Patient Protection, Preventive Care, and Pre-existing Conditions

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

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 March 15 2010

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

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

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

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 from EasyToInsureME health insurance

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.”

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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

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

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

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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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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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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

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.

1. 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.
   .
   
2. 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.

This Week in Health Care Reform EasyToInsureME health insurance

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.

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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.