Individual Health Insurance Reform Future Proceedings Easy To Insure ME

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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Health Insurance Care Reform 7/9/09 EasyToInsureME

DISTRICT OF COLUMBIA Health Insurance : The District Council is considering extending its legislative session past its normal July 14 recess date due to the recent announcement by the chief financial officer that the expected 2009 fiscal year revenue is now projected to be $190 million less than was estimated in February. This development will force the Council to borrow from the $1.4 billion rainy day fund in order to balance the budget as required by law.

The Council passed an amendment to the Health Occupations Revision Act that included a definition of "the practice of medicine." As passed, the provision does not contain language opposed by the health insurance industry that would have arguably included utilization review. Also deemed approved was a rule permitting those enrolled in the District's Employee Benefits Program to enroll a domestic partner and children of the domestic partner under family coverage, provided the employee pays 25 percent of the premium.

NEW JERSEY Health Insurance : The legislature passed the state budget with supplementary legislation calling for a .35 percent premium tax increase on group accident and health insurance policies, and a 2 percent increase on surplus lines, effectively increasing the tax to 1.35 percent and 5 percent respectively. Both are a part of the state's overall $1 billion in tax increases for the new fiscal year and include a one-year sunset provision. An autism coverage mandate is on its way to Governor Corzine's desk for his signature. The Senate also gave final approval to legislation requiring installment payments for maternity services. This bill calls for the Department of Banking & Insurance to develop a mechanism to provide incremental payments for prenatal services. The immediate effective date was postponed for one year. The legislature is now in recess and is unlikely to return until after the November election.

NORTH CAROLINA Health Insurance : Discussion continues regarding the proposal to increase premium taxes across all lines of insurance from 1.9 percent to 2.25 percent effective January 1, 2011. Several trade organizations, including America's Health Insurance Plans and the North Carolina Association of Health Plans, are working on letters to key legislators in opposition to the tax. Aetna is also working on similar communications and is urging customers to get involved.

OHIO Health Insurance : Despite the June 30 deadline for passing the state's biennial budget, Governor Strickland and the General Assembly remain at a stalemate. The Senate President has rescheduled meetings of the joint conference committee several times as he and the governor spar over whether the decision to permit video terminals at racetracks should be legislated or put to a ballot vote. Faced with a $3.2 billion budget shortfall, allowing an expansion of gambling is projected to decrease the deficit by $933 million. In the meantime, Governor Strickland signed an interim seven-day budget that sets funding for a number of agencies at 30 percent less than they received in 2008. This is the first time in 18 years that Ohio has had an interim budget.

The House Civil and Commercial Law Committee passed a bill prohibiting a material amendment to a provider contract from becoming effective absent the affirmative consent of both parties. This was an expected result in the Democratically controlled House. Efforts to defeat the bill will be focused on the Senate.

OKLAHOMA Health Insurance : The following interim studies were recently approved to go forward by legislative leadership: a study concerning systematic health education in the schools, health care access for primary care in schools (Community School Initiative) and care coordination to facilitate access to health care in the community; a study regarding how the State of Oklahoma buys benefits for their employees and dependents (state-run versus private carriers and private TPA-run insurance programs and pension plans); a study regarding the subject of insurance companies rescinding and canceling citizens' health insurance policies for arbitrary reasons; and a study considering issues relating to interstate purchasing of health insurance policies.

OREGON Health Insurance : Governor Kulongoski signed comprehensive health care reform legislation this week that establishes a Health Policy Board to serve as the policy making and oversight body for the newly created Oregon Health Authority. The Board is charged with a number of duties including the development of a universal coverage proposal, quality and cost containment programs, premium assistance and a statewide Health Insurance Exchange. The Authority will take on the responsibility for the Exchange, including the development of rules and base-line benefit packages for the plans offered within the Exchange. The Authority will also develop uniform contracting standards and claim processing, a framework for rate filings, MCR standards, the use of medical homes, quality data reporting and dissemination and the use comparative effective research.

The Governor is also expected to sign a new funding mechanism that would institute a temporary 1 percent premium tax, higher hospital fees and assessments, new corporate tax rates to pay for the reform proposal and expand coverage for low-income families and children.

TEXAS Health Insurance : A "Special Session" called by Governor Rick Perry began July 1 and wrapped up on July 2. HB2, which will take the Texas Department of Insurance out of "wind down" mode and continue the agency's existence until it can be reviewed on a limited basis by the Sunset Commission during the 2011 legislative session, was passed by the House on July 2 and by the Senate on July 3. The legislature then quickly adjourned in time to enjoy the July 4 holiday. TDI will now immediately begin its review by the Sunset Commission.

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