview: CBO Score of Senate Finance Committee Proposal
As briefly mentioned above, the CBO has issue its preliminary analysis of the Senate Finance Committee’s “America’s Healthy Future Act.” CBO estimates that under this legislation, the percentage of legal nonelderly residents covered by health insurance would increase from 83 percent today to about 94 percent by 2019. CBO further estimates that:

* The bill’s coverage provisions would cost $829 billion over ten years. This includes $345 billion in increased spending in Medicaid and CHIP, $461 billion for premium subsidies provided through the exchange and related spending, and $23 billion for small employer tax credits.

* These costs would be offset by increased tax revenues and spending reductions in other areas, resulting in a net reduction in the federal budget deficit that is estimated to be approximately $81 billion over ten years. The bill’s offsets include: $201 billion from the high-cost health plan tax; $117 billion from changes to Medicare Advantage payments; $106 billion from changes to Medicare hospital payments; $23 billion from penalty payments by employers; and $4 billion from penalty payments by individuals.

Health Insurance Quote Reform Weekly EasyToInsureME

2009-10-09T11:20:00.000-07:00

Oct. 9, 2009

This Week in Health Care Reform

This week, legislators from the Senate Finance Committee waited for the Congressional Budget Office (CBO) to provide a cost estimate for the revised health care reform bill before bringing the legislation to a committee vote, now expected to take place next week.

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Senate Negotiations

CBO Provides Revised Cost Estimate: On Wednesday, the CBO estimated that the revised Senate Finance Committee bill would cost $829 billion over the next 10 years, reducing the budget deficit by $81 billion over the same time period. The CBO also projected that the health reform legislation would expand health care coverage to 94% of Americans by 2019 . This estimate provides a significant political boost to the Finance Committee bill, as it is the only proposed health care reform legislation that meets President Barack Obama's guidelines, which include having a price tag of $900 billion or less over 10 years, vastly expanding coverage and not adding to the budget deficit. However, the CBO's estimate did not include the impact of the legislation on premiums.

Senate Finance Committee Finalizes Bill: Last Friday, the Senate Finance Committee wrapped up days of negotiations and finalized its bill to overhaul the U.S. health care system. In the last days of committee negotiations, lawmakers voted to:

*
Reduce penalties on those who do not obtain insurance;
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Modify the proposed tax on high-cost insurance policies;
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Prevent health insurance companies from taking tax deductions for compensation in excess of $500,000; and
*
Create a government plan to offer a state option operated by private insurers.

The committee originally planned to vote on the bill this week. However, the vote was delayed to give the CBO time to assess the cost of the revised package and to give the committee time to review the legislation before the vote.

Sen. Max Baucus (D-MT) has indicated he has the necessary votes to bring his bill across the committee finish line. Yet, it is still unclear whether or not he will achieve bipartisan support of the bill. In addition, at least two Democrats , Sens. Ron Wyden (D-OR) and John D. Rockefeller IV (D-WV) have refused to support the bill in its current form.

Joint Committee on Taxation Reports Increase in Industry Fees: On Tuesday, the Joint Committee on Taxation indicated that the revised bill coming out of the Senate Finance Committee would raise $121 billion from fees on drug companies, health insurers and medical device manufacturers, up from the original $92 billion previously reported. The increase in tax revenue stems from restrictions prohibiting companies from deducting the proposed industry fees from their corporate taxes. The new estimate has fueled increased Republican opposition to the reform legislation.

Senators Call for 72-Hour Window for Public Review: On Tuesday, a group of six moderate Democratic senators and one independent senator sent a letter to Senate Majority Leader Harry Reid (D-NV). The letter called for a 72-hour period for public review of the upcoming combined Senate health care reform legislation, along with the complete budget score from the CBO, prior to a full Senate vote.

House Activities

House Democrats Reject Taxing "Cadillac" Plans: On Wednesday, 154 House Democrats signed a letter addressed to Speaker of the House Nancy Pelosi (D-CA) denouncing a plan to pay for health care reform by taxing high-end health insurance plans, known as "Cadillac" plans. The letter urged the Speaker to reject proposals with a tax on Cadillac plans because it could potentially place a heavy burden on the middle class. This letter is in contrast with legislation moving through the Senate Finance Committee that includes a tax on insurers who offer these high-end plans. Speaker Pelosi has indicated she is considering adding a tax on health insurance to the House bill.

Public Opinion

Poll Shows Increased Public Support: The latest Associated Press-GfK poll has found that public support for President Obama's health care reform initiative has increased, split evenly between those who support reform (40%) and those who do not (40%). In September, 34% of the public supported Congressional proposals and 49% opposed them.

Additional Activities

President Obama Pitches Health Care Reform to Doctors: President Obama addressed approximately 150 doctors from across all 50 states on the White House lawn to win their support for health care reform. Many doctors oppose reform efforts, particularly due to potential cuts in Medicare and lack of protection from "abusive" malpractice lawsuits.

Looking Ahead

Following the Senate Finance Committee vote expected next week, Sen. Reid will work to merge the Senate Finance Committee bill with the other proposed legislation from the Senate Health, Education, Labor and Pensions Committee. He expects that the debate before the full Senate will begin after Columbus Day (October 12). House Speaker Pelosi expects to have merged the three proposed bills coming out of the House and to begin full House voting by mid-October.

Individual Health Insurance Reform Weekly EasyToInsureME

2009-10-08T08:52:00.000-07:00

Week of October 5, 2009

The Senate Finance Committee essentially wrapped up its work on a health care reform bill last week, though additional changes are still possible as the bill is put to a vote of the full Committee later this week. A number of changes made to the bill at the 11th hour last week already are generating concerns about the direction of the legislation. For example, one amendment approved by the Committee would result in a significant weakening of the individual coverage requirement (see below). This requirement is the cornerstone on which a host of insurance market reforms are supported. The bill also would levy significant new fees and taxes on different sectors of the health care system, such as health insurance, without adequately tackling the true drivers of health care costs. Clearly the rubber is now meeting the road as health care reform moves toward floor debate in the House and Senate. Aetna will monitor events closely and weigh in on issues of substance. While this summer's town hall meetings were an important part of the process, there will be no more important time for all Americans to stay informed and be involved than in the weeks ahead.

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Federal

The Senate Finance Committee last week finished slogging through dozens of amendments, paving the way for a vote on the finished bill sometime this week after the Congressional Budget Office provides a cost estimate. While many amendments were rejected, the panel did approve at the last minute some significant changes to the bill introduced by Chairman Max Baucus (D-MT) in mid-September. One amendment adopted would weaken the individual coverage requirement by delaying and reducing penalties attached to the requirement. The maximum penalty for a family of four would start at $200 in 2014 and rise to $750 in 2017. Also, an estimated 2 million people who would face financial difficulties would be exempt from buying even the cheapest insurance available -- those who would have to pay more than 8 percent (a change from 10 percent) of their adjusted gross income for the cheapest plan would be exempt. The Committee rejected amendments for a public plan option, but it did include a mini-public plan option for those under 200 percent of the federal poverty level. To help pay for the legislation, new fees and taxes would be levied on insurance companies, drug makers, medical device manufacturers, and some families. Senate leaders already have begun looking at ways to blend together the Senate Finance Committee bill and a competing Senate HELP Committee bill so that floor debate can begin later in October.

States

INDIANA: Hearings resumed last week on the Health Provider Patient Limit Study supported by the Indiana Medical Association. The Health Finance Commission is required to study: 1) health plan provider contract provisions that would require a contracted provider to mandatorily accept more than a certain number of patients (open access clause); and 2) whether an insurer should be required to directly reimburse an out-of- network health care provider (assignment of benefits). Arguments were presented on both sides of these issues. In addition, HEA 1300 requires the Indiana Department of Insurance (DOI) to collect information regarding the costs of initiation and operation for recognizing assignment of benefits and report to the Health Finance Commission on its actuarial findings. The data has been collected by DOI, which will present its final findings on assignment at the October 19 Health Finance Commission meeting. A final report from the Health Finance Commission is due to the Legislative Council by November 1.

TEXAS Health Insurance : The Department of Insurance has prepared a working draft of rules concerning physician ranking requirements and notice requirements that would limit health plans' ability to publish physician rankings. These draft rules would implement the provisions of legislation recently passed establishing standards for the use of physician ranking systems by health plans. The legislation outlines a process to be used by the TDI in determining nationally accepted standards for provider rankings. The standards used must be disclosed to each affected provider, as well as the details of a process that may be used to dispute the rankings. The measure also prohibits physicians from taking action that would prevent a patient from participating in an evaluation of the physician’s performance. Aetna worked throughout the session with the bill’s authors to ensure that the final version tracked the patient charter and national best practices. Aetna will continue to work with TDI in the crafting of its final rules.

WASHINGTON: Aetna is working with the state and other industry stakeholders to determine the feasibility of maintaining the state's Universal Vaccine Program for children. Due to budget cuts, the state is scaling back the vaccine program next spring to cover only low-income children. Currently, the program is available for all vaccinations for any child residing in the state, even those with private insurance. Due to the state's purchasing power and its ability to distribute vaccine effectively, there are multiple benefits to the state continuing the program.

Health Insurance Quote Reform Weekly EasyToInsureME

2009-10-02T12:22:00.000-07:00

Oct. 2, 2009

This Week in Health Care Reform

This week, legislators from the Senate Finance Committee continued mark-up of the legislation proposed by Sen. Max Baucus (D-MT).

Senate Negotiations

Senate Finance Committee Negotiates Amendments: After days of negotiations, Sen. Baucus indicated on Wednesday that the Senate Finance Committee now had the necessary votes to pass legislation and that he anticipated finalizing the bill by the end of the week. Lawmakers from the Committee convened this week to continue voting on the hundreds of proposed amendments to the health care reform legislation offered by the senator earlier this month. Committee voting this week included:

* Rejection of two amendments, one from Sen. Jay Rockefeller (D-WV) and one from Sen. Charles Schumer (D-NY), that would have incorporated a public option in the bill.
* Modification of a financing provision that would make it harder to deduct medical expenses on personal tax returns. Lawmakers voted to exempt taxpayers older than 65.
* Rejection of Republican amendments that would have strengthened limits on both abortion coverage and medical coverage for illegal immigrants.
* Adoption of an amendment by Sen. Chuck Grassley (R-IA) and Sen. Jim Bunning (R-KY) requiring federal employees, lawmakers and their aides to buy health insurance from the health insurance exchanges to be created by the legislation in 2013.
* Rejection of an amendment proposed by Republicans to allow individuals to opt out of the bill's requirement for everyone to have insurance coverage, upholding the bill's inclusion of an individual mandate.
* Rejection of an amendment proposed by Sen. Bill Nelson (D-FL) to require drugmakers to provide $106 billion in rebates over 10 years. The Committee upheld an agreement made last June with drug manufacturers to provide $80 billion in rebates.
* Rejection of two Republican amendments that would have blocked cuts in the Medicare Advantage program.

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Public Plan

Public Support for Reform Increases: After a summer embattled by contentious town hall meetings and characterized by slipping public support, the latest Kaiser Health Tracking Poll indicates that public support for health care reform is now on the rise. About 57% of Americans now say that tackling health care reform is more important than ever - up from 53% in August. However, 47% of Americans favor taking additional time to craft a bipartisan approach to health care reform, compared to 42% who say Democrats should move faster on their own. In addition, substantial majorities support the individual mandate, the employer mandate and an expansion of programs such as Medicaid and the State Children's Health Insurance Program.

Small Business Owners Support Health Care Reform: A recent study by Small Business Majority, a California-based advocacy group, found that small businesses in 17 states are struggling to keep up with health care costs and favor health care reform. Of small business owners in Pennsylvania who do not offer health insurance to employees, 87% say they cannot afford to do so; and, of those who do provide health insurance, 71% are struggling to afford it. Across the 17 states surveyed, 67% of small business owners agreed that health care reform is "urgently needed to fix the U.S. economy" - revealing a growing divide between small business and its traditional Washington ally, the Republican Party.

Young Adults Support Health Care Reform: While many young adults acknowledge that they do not fully understand the health care reform proposals and the potential costs that younger generations may bear, the group remains one of the strongest supporters of reform legislation.

House Activities

House Leaders Merge Bills: House Democratic leaders are working to merge the bills from the three House committees: the Energy and Commerce Committee, the Education and Labor Committee and the Ways and Means Committee. While House leaders now hope to have a final bill sometime in October, they are still debating major elements of the legislation, including whether public-option provider reimbursement rates should be based on Medicare rates and how to reduce the overall cost of the reform legislation. Managing the cost of the legislation is a key requirement for President Barack Obama, who has indicated that a viable bill must be deficit-neutral and cost $900 billion or less over 10 years. The Congressional Budget Office (CBO) has estimated that the cost of the current House package stands at more than $1 trillion.

Additional Activities

President Obama Allocates Money for New Medical Research: On Wednesday, President Obama announced the allocation of $5 billion in grants for medical and scientific research, medical supplies and upgrading laboratory capacity. The funds will be drawn from the $787 billion American Recovery and Reinvestment Act of 2009.

Looking Ahead

Sen. Baucus seeks to finalize the Senate Finance Committee bill today. The Committee vote will be delayed until early next week to give the CBO time to assess the cost of the revised legislation.

Individual Health Insurance Reform Weekly EasyToInsureME

2009-10-01T09:19:00.000-07:00

Week of September 28, 2009

The Senate Finance Committee wasted no time last week in wading through a seemingly endless number of amendments to its proposed health care reform legislation (see below). The committee turned aside a number of amendments, including attempts to avert cuts to the Medicare Advantage program to help pay for expanded coverage for the uninsured. But the sparring that occurred over the issue is a good indication that emotions are running high, and the dispute is bound to reappear when the bill makes it to the Senate floor. Democrats and the Obama administration last week sought to reassure seniors that health care reform would not cost them their current levels of Medicare benefits, but the head of the Congressional Budget Office, Douglas Elmendorf, recently told Senators that seniors in Medicare Advantage could very well see reduced benefits. The bill's momentum continues, but some Democrats are now struggling to figure out how to vigorously support health care reform without alienating many elderly voters.

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Federal

The Senate Finance Committee began its long-awaited mark-up of a health care reform bill and by the end of last week had slogged its way through about two dozen amendments, both in open session and as part of after-hours talks dealing with Medicare, taxes, insurance and delivery items. Of note are the proposed increase in the insurer tax and the defeat of several Republican amendments to soften the burden on seniors in Medicare Advantage. The individual coverage requirement is still intact, but the dollar penalty for noncompliance has been lowered. And the age rating limit of 5:1 has been reduced to 4:1, which would increase the eventual rate shock for younger insureds. Additionally, the Committee approved an amendment to dramatically increase transparency by forcing PBMs to disclose certain pricing information to government and plan sponsors. It seems likely that some member will offer an amendment to add an employer mandate to the bill as well as an amendment to replace the current co-op provision with a full-fledged government plan. This mark-up process is expected to continue through this week. It is likely that the Committee will finish by the end of the week but probably not in time to meld its product with the HELP Committee bill before the Columbus Day break.

The House Energy & Commerce Committee held a mark-up last week to take up a handful of amendments left over from its mark-up of reform legislation back in July. Two major items include: passage of a provision to provide grants to large employers (not covered in the original bill) for establishing wellness programs; and the defeat of a provision that would have prohibited insurers from recovering insurance payments through subrogation. Insurers and employers worked together to help defeat this latter item. On a related House matter, it is becoming increasingly clear that the compromise between the House leadership and the Blue Dogs seems to be more tenuous than ever, which may well give the Speaker the political "room" to beef up the existing public plan provision in the House bill by adding back the government rate-setting provision she favors.

States

CALIFORNIA Health Insurance : Governor Arnold Schwarzenegger signed legislation that subjects Medicaid (Medi-Cal) managed care plans to a tax to fund Medi-Cal and the state's Children's Health Insurance Program (Healthy Families). The tax, which is assessed on the plan's total operating revenue, is effective for Medi-Cal managed care plans through January 1, 2011. Approval of the measure will prevent more than 600,000 children from losing access to Healthy Families coverage. In addition, this bill has allowed the state to reopen Healthy Families enrollment and begin processing the more than 80,000 applications that were placed on a wait list. In other news, the California Privacy and Security Advisory Board (CalPSAB) approved a "hybrid approach" to patient consent guidelines for participation in a health insurance exchange. The approach, outlined by CalPSAB, appears to be inconsistent with federal privacy and security standards. CalPSAB is developing new privacy and security standards to enable the adoption and application of health information exchange in California.

CONNECTICUT Health Insurance : Gov. M. Jodi Rell is threatening to veto a bill being debated during a special legislative budget session because it represents a back-door maneuver around her veto of a controversial health care pooling bill. In a detailed letter to top legislators, Rell said flatly that she would veto the bill because it did not meet certain requirements. One of the troubling provisions, Rell said, is that Section 15 of the general government bill would allow the state comptroller, Democrat Nancy Wyman, to merge various insurance plans into the state's self-insured plan. Rell stated that this effectively would allow the comptroller to implement the pooling concept that she previously vetoed, which would likely result in a significant cost increase to the state at a time when the state is making cuts to virtually every program.

IOWA Health Insurance : The Iowa Health Care Coverage Commission has begun meeting to develop a plan to ensure that all Iowans have access to health care coverage that meets minimum standards of quality and affordability. The Commission, which has representation from a wide spectrum of stakeholders including the health insurance industry, has broken into three work groups addressing (1) coverage of uninsured and underinsured adults; (2) the use and creation of a group insurance plan to provide coverage to non-state public employees, employees of not-for-profit groups, and small employers; and (3) administration of health care reform. The Commission is required to issue its first quarterly progress report to the Iowa Legislative Council by January 1, 2010.

NEW YORK: The State Insurance Department (DOI) is conducting public hearings in Rochester, Newburgh and New York City to gather information about limited benefits health insurance plans. The goal is to ascertain how these policies are marketed by insurers and producers, assess what disclosures are made regarding the services they cover, evaluate what advantages these policies provide, and determine whether additional oversight and regulation are needed. The DOI investigations have revealed that some policies are sold through telemarketing firms using unlicensed agents, which runs afoul of the New York Insurance Law and that some insurers issue limited benefits health plan policies as group coverage through invalid associations. Consumers must join the association for an additional fee in order to be eligible to purchase the coverage. The NYS Health Plan Association will be submitting written testimony on behalf of its members who offer limited benefits plans, to distinguish these legitimate products from the fraudulent types of associations being investigated by the DOI.

OKLAHOMA Health Insurance : Senate President Pro Tem Republican Glenn Coffee recently announced the approval of 34 interim studies and the committees that will conduct them. With nearly one-third of the studies having implications for health insurance, the list yields insights into a number of issues, especially autism, that could be the subjects of key legislation in 2010. The following studies are the most relevant to the health insurance industry, and Aetna will be watching them closely: Review of health insurance mandates; health insurance policy rescissions; high-risk pool coverage of autism spectrum disorder diagnosis and treatment; autism insurance mandates and the state’s economy; issues relating to interstate purchasing of health insurance policies; and possible funding for PPO coverage of persons in rural Oklahoma.

TENNESSEE Health Insurance : Preliminary meetings are being scheduled to discuss Silent PPO legislation related to workers' compensation, which was defeated earlier this year. This is expected to be a significant issue for the 2010 legislative session. In addition, Aetna is participating in a workgroup at the Tennessee Department of Commerce and Insurance regarding implementation of claims data legislation passed earlier this year.

WISCONSIN Health Insurance : The Office of the Commissioner of Insurance (OCI) intends to publish emergency rules to comply with the federal American Recovery and Reinvestment Act (ARRA) and provisions related to continuation of employer-discounted group coverage. The draft rules contain a new COBRA eligibility category for group coverage discontinuation retroactive to May 2009. In addition, the Autism Workgroup, created under the auspices of the OCI, has developed an administrative rule to implement recently enacted legislation requiring health insurance coverage for autism spectrum disorders. The rule will be promulgated on an emergency basis and takes effect for insurance products that are issued or renewed on or after November 1, 2009.

Health Insurance Quote Reform Weekly EasyToInsureME

2009-09-25T12:24:00.000-07:00

Sept. 25, 2009

This Week in Health Care Reform

This week's health care reform debate focused on the long-awaited health care reform legislation proposed by Finance Committee Chairman Sen. Max Baucus (D-MT).

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Senate Negotiations

Introduced last week, Sen. Baucus's Finance Committee bill has faced criticisms from both sides of the aisle, resulting in 564 proposed amendments to the legislation. On Tuesday, to address some of the concerns outlined in those amendments, Sen. Baucus suggested changes to the bill that would further increase regulation of insurance companies, expand consumer protections and increase subsidies to help people buy insurance. In an effort to appease Republicans, he also exempted consumer items of $100 or less - items ranging from Q-tips to contact lenses - from a proposed tax on medical device manufacturers. As the week progressed, clear partisan battle lines emerged as Senate Democrats and Republicans debated controversial proposals, such as changes to Medicare .

As the Finance Committee continues the mark-up process and votes on amendments, Sen. Baucus will attempt to keep the 13 Finance Committee Democrats on board. He will have to achieve this without moving so far left politically that he loses the support of key Republicans, including Sen. Olympia Snowe (R-ME), the only Republican of the 10 who sit on the Finance Committee seen as likely to vote for the bill.

Outside of the committee, Sen. Snowe has become a pivotal figure in bipartisan negotiations for reform as Democrats seek the 60 votes in the Senate required to pass the legislation. Other reports suggest that the Finance Committee bill also has the backing of Sen. Blanche Lincoln (D-AR), another key swing senator.

Public Plan

President Obama Conducts Media Blitz: On Sunday, President Obama advocated for health care form legislation in back-to-back broadcasts of taped interviews on five morning news shows (ABC's "This Week," NBC's "Meet the Press," CBS's "Face the Nation," CNN's "State of the Union" and Spanish-language Univision's "Al Punto"). While admitting to being "humbled" by the challenge of reform, he called for a more civil tone in the debate.

Going into the Sunday interviews, a Siegel+Gale poll showed that, following President Obama's televised address to a joint session of Congress earlier this month, only 36.9% of Americans said they understood the President's reform plan. Of those who actually watched the President's address to Congress, 57.9% claimed to understand his platform.

Democrats Woo Seniors: White House officials and Democrats have focused on convincing skeptical seniors to support the administration's reform legislation. On Wednesday, Vice President Joe Biden visited a retirement community in Maryland to deliver the Democratic health care reform message and to reassure seniors that they will not see cuts in their Medicare coverage.

Additional Activities

First Lady Enters Health Care Debate: Working to galvanize women around health care reform, First Lady Michelle Obama jumped into the debate last week at a meeting of the newly formed White House Council on Women and Girls. Michelle Obama urged women to mobilize behind the President's plan. Meeting attendees included members of the Business and Professional Women, the YWCA, the Women's Chamber of Commerce and the National Council of Negro Women.

President Obama Speeds Up Tort Reform: Last Thursday, President Obama sought to ease tensions this week among physicians whose concerns over malpractice costs and Medicare reimbursement were modestly addressed in the Finance Committee bill. The President moved to accelerate a $25 million grant program aimed at addressing medical malpractice lawsuits.

Looking Ahead

Sen. Baucus plans to steer his health care reform bill through the Finance Committee by the end of the week. Once the Finance Committee votes and approves the bill, Senate leaders will then combine it with another bill approved by the Health, Education, Labor and Pensions Committee in July.

A similar process is also occurring in the House with bills passed by three committees: Energy and Commerce; Education and Labor, and Ways and Means. House Speaker Nancy Pelosi (D-CA) has indicated that she hopes to have a single, final version of the House bill by the end of next week.

White House Budget Director Peter Orszag anticipates completion of health care legislation by mid-November. He also believes that the final version will be largely based on the Senate Finance Committee bill.

Individual Health Insurance Reform Weekly : EasyToInsureME

2009-09-24T09:55:00.000-07:00

Week of September 21, 2009

While the proposals being considered by Congress to help reform the health care system could make significant strides in addressing health care access problems, many remain concerned that the proposals made to date do not do enough to take on the overarching problem of rapidly rising health care costs. To help draw more attention to this daunting problem, Aetna and the Aetna Foundation recently were the major sponsors of the September/October edition of the journal Health Affairs, which is devoted to "bending the cost curve." The current issue and the launch event highlighted innovative solutions that could have a significant impact on the future cost of health care. Bending the cost curve is the key -- if we don’t make health care more affordable, other reforms will have little value.

Federal

Senate Finance Committee Chairman Max Baucus released his "mark," which is the Senator's offering to the full Committee of the legislative pathway he thinks the Committee should follow to pass health care reform. While those on both the left (Senator Rockefeller) and on the right (Senator Grassley) expressed negative views on the mark, all the headline posturing ceases when the committee officially begins to review and amend the mark this week. The key for Chairman Baucus is to garner sufficient support to pass the bill out of committee in a fashion that bodes well for floor passage. Right now the prospects are far from certain.

States

ARIZONA Health Insurance : The Department of Insurance has issued a bulletin summarizing several insurance-related bills enacted during the 2009 legislative session. The bulletin expressly notes: the revision of the acceptable medical references an insurer may use in its determination of whether a drug has been found to be safe and effective for treatment of a specific type of cancer and the amended definition of "network plan" to include a plan under which the financing and delivery of health care services are provided through a defined set of providers under contract with a hospital, medical, dental or optometric service corporation; the ability of service corporations to issue subscription contracts free of many state-mandated benefits and also reduce the allowable uninsured period for small groups to qualify for state vouchers for free coverage; and the permissibility of issuing coverage to uninsured individuals without being subjected to many of the state's mandated benefits.

CALIFORNIA Health Insurance : Proponents of a new statewide initiative to return the legislature back to a part-time status are attempting to collect the 700,000 signatures necessary to qualify for the ballot in 2010. The measure would cut the current legislative calendar to 90 days. Supporters of the initiative say that the full-time legislature, authorized by voters in 1966, has failed to produce the results promised. After another rocky legislative year marked by a soaring budget deficit and a failure to address education spending and health reform issues, broad support for the measure seems likely. However, a bipartisan group of three former state lawmakers have formed an alliance to fight the effort, arguing that it would not allow the legislature sufficient time to address the state's serious problems.

CONNECTICUT Health Insurance : The General Assembly is holding September 23 and 24 to take up several bills needed to implement the new, two-year budget that took effect September 8. The “implementer bills” are required to put in statute the policy changes necessitated by passage of the budget. The session bears watching because of a trend of late to attempt to include non-budget-related proposals in these implementer bills. In the past, ideas that died in the regular session came back to life during an implementer session, only to expire again once they were publicized.

FLORIDA Health Insurance : The Agency for Healthcare Administration has asked carriers to participate in a workgroup regarding Explanation of Benefits (EOB) sent to members. The goal of the workgroup is to develop best practices for information contained on an EOB and assure the EOB is clear to consumers. Aetna is participating along with other carriers.

ILLINOIS: The Department of Insurance's (DOI) proposed rules for preferred provider programs and networks were heard last week by a legislative panel. These rules would affect both insurers and network administrators that offer incentives to insureds to utilize the services of contracted providers. At the hearing DOI agreed to remove objectionable language to business and insurance groups that would have limited a consumer's exposure to 50 percent of out-of-network billed costs by a provider. The DOI Director was given discretion on the rest of the proposed rule and agreed to hold it for 30 days and meet with the industry to discuss other objections. The two major issues that remain for business and insurance groups are: a provision stating that a provider's written approval must be obtained whenever an insurer or administrator buys another network, if it represents a material change to the contract; and the effect of language that would require insurers and administrators to hold beneficiaries harmless for out-of-network physician costs. The industry is preparing for meetings with DOI.

MASSACHUSETTS: The Division of Health Care Finance and Policy (DHFP) has introduced amendments to the Employer Fair Share Contribution regulation. The proposed amendments clarify that to be considered a contributing employer, an employer must maintain a written plan document for its group health plan. In addition, the employer must be able to document in writing its offer to employees to make a percentage premium contribution and the minimum number of hours that the employees are required to work to be eligible for full-time benefits. The amendments also clarify that a Premium Reimbursement Arrangement (in which an employee enrolls in an individual plan and is reimbursed by the employer for a portion of the premium expense) may qualify as a group health plan, provided there is written plan documentation that designates a particular plan for use by employees.

NEW JERSEY: Legislation requiring disclosure of certain serious reportable events was recently enacted by Governor Jon Corzine. Under the new law, the Department of Health and Senior Services will annually issue a report of specific hospital Patient Safety Indicators (PSI) as enumerated under federal guidelines by CMS. Additionally the law prohibits hospitals from charging for certain "never events." These events, for which reimbursement cannot be sought, include: transfusion reaction; air embolism; foreign body left in during a procedure; surgery on wrong side, body part, or person; and performing the wrong procedure on a patient. Also, the Department of Banking & Insurance adopted regulations establishing minimum benefits standards for health benefits plans, dental plans, and prescription drug plans. The regulations, among other things, set maximum cost-sharing and network copayment limits.

SOUTH DAKOTA: The Division of Insurance has issued a three-sentence, proposed regulation addressing the relationship between Centers of Excellence and access plans. The proposed regulation currently states that each contracted Center of Excellence and each contracted network of a Center of Excellence must be included in a health carrier’s access plan. For purposes of network adequacy, the health carrier’s entire Center of Excellence network, including both direct–contracted Centers of Excellence and contracted networks, shall be considered. A health carrier may not contract with a Center of Excellence network or any other network that is not registered pursuant to South Dakota law. When originally circulated, this regulation also contained a definition of Centers of Excellence, placed restrictions on carriers with Centers of Excellence for transplant services, and required “closed plans” to have certificates of authority to operate as HMOs. The new language is strongly preferable. A hearing regarding these proposed regulations is scheduled for October 21, 2009. Aetna will attend the hearing to discuss any proposed changes.

UTAH: The Utah Insurance Department (UID) has issued amendments to the state's requirements for the Basic Health Care Plan to bring the rules into compliance with new statutory requirements that were enacted in 2008 and 2009. Individual and small group health insurers are required to offer the Plan until January 1, 2010. The Plan includes the following maximum benefit limitations: 1) a lifetime maximum of no less than $1 million per person, 2) a minimum $250,000 annual maximum per person, and 3) out-of-pocket maximums on various cost-sharing obligations. After January 1, 2010, the Plan will be replaced with a new basic health care plan that is defined as: 1) a federally qualified, high-deductible health plan (HDHP), 2) has the lowest deductible that qualifies as an HDHP, and 3) has an out-of-pocket maximum no greater than three times the annual deductible.

Health Insurance Quote Reform Weekly EasyToInsureME

2009-09-18T13:00:00.000-07:00

Sept. 18, 2009

This Week in Health Care Reform
Lawmakers continued to negotiate health care reform legislation this week. On Wednesday, Sen. Max Baucus (D-MT), chairman of the Senate Finance Committee, revealed his proposed reform legislation despite ongoing concerns from both Republicans and Democrats.

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Senate Negotiations

Sen. Baucus Unveils Proposed Legislation: On Wednesday, after months of negotiations to develop a bipartisan reform proposal, Sen. Baucus unveiled a major health care reform bill. The GOP, to date, has withheld its support of the bill.

With an expected price tag of $856 billion , the bill proposes insurance cooperatives, individual mandates, taxes on high-end insurance plans, fees on industry players, Medicaid expansions and government subsidies for qualifying families. It would also prohibit insurance companies from dropping or denying coverage based on preexisting conditions. The bill is deficit-neutral and less costly than prior proposed bills. In addition, the Congressional Budget Office (CBO) reports that the bill will trim federal deficits by $49 billion over 10 years.

Sen. Baucus has indicated he will continue to work to forge bipartisan consensus, saying that the bipartisan talks could continue even as the Finance Committee begins its formal bill drafting and voting session next week. With concerns voiced from both sides of the aisle, however, it is not clear whether the bill will receive enough support.

Republicans question the states' role in paying for Medicaid expansion, an individual requirement to purchase coverage, and fees on health insurance companies, clinical laboratories and medical device manufacturers. In addition, they want to include specific language restricting the use of federal dollars for abortion.

Democrats believe there are excessive cost burdens placed on some families and have concerns about the financing of the plan. Interested parties, from consumers to employers to industry groups, are still digesting what Sen. Baucus's reform bill will mean for them.

Public Plan

American Opposition Drops if Public Option Dropped: A recent Washington Post-ABC News poll, conducted in the days following President Obama's televised address to a joint session of Congress, found that 46 percent of those polled favor proposed changes to the nation's health care system, while 48 percent are opposed. Public opinion appears to shift if the public option is dropped from the reform package, though, with opposition dropping 6 percent. About 55 percent of those polled like the idea of a public option.

Additional Activities

Industry Groups Give Support Following President Obama's Speech: Following the President's presentation of a health care reform blueprint to a joint session of Congress, industry groups expressed support for the proposed reform plans . The Americas Health Insurance Plans (AHIP), the American Medical Association (AMA), the Pharmaceutical Research and Manufacturers Association (PhRMA) and the American Association of Retired Persons (AARP), endorsed President Obama's calls for change, saying they remain open to major reform for availability, financing and regulation of health care.

Debate Swirls Around Illegal Immigrants and Health Care: House Democrats asked White House officials to clarify statements made by Press Secretary Robert Gibbs last week indicating that President Obama would bar illegal immigrants from directly buying health insurance from a government-created insurance exchange. Democrats believe that the health care proposals were developed to prevent illegal immigrants from getting tax-supported subsidies to buy health insurance, but not to prevent them from using their own money for private insurance.

White House officials clarified that illegal immigrants could use their own money to buy coverage from the few private insurance companies that will be permitted to sell insurance outside the exchange. Rep. Lamar Smith (R-TX) accused the Administration of providing coverage to illegal immigrants with this arrangement.

Looking Ahead

The Senate Finance Committee is expected to begin mark-up on Tuesday, preparing the bill for debate in the full Senate next month. The full committee will meet on Thursday to discuss the proposal, with any amendments due by end of the day Friday.