Health Insurance Reform In Conclusion

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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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.

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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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Individual Health Insurance Quote Reform Weekly : EasyToInsureME : 08/13/09

Even as partisan rhetoric swirled even stronger around the subject of health care reform, the Senate Finance Committee continued its health reform negotiations last week in what is the last hope for a bipartisan bill from Congress. Senators left Washington late last week to start their August recess, but Finance Committee members have vowed to continue negotiations throughout the month. A bipartisan group of six Senators on the Committee, led by Chairman Max Baucus, briefed President Obama on their work Thursday, and they also conducted a conference call with a dozen governors. The emerging legislation would expand Medicaid coverage to millions of additional people, and the governors are concerned about the impact on state budgets. No details of the still-developing proposal have been officially released, but participants have indicated the package could shave $100 billion off the cost of the legislation over the next decade, providing coverage to 94 percent of the nation, expanding Medicaid, abandoning the government-insurance option and possibly replacing it with a state-based co-op plan, and taxing insurance companies that offer health care benefits under the richest plans. Baucus has set a Sept. 15 deadline for a bipartisan deal.

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States
ARIZONA: The State Senate last week postponed a vote on a plan to close the state's estimated a $3.2 billion budget deficit using spending cuts, funding delays, borrowing, and federal stimulus funds. Approved by the House on July 31, the plan's health-related provisions include: eliminating the KidsCare Parents Program; reducing AHCCCS (Medicaid) reimbursement rates to non-institutional providers by 5 percent but not reducing AHCCCS reimbursement rates to institutional providers; delaying one month's capitation payment to AHCCCS contracted health plans; and requiring AHCCCS to comply with the federal False Claims Act.

NORTH CAROLINA: In a very positive development, a new budget was issued by the legislature last week that includes no premium tax increases. Previous budget proposals included increases from 1.9 to 2.25 percent, effective January 2011. Aetna, along with other carriers and trade associations, worked to educate legislators and oppose a premium tax increase. A final vote on the budget is expected soon.

OREGON: Governor Ted Kulongoski has signed legislation enacting a 1 percent premium tax that will be used to expand access to affordable health care for children. The premium tax will be assessed beginning October 1, 2009 through September 30, 2013. Rate filings submitted for approval may include the premium assessment as a valid administrative expense or retention element. The law also establishes the Health Care for Oregon Children program, which includes an expansion of SCHIP and a premium assistance program administered by the Office of Private Health Partnerships (OPHP). Under the premium assistance program: Children in families with incomes at or below 200 percent of the federal poverty level (FPL) and who have access to employer-sponsored coverage will receive a subsidy equal to the full cost of the premium; children in families with incomes above 200 percent but at or below 300 percent of FPL will receive assistance on a sliding-scale basis as determined by the OPHP; and children in families with incomes exceeding 300 percent of the FPL will not receive premium assistance but will have the opportunity to purchase coverage through the new OPHP private health option.

TEXAS Health Insurance : With Dallas saddled by the most expensive health care in the state, Mayor Tom Leppert and a local health insurer last week took a step toward changing the city's direction. They are working on scheduling a North Texas health care summit on Sept. 30 at which company and government executives hope to agree on payment, practice and transparency fixes leading to greater competition based on quality and cost efficiency. In its national quality-to-cost ranking, Texas is rated third worst, behind Mississippi and Louisiana. Dartmouth Institute for Health Policy data indicates that on average Dallas health care providers submit $10,100 in Medicare claims for every enrollee, the highest among Texas cities with more than 50,000 residents. Dartmouth's data shows that higher health care spending is not associated with better quality outcomes.

Health Insurance Reform Weekly : EasyToInsureME : July 16th 2009

On the health care reform front, the Senate HELP Committee continues to slug it out amendment by amendment, with Democrats winning all of the important ones on straight party-line votes. The HELP Committee started the week by unveiling its new language on the public plan and the employer mandate, but it still has no language on biogenerics. The committee hopes to complete this work by week's end. The Finance Committee has yet to meet to mark up a bill because it doesn't have a bill as yet - the Chairman is still seeking a bipartisan compromise with Republicans. The long-awaited beginning of the Finance Committee mark-up will have to wait until the following week at the earliest. The House-planned introduction of its bill was postponed until early this week, which puts off the beginning of the House mark-up until later in the week. It seems clear that the Democratic leadership is seeking to convey the impression that progress is being achieved, while having to deal with constant rumblings that the bills simply cost too much for even Democrats to accept. While the House surely has the capacity to meet its goal of having a bill ready for floor debate by mid-July, it is unlikely that Speaker Pelosi will allow this without an expectation that the Senate also will debate a bill before the August recess, set for August 7 in the Senate.

States
ARIZONA Health Insurance : In the wake of the failed 2008 ballot "Medical Choices Act" initiative, the legislature passed a resolution proposing to amend the Arizona Constitution to state that "no law or rule shall compel a person, employer, or health care provider to participate in any health care system, including a prohibition of penalties or fines for direct payment of lawful health care services." The amendment would also state that "the purchase or sale of health insurance in private health care systems shall not be prohibited by law." The resolution was certified for the 2010 general election. Additionally, the legislature passed and sent to the Governor a proposal to limit the benefit mandates that apply to the individual market; the proposal awaits the Governor's signature.

CONNECTICUT Health Insurance : As anticipated, Gov. M. Jodi Rell vetoed two of the most significant and flawed pieces of legislation approved this year by the legislature. The first, the Connecticut HealthCare Partnership bill, would have opened the very expensive state employee health plan to small businesses and other groups on an unregulated, self-insured and financially risky basis. The second would have set in motion a fully state-run health care system in Connecticut by implementing the "SustiNet Plan." Either measure would be very costly to taxpayers, especially with the state facing a projected $8.85 billion budget deficit over the next two years. The legislature may attempt to override these vetoes in a "veto session" scheduled for July 20. A veto override requires 101 votes in the House and 24 votes in the Senate - all 24 Senate Democrats would need to be present on a summer day to enact the override. The Democrats have only overridden one of Rell's vetoes during the past five years. The insurance industry has advocated for an alternate concept for expanding health coverage. That plan also would create an insurance pool, but the plan would permit insurers to offer coverage rather than forcing people to use a public pool.

Governor Rell has also issued an Executive Order creating a 15-member Connecticut Health Care Reform Advisory Board to develop a set of health care policies in response to federal reform initiatives. These proposals are directed at emphasizing cost containment, maximizing federal matching funds, enhancing access to preventative care, and assuring coverage for all children. The board is required to make interim recommendations by Feb. 1, 2010 and submit final recommendations to the Governor and General Assembly by January 1, 2011.

MASSACHUSETTS Health Insurance : Harvard Pilgrim Health Care President Charlie Baker announced that he is pursuing the 2010 GOP nomination for Governor of Massachusetts, and will be leaving his job at Harvard Pilgrim Health Care. Baker is seeking to unseat incumbent Democratic Gov. Deval Patrick. Patrick was elected the state's first African American governor in November 2006, ending a 16-year run of Republican control over the Executive Office. State Treasurer Timothy Cahill may also be in the mix as he announced he is leaving the Democratic Party and weighing an independent candidacy for governor. Cahill has been espousing a fiscal conservatism usually voiced by Republicans. Bruce Bullen, Harvard Pilgrim's current chief operating officer, will become interim chief executive officer.

NEW YORK Health Insurance : After more dramatic developments late last week, the deadlock in the Senate was finally broken and the Senate immediately began passing bills. More than 100 were moved through the process in one night. As expected, the Senate voted to make the state's mental-health parity law (Timothy's Law) permanent. They did not take up any other health industry issues. The way toward legislative action was paved when breakaway Democrat Senator Pedro Espada announced he would rejoin the Democrats, giving them the needed 32-30 majority over Senate Republicans. Sen. Espada will be the Senate Majority Leader, and Senator Malcolm Smith will serve as the Senate President. The scope of their authority in those roles is undefined at this time, as ordinarily those titles are held by the same Senator. The Senate plans to be back in session on Wednesday, July 15, to address several local municipality bills. The complete calendar of bills has yet to be made public.

NORTH CAROLINA Health Insurance : Key legislators have heard from numerous interested parties regarding the proposal to increase premium taxes across all lines of insurance from 1.9 percent to 2.25 percent, effective January 1, 2011. Because of the strong opposition to the tax, alternatives measures continue to be discussed. Aetna is working with all interested parties to defeat the new taxes.

Ohio Health Insurance : The state's budget woes continue as the deadline for the interim budget expired on July 7. Governor Ted Strickland signed a second seven-day extension through July 14, giving the legislature additional time to craft a bipartisan plan. But, with the ongoing stalemate between the Governor and the Senate over video lottery terminals, the conference committee has been unable to engage in any substantive discussion regarding the deficit. Instead, Senate President Harris forwarded a letter and a joint resolution to the Governor calling for a ballot vote in November. It is unclear what the next step will be. Health industry issues, including open enrollment program changes, electronic claims payment, a dependent age increase and administrative expense reporting, remain in limbo.