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.
Quoting & Saving just got easier...Easy To Insure ME Health Insurance Quotes... Quote all carriers in seconds
Health insurance
Health insurance quotes
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.
Chad Levin EasyToInsureME.com | Work: 866-492-3905 Fax: 215-364-3990 easytoinsureme@yahoo.com  |  |
Quoting and Saving on your health insurance has never been easier                             | ||
| Visit MyBlogLog and get a signature like this! | ||
Showing posts with label health insurance quotes. Show all posts
Showing posts with label health insurance quotes. Show all posts
Thursday, January 28, 2010
Thursday, December 24, 2009
Health Insurance Exchange Reform Weekly EasyToInsureME
DECEMBER 23, 2009
This Week in Health Reform
Senate Majority Leader Harry Reid (D-NV), may just reach his goal of getting a health care reform package approved by the Senate by Christmas. This past week, Sen. Reid clinched the 60th vote needed to pass the legislation. As of this communication, he has scheduled the final Senate vote for 7 a.m. on Christmas Eve day. In an effort to shore up votes, Sen. Reid and his colleagues struck deals to overcome hot-button issues such as abortion funding.
Quoting & Saving just got easier...Easy To Insure ME Health Insurance Quotes... Quote all carriers in seconds
Health care reform
Health insurance Exchange
Senate Negotiations
Senate Eyes Finish Line: After weeks of rancorous debate and more than 20 straight days and nights spent negotiating on Capitol Hill, Senate lawmakers cleared all three major procedural hurdles prior to a final vote on the legislation.
* The first procedural motion passed on a 60-40 vote early Monday morning , ending debate on Sen. Reid's proposed amendments, called the "manager's package," and cutting off a Republican filibuster. The "manager's package" represented a series of last-minute deals and compromises to shore up support for the legislation.
* The second procedural motion to approve the "manager's package" passed 60-39 on Tuesday morning.
* The third motion came Wednesday and ended debate on the final legislation in a 60-39 vote, setting up the reform bill for a final vote just in time for Sen. Reid's Christmas deadline.
Sen. Reid Carves Out State-Specific Deals to Secure the 60 Votes: On Saturday, Sen. Reid secured the 60 votes needed to pass the historic legislation, winning over Sen. Ben Nelson, (D-NE), with an amendment to prevent federal subsidies from being used for abortions. Under the new abortion provisions, states can opt out of allowing coverage for abortion. If states do offer coverage, enrollees must pay for abortion coverage separately - a compromise that has sparked criticism from both sides of the abortion divide. Sen. Nelson also secured other benefits for the state of Nebraska, including:
* Millions of dollars from the federal government to pay for the proposed cost of the Medicaid expansion in his state; and
* An exemption for Blue Cross Blue Shield of Nebraska from an annual fee on insurers.
Throughout his amendment package, Sen. Reid included several other state-specific deals to secure the 60 votes. Such last-minute deals have been criticized by Republicans, including:
* For Sen. Max Baucus, (D-MT), the package included a provision to help 2,900 residents of Libby, Mont., sign up for Medicare benefits. Many residents have asbestos-related illnesses;
* For Sen. Christopher Dodd, (D-CT), it included a measure to provide $100 million for the construction of a hospital at a public university;
* Sen. Patrick Leahy, (D-VT), negotiated for $600 million in additional Medicaid benefits for his state over 10 years;
* Sen. Bernie Sanders, (I-VT), got a $10 billion increase for community health centers over a number of years;
* Sen. Mary Landrieu, (D-LA), procured at least $100 million in 2011 from the federal government for help with Medicaid; and
* For Sen. Bill Nelson, (D-FL), the package included a measure allowing some 800,000 Florida senior citizens currently enrolled in private Medicare Advantage plans to keep their extra benefits.
Sen. Reid's negotiations also included:
* The removal of a 5 percent tax on elective cosmetic surgeries, and the inclusion of a 10 percent tax on indoor tanning services;
* 12 years of patent protection for the makers of brand-name biotech drugs;
* An increase in the Medicare payroll tax percent of an additional 0.9 percent of income for those making $200,000 as an individual and $250,000 for couples;
* An exemption from taxes on high-value insurance plans for those with certain professions, such as firefighters, policemen, construction workers, emergency first responders and longshoremen;
* A provision allowing for doctors and hospitals in Montana, North Dakota, South Dakota, Utah and Wyoming to get paid more than providers elsewhere; and
* About $1 billion extra in Medicaid payments for visiting nurses and other in-home or community services.
CBO Updates Estimates on Health Care Bill's Impact: In a letter sent to Sen. Reid, the Congressional Budget Office (CBO) said that it had over-estimated the latest Senate health care bill's impact on deficit reduction during the second decade of enactment. The original estimate indicated the overhaul would yield deficit reductions by one-half percent of GDP; the revised estimates indicate a reduction of between one-quarter and one-half percent of GDP. The CBO confirmed that its estimate over the first 10 years remains accurate, reducing the deficit by up to $132 billion by 2019.
However, in a Wednesday letter to Sen. Jeffery Sessions, (R-AL), the CBO indicated that the current Senate bill may potentially double count the savings from Medicare as a means to pay for the Senate health care bill. In the letter, CBO Director Doug Elmendorf writes: "The key point is that the savings to the (Hospital Insurance) trust fund under the (Patient Protection and Affordable Care Act) would be received by the government only once, so they cannot be set aside to pay for future Medicare spending and, at the same time, pay for current spending on other parts of the legislation or on other programs." Republicans quickly jumped on the letter as proof that the Senate's bill will not decrease the federal deficit over time, but rather add to it.
Late last week, the CBO estimated that the revised Senate bill will cost $871 billion over the next decade to extend coverage to the uninsured. It would dramatically expand Medicaid and offer federal subsidies to those who lack affordable coverage through employers. The nation will pay for the overhaul with about $400 billion in new taxes and about $500 billion in cuts to programs such as Medicare.
Sen. Snowe Indicates "No" Vote: Despite many weeks of negotiations with Republican Sen. Olympia Snowe of Maine and several one-on-one meetings with President Barack Obama, Sen. Snowe indicated that she will vote against the Senate's legislation without significant changes. Sen. Snowe has been a pivotal figure in the health care reform debate as the only Republican to have voted for the Senate Finance Committee's bill, which passed in October. The loss of Sen. Snowe's support comes as a blow to Democratic leaders who were hoping to achieve some level of bipartisan support.
Other Activities
AMA, AHA, AARP and FAH Show Support; AHIP Opposes: On Monday, both the American Medical Association (AMA) and the American Hospital Association ( AHA) sent letters to Sen. Reid indicating support for the latest version of the Senate health care bill, while highlighting requests for changes. The AMA, for example, hopes to see changes to the independent board that would be created to slow the growth of Medicare costs. Among other adjustments, the AHA requested a change that would lower Medicare payments to hospitals with high readmission rates. Endorsements also came from AARP and from the Federation of American Hospitals (FAH). In contrast, a statement Friday from America's Health Insurance Plans (AHIP) voiced opposition to the bill, citing cuts to Medicare Advantage programs and caps on insurers' administrative costs as problematic.
Public Opinion
December Polls Show Americans Disapprove: As a final vote on the Senate's health care reform package nears, Americans are increasingly wary of its impact. The December Kaiser Health Tracking Poll found that:
* Only 35 percent of Americans said they would personally be better off if health care reform passes - down from 42 percent last month;
* Only forty-five percent of voters said the country would be better off with health reform - down from 54 percent last month.
The latest poll results released Tuesday from Quinnipiac University show that:
* Americans "mostly disapprove" (53 percent to 36 percent) of the Senate's plan;
* A majority (56 percent to 38 percent) disapprove of President Obama's handling of health care reform;
* Voters oppose (72 percent to 23 percent) using any public money in the health care overhaul to pay for abortions;
* Americans support (56 percent to 38 percent) giving people the option of coverage by a government health insurance plan; and
* A majority (64 percent to 30 percent) support allowing younger people to buy into Medicare.
As a volatile year in health care reform comes to a close, an average of monthly polls since April shows that 82 percent of Americans say an overhaul of the nation's health care system is important for recharging the economy. However, in the most recent Robert Wood Johnson Foundation poll taken in November, 60 percent said an overhaul will not affect their personal access to health care or their family finances, and only about 40 percent said a revamping will improve access to care in the nation overall. Further, only about 30 percent believe health care reform will help the county's financial status.
Looking Ahead
Senate lawmakers are expected to vote on their final health care reform legislation early Thursday morning, setting the stage for reconciliation with the House bill passed in November. When lawmakers return from holiday break in January, the conference committee between the two chambers is expected to begin discussions about merging the two bills. Leaders of the House and Senate had hoped to have a final bill approved by Congress and sent to President Obama before the State of the Union address, scheduled for late January or early February. However, White House officials now indicate that given January's tight legislative calendar, this timeframe is unlikely.
This Week in Health Reform
Senate Majority Leader Harry Reid (D-NV), may just reach his goal of getting a health care reform package approved by the Senate by Christmas. This past week, Sen. Reid clinched the 60th vote needed to pass the legislation. As of this communication, he has scheduled the final Senate vote for 7 a.m. on Christmas Eve day. In an effort to shore up votes, Sen. Reid and his colleagues struck deals to overcome hot-button issues such as abortion funding.
Quoting & Saving just got easier...Easy To Insure ME Health Insurance Quotes... Quote all carriers in seconds
Health care reform
Health insurance Exchange
Senate Negotiations
Senate Eyes Finish Line: After weeks of rancorous debate and more than 20 straight days and nights spent negotiating on Capitol Hill, Senate lawmakers cleared all three major procedural hurdles prior to a final vote on the legislation.
* The first procedural motion passed on a 60-40 vote early Monday morning , ending debate on Sen. Reid's proposed amendments, called the "manager's package," and cutting off a Republican filibuster. The "manager's package" represented a series of last-minute deals and compromises to shore up support for the legislation.
* The second procedural motion to approve the "manager's package" passed 60-39 on Tuesday morning.
* The third motion came Wednesday and ended debate on the final legislation in a 60-39 vote, setting up the reform bill for a final vote just in time for Sen. Reid's Christmas deadline.
Sen. Reid Carves Out State-Specific Deals to Secure the 60 Votes: On Saturday, Sen. Reid secured the 60 votes needed to pass the historic legislation, winning over Sen. Ben Nelson, (D-NE), with an amendment to prevent federal subsidies from being used for abortions. Under the new abortion provisions, states can opt out of allowing coverage for abortion. If states do offer coverage, enrollees must pay for abortion coverage separately - a compromise that has sparked criticism from both sides of the abortion divide. Sen. Nelson also secured other benefits for the state of Nebraska, including:
* Millions of dollars from the federal government to pay for the proposed cost of the Medicaid expansion in his state; and
* An exemption for Blue Cross Blue Shield of Nebraska from an annual fee on insurers.
Throughout his amendment package, Sen. Reid included several other state-specific deals to secure the 60 votes. Such last-minute deals have been criticized by Republicans, including:
* For Sen. Max Baucus, (D-MT), the package included a provision to help 2,900 residents of Libby, Mont., sign up for Medicare benefits. Many residents have asbestos-related illnesses;
* For Sen. Christopher Dodd, (D-CT), it included a measure to provide $100 million for the construction of a hospital at a public university;
* Sen. Patrick Leahy, (D-VT), negotiated for $600 million in additional Medicaid benefits for his state over 10 years;
* Sen. Bernie Sanders, (I-VT), got a $10 billion increase for community health centers over a number of years;
* Sen. Mary Landrieu, (D-LA), procured at least $100 million in 2011 from the federal government for help with Medicaid; and
* For Sen. Bill Nelson, (D-FL), the package included a measure allowing some 800,000 Florida senior citizens currently enrolled in private Medicare Advantage plans to keep their extra benefits.
Sen. Reid's negotiations also included:
* The removal of a 5 percent tax on elective cosmetic surgeries, and the inclusion of a 10 percent tax on indoor tanning services;
* 12 years of patent protection for the makers of brand-name biotech drugs;
* An increase in the Medicare payroll tax percent of an additional 0.9 percent of income for those making $200,000 as an individual and $250,000 for couples;
* An exemption from taxes on high-value insurance plans for those with certain professions, such as firefighters, policemen, construction workers, emergency first responders and longshoremen;
* A provision allowing for doctors and hospitals in Montana, North Dakota, South Dakota, Utah and Wyoming to get paid more than providers elsewhere; and
* About $1 billion extra in Medicaid payments for visiting nurses and other in-home or community services.
CBO Updates Estimates on Health Care Bill's Impact: In a letter sent to Sen. Reid, the Congressional Budget Office (CBO) said that it had over-estimated the latest Senate health care bill's impact on deficit reduction during the second decade of enactment. The original estimate indicated the overhaul would yield deficit reductions by one-half percent of GDP; the revised estimates indicate a reduction of between one-quarter and one-half percent of GDP. The CBO confirmed that its estimate over the first 10 years remains accurate, reducing the deficit by up to $132 billion by 2019.
However, in a Wednesday letter to Sen. Jeffery Sessions, (R-AL), the CBO indicated that the current Senate bill may potentially double count the savings from Medicare as a means to pay for the Senate health care bill. In the letter, CBO Director Doug Elmendorf writes: "The key point is that the savings to the (Hospital Insurance) trust fund under the (Patient Protection and Affordable Care Act) would be received by the government only once, so they cannot be set aside to pay for future Medicare spending and, at the same time, pay for current spending on other parts of the legislation or on other programs." Republicans quickly jumped on the letter as proof that the Senate's bill will not decrease the federal deficit over time, but rather add to it.
Late last week, the CBO estimated that the revised Senate bill will cost $871 billion over the next decade to extend coverage to the uninsured. It would dramatically expand Medicaid and offer federal subsidies to those who lack affordable coverage through employers. The nation will pay for the overhaul with about $400 billion in new taxes and about $500 billion in cuts to programs such as Medicare.
Sen. Snowe Indicates "No" Vote: Despite many weeks of negotiations with Republican Sen. Olympia Snowe of Maine and several one-on-one meetings with President Barack Obama, Sen. Snowe indicated that she will vote against the Senate's legislation without significant changes. Sen. Snowe has been a pivotal figure in the health care reform debate as the only Republican to have voted for the Senate Finance Committee's bill, which passed in October. The loss of Sen. Snowe's support comes as a blow to Democratic leaders who were hoping to achieve some level of bipartisan support.
Other Activities
AMA, AHA, AARP and FAH Show Support; AHIP Opposes: On Monday, both the American Medical Association (AMA) and the American Hospital Association ( AHA) sent letters to Sen. Reid indicating support for the latest version of the Senate health care bill, while highlighting requests for changes. The AMA, for example, hopes to see changes to the independent board that would be created to slow the growth of Medicare costs. Among other adjustments, the AHA requested a change that would lower Medicare payments to hospitals with high readmission rates. Endorsements also came from AARP and from the Federation of American Hospitals (FAH). In contrast, a statement Friday from America's Health Insurance Plans (AHIP) voiced opposition to the bill, citing cuts to Medicare Advantage programs and caps on insurers' administrative costs as problematic.
Public Opinion
December Polls Show Americans Disapprove: As a final vote on the Senate's health care reform package nears, Americans are increasingly wary of its impact. The December Kaiser Health Tracking Poll found that:
* Only 35 percent of Americans said they would personally be better off if health care reform passes - down from 42 percent last month;
* Only forty-five percent of voters said the country would be better off with health reform - down from 54 percent last month.
The latest poll results released Tuesday from Quinnipiac University show that:
* Americans "mostly disapprove" (53 percent to 36 percent) of the Senate's plan;
* A majority (56 percent to 38 percent) disapprove of President Obama's handling of health care reform;
* Voters oppose (72 percent to 23 percent) using any public money in the health care overhaul to pay for abortions;
* Americans support (56 percent to 38 percent) giving people the option of coverage by a government health insurance plan; and
* A majority (64 percent to 30 percent) support allowing younger people to buy into Medicare.
As a volatile year in health care reform comes to a close, an average of monthly polls since April shows that 82 percent of Americans say an overhaul of the nation's health care system is important for recharging the economy. However, in the most recent Robert Wood Johnson Foundation poll taken in November, 60 percent said an overhaul will not affect their personal access to health care or their family finances, and only about 40 percent said a revamping will improve access to care in the nation overall. Further, only about 30 percent believe health care reform will help the county's financial status.
Looking Ahead
Senate lawmakers are expected to vote on their final health care reform legislation early Thursday morning, setting the stage for reconciliation with the House bill passed in November. When lawmakers return from holiday break in January, the conference committee between the two chambers is expected to begin discussions about merging the two bills. Leaders of the House and Senate had hoped to have a final bill approved by Congress and sent to President Obama before the State of the Union address, scheduled for late January or early February. However, White House officials now indicate that given January's tight legislative calendar, this timeframe is unlikely.
Friday, December 11, 2009
Health Insurance Quotes Reform Weeklys EasyToInsureME
DECEMBER 11, 2009
This Week in Health Reform
This week Senate lawmakers continued to debate numerous proposed amendments to Senate Majority Leader Harry Reid's (D-NV) health care reform bill.
An updated analysis by our parent company shows that, with the proposed health care reform legislation, across- the-board premiums will increase significantly for younger and healthier people who purchase insurance on the individual market or through small employer groups.
Quoting & Saving just got easier...EasyToInsureME Health Insurance Quotes... Quote all carriers in seconds
Health insurance
Health insurance quotes
Senate Negotiations
Senate Continues Debate on Health Care Reform Bill: As Senate lawmakers continued to debate through the weekend and voted on proposed amendments, President Barack Obama encouraged this effort by visiting Capital Hill on Sunday and urging lawmakers to put aside their differences and pass the historic legislation. While the President did not mention abortion or the government-run option specifically, those issues remain particularly divisive and at the center of debate on the Senate floor:
* Abortion - On Tuesday the Senate rejected (54-45) an amendment proposed by Sen. Ben Nelson (D-NE) that would have imposed restrictions on coverage of abortion services for people who received subsidies to buy insurance. Sen. Nelson has indicated that he will not support a health care reform bill that does not include language restricting abortion coverage. Tuesday's vote puts into question whether Sen. Reid has the 60 votes necessary to pass the reform package.
* Government-Run Option - On Tuesday night a group of 10 appointed Democratic Senate lawmakers announced a tentative agreement in regards to the public option. In an effort to remove a major hurdle to passing legislation this year, the group of negotiators offered an alternative program to the government-run option that would create several national insurance plans administered by private companies but negotiated by the Office of Personnel Management, which oversees health policies for federal workers. The negotiators said that a government plan would only be created if private firms were unable to deliver acceptable national policies.
The agreement would allow individuals to buy into Medicare starting at age 55, and insurance companies would face new regulations, including a requirement that they spend at least 90 cents of every dollar collected in premiums on medical services for customers.
In response to the agreement, the American Hospital Association, the American Medical Association, the American Federation of Hospitals - along with other health care companies, including insurers and drug makers - expressed concerns over the proposed Medicare expansion. Some also voiced concerns that the agreement simply represents another form of a public option. Those in opposition cite potential cost increases, low Medicare reimbursements and greater government control over parts of the health care industry. Hospital representatives said an expansion of Medicare would violate a deal they reached with the White House this year to give up $155 billion in Medicare payments over the next decade. Furthermore, The National Federation of Independent Business, a small-business association, released a statement opposing the legislation as an inadequate response to rising costs.
Currently Sen. Reid has only released a few specific details about the agreement, and lawmakers are hesitant to endorse the plan until it is better understood. Sen. Joe Lieberman (I-CT) has indicated that the inclusion of a public option trigger may be a possible deal breaker. Sen. Reid presented this new agreement to the Congressional Budget Office (CBO) to be analyzed and is currently waiting for the CBO costs estimates.
In addition, on Wednesday Senate lawmakers debated an amendment offered by Byron L. Dorgan (D-ND) that would allow for the importation of prescription drugs from other countries. Should it pass, the measure could threaten the pharmaceutical industry's support for President Obama's health care reform. The pharmaceutical industry strongly opposes allowing prescription drug imports, indicating that the risk for counterfeit drugs would increase. While the amendment was supposed to come to a vote on Wednesday, an agreement was not reached and debate continued on Thursday.
Other Activities
Federal Insurers Warn of Higher Premiums: The Association of Federal Health Organizations , which includes federal employee-sponsored health insurance companies and Associate Member Blue Cross and Blue Shield Association, is starting to make waves on Capitol Hill with information released in a November 25 report to the Office of Management and Budget. The report indicates that health insurance premiums could go up and benefits could be hurt due to impending fees on the insurance industry and the excise tax on premiums above a certain amount.
Drug Makers May See Increased Fees: Media reports indicate that the bill emerging from the Senate may include fees on the pharmaceutical industry that are greater than the $80 billion originally discussed in June. Given that the House bill would cost drug makers about $140 billion, the eventual House-Senate bill is likely to include fees exceeding $80 billion.
Public Opinion
Americans Oppose Reform Plan: As special interest groups express concern over the latest Senate proposal, polls continue to show that Americans are increasingly worried about the impact of reform. The most recent Quinnipiac University Poll indicates that Americans disapprove (52-38 percent) of the health care reform proposal under consideration in Congress. Furthermore, a Bloomberg National Poll indicates that 62 percent of Americans say they are mostly pessimistic that they would benefit from the bill.
Looking Ahead
Senate lawmakers will continue working around the clock and weekends to debate and vote on the proposed amendments. Sen. Reid is still pushing to have a final Senate reform package put together by Christmas.
This Week in Health Reform
This week Senate lawmakers continued to debate numerous proposed amendments to Senate Majority Leader Harry Reid's (D-NV) health care reform bill.
An updated analysis by our parent company shows that, with the proposed health care reform legislation, across- the-board premiums will increase significantly for younger and healthier people who purchase insurance on the individual market or through small employer groups.
Quoting & Saving just got easier...EasyToInsureME Health Insurance Quotes... Quote all carriers in seconds
Health insurance
Health insurance quotes
Senate Negotiations
Senate Continues Debate on Health Care Reform Bill: As Senate lawmakers continued to debate through the weekend and voted on proposed amendments, President Barack Obama encouraged this effort by visiting Capital Hill on Sunday and urging lawmakers to put aside their differences and pass the historic legislation. While the President did not mention abortion or the government-run option specifically, those issues remain particularly divisive and at the center of debate on the Senate floor:
* Abortion - On Tuesday the Senate rejected (54-45) an amendment proposed by Sen. Ben Nelson (D-NE) that would have imposed restrictions on coverage of abortion services for people who received subsidies to buy insurance. Sen. Nelson has indicated that he will not support a health care reform bill that does not include language restricting abortion coverage. Tuesday's vote puts into question whether Sen. Reid has the 60 votes necessary to pass the reform package.
* Government-Run Option - On Tuesday night a group of 10 appointed Democratic Senate lawmakers announced a tentative agreement in regards to the public option. In an effort to remove a major hurdle to passing legislation this year, the group of negotiators offered an alternative program to the government-run option that would create several national insurance plans administered by private companies but negotiated by the Office of Personnel Management, which oversees health policies for federal workers. The negotiators said that a government plan would only be created if private firms were unable to deliver acceptable national policies.
The agreement would allow individuals to buy into Medicare starting at age 55, and insurance companies would face new regulations, including a requirement that they spend at least 90 cents of every dollar collected in premiums on medical services for customers.
In response to the agreement, the American Hospital Association, the American Medical Association, the American Federation of Hospitals - along with other health care companies, including insurers and drug makers - expressed concerns over the proposed Medicare expansion. Some also voiced concerns that the agreement simply represents another form of a public option. Those in opposition cite potential cost increases, low Medicare reimbursements and greater government control over parts of the health care industry. Hospital representatives said an expansion of Medicare would violate a deal they reached with the White House this year to give up $155 billion in Medicare payments over the next decade. Furthermore, The National Federation of Independent Business, a small-business association, released a statement opposing the legislation as an inadequate response to rising costs.
Currently Sen. Reid has only released a few specific details about the agreement, and lawmakers are hesitant to endorse the plan until it is better understood. Sen. Joe Lieberman (I-CT) has indicated that the inclusion of a public option trigger may be a possible deal breaker. Sen. Reid presented this new agreement to the Congressional Budget Office (CBO) to be analyzed and is currently waiting for the CBO costs estimates.
In addition, on Wednesday Senate lawmakers debated an amendment offered by Byron L. Dorgan (D-ND) that would allow for the importation of prescription drugs from other countries. Should it pass, the measure could threaten the pharmaceutical industry's support for President Obama's health care reform. The pharmaceutical industry strongly opposes allowing prescription drug imports, indicating that the risk for counterfeit drugs would increase. While the amendment was supposed to come to a vote on Wednesday, an agreement was not reached and debate continued on Thursday.
Other Activities
Federal Insurers Warn of Higher Premiums: The Association of Federal Health Organizations , which includes federal employee-sponsored health insurance companies and Associate Member Blue Cross and Blue Shield Association, is starting to make waves on Capitol Hill with information released in a November 25 report to the Office of Management and Budget. The report indicates that health insurance premiums could go up and benefits could be hurt due to impending fees on the insurance industry and the excise tax on premiums above a certain amount.
Drug Makers May See Increased Fees: Media reports indicate that the bill emerging from the Senate may include fees on the pharmaceutical industry that are greater than the $80 billion originally discussed in June. Given that the House bill would cost drug makers about $140 billion, the eventual House-Senate bill is likely to include fees exceeding $80 billion.
Public Opinion
Americans Oppose Reform Plan: As special interest groups express concern over the latest Senate proposal, polls continue to show that Americans are increasingly worried about the impact of reform. The most recent Quinnipiac University Poll indicates that Americans disapprove (52-38 percent) of the health care reform proposal under consideration in Congress. Furthermore, a Bloomberg National Poll indicates that 62 percent of Americans say they are mostly pessimistic that they would benefit from the bill.
Looking Ahead
Senate lawmakers will continue working around the clock and weekends to debate and vote on the proposed amendments. Sen. Reid is still pushing to have a final Senate reform package put together by Christmas.
Friday, September 25, 2009
Health Insurance Quote Reform Weekly EasyToInsureME
Sept. 25, 2009
This Week in Health Care Reform
This week's health care reform debate focused on the long-awaited health care reform legislation proposed by Finance Committee Chairman Sen. Max Baucus (D-MT).
EasyToInsureME.com offers clients the easiest way to buy individual health insurance. Free services include instant online health insurance quotes, custom proposals for each client, free phone consultation, and 10-minute application by phone. Nobody does what we do for our clients!
Senate Negotiations
Introduced last week, Sen. Baucus's Finance Committee bill has faced criticisms from both sides of the aisle, resulting in 564 proposed amendments to the legislation. On Tuesday, to address some of the concerns outlined in those amendments, Sen. Baucus suggested changes to the bill that would further increase regulation of insurance companies, expand consumer protections and increase subsidies to help people buy insurance. In an effort to appease Republicans, he also exempted consumer items of $100 or less - items ranging from Q-tips to contact lenses - from a proposed tax on medical device manufacturers. As the week progressed, clear partisan battle lines emerged as Senate Democrats and Republicans debated controversial proposals, such as changes to Medicare .
As the Finance Committee continues the mark-up process and votes on amendments, Sen. Baucus will attempt to keep the 13 Finance Committee Democrats on board. He will have to achieve this without moving so far left politically that he loses the support of key Republicans, including Sen. Olympia Snowe (R-ME), the only Republican of the 10 who sit on the Finance Committee seen as likely to vote for the bill.
Outside of the committee, Sen. Snowe has become a pivotal figure in bipartisan negotiations for reform as Democrats seek the 60 votes in the Senate required to pass the legislation. Other reports suggest that the Finance Committee bill also has the backing of Sen. Blanche Lincoln (D-AR), another key swing senator.
Public Plan
President Obama Conducts Media Blitz: On Sunday, President Obama advocated for health care form legislation in back-to-back broadcasts of taped interviews on five morning news shows (ABC's "This Week," NBC's "Meet the Press," CBS's "Face the Nation," CNN's "State of the Union" and Spanish-language Univision's "Al Punto"). While admitting to being "humbled" by the challenge of reform, he called for a more civil tone in the debate.
Going into the Sunday interviews, a Siegel+Gale poll showed that, following President Obama's televised address to a joint session of Congress earlier this month, only 36.9% of Americans said they understood the President's reform plan. Of those who actually watched the President's address to Congress, 57.9% claimed to understand his platform.
Democrats Woo Seniors: White House officials and Democrats have focused on convincing skeptical seniors to support the administration's reform legislation. On Wednesday, Vice President Joe Biden visited a retirement community in Maryland to deliver the Democratic health care reform message and to reassure seniors that they will not see cuts in their Medicare coverage.
Additional Activities
First Lady Enters Health Care Debate: Working to galvanize women around health care reform, First Lady Michelle Obama jumped into the debate last week at a meeting of the newly formed White House Council on Women and Girls. Michelle Obama urged women to mobilize behind the President's plan. Meeting attendees included members of the Business and Professional Women, the YWCA, the Women's Chamber of Commerce and the National Council of Negro Women.
President Obama Speeds Up Tort Reform: Last Thursday, President Obama sought to ease tensions this week among physicians whose concerns over malpractice costs and Medicare reimbursement were modestly addressed in the Finance Committee bill. The President moved to accelerate a $25 million grant program aimed at addressing medical malpractice lawsuits.
Looking Ahead
Sen. Baucus plans to steer his health care reform bill through the Finance Committee by the end of the week. Once the Finance Committee votes and approves the bill, Senate leaders will then combine it with another bill approved by the Health, Education, Labor and Pensions Committee in July.
A similar process is also occurring in the House with bills passed by three committees: Energy and Commerce; Education and Labor, and Ways and Means. House Speaker Nancy Pelosi (D-CA) has indicated that she hopes to have a single, final version of the House bill by the end of next week.
White House Budget Director Peter Orszag anticipates completion of health care legislation by mid-November. He also believes that the final version will be largely based on the Senate Finance Committee bill.
This Week in Health Care Reform
This week's health care reform debate focused on the long-awaited health care reform legislation proposed by Finance Committee Chairman Sen. Max Baucus (D-MT).
EasyToInsureME.com offers clients the easiest way to buy individual health insurance. Free services include instant online health insurance quotes, custom proposals for each client, free phone consultation, and 10-minute application by phone. Nobody does what we do for our clients!
Senate Negotiations
Introduced last week, Sen. Baucus's Finance Committee bill has faced criticisms from both sides of the aisle, resulting in 564 proposed amendments to the legislation. On Tuesday, to address some of the concerns outlined in those amendments, Sen. Baucus suggested changes to the bill that would further increase regulation of insurance companies, expand consumer protections and increase subsidies to help people buy insurance. In an effort to appease Republicans, he also exempted consumer items of $100 or less - items ranging from Q-tips to contact lenses - from a proposed tax on medical device manufacturers. As the week progressed, clear partisan battle lines emerged as Senate Democrats and Republicans debated controversial proposals, such as changes to Medicare .
As the Finance Committee continues the mark-up process and votes on amendments, Sen. Baucus will attempt to keep the 13 Finance Committee Democrats on board. He will have to achieve this without moving so far left politically that he loses the support of key Republicans, including Sen. Olympia Snowe (R-ME), the only Republican of the 10 who sit on the Finance Committee seen as likely to vote for the bill.
Outside of the committee, Sen. Snowe has become a pivotal figure in bipartisan negotiations for reform as Democrats seek the 60 votes in the Senate required to pass the legislation. Other reports suggest that the Finance Committee bill also has the backing of Sen. Blanche Lincoln (D-AR), another key swing senator.
Public Plan
President Obama Conducts Media Blitz: On Sunday, President Obama advocated for health care form legislation in back-to-back broadcasts of taped interviews on five morning news shows (ABC's "This Week," NBC's "Meet the Press," CBS's "Face the Nation," CNN's "State of the Union" and Spanish-language Univision's "Al Punto"). While admitting to being "humbled" by the challenge of reform, he called for a more civil tone in the debate.
Going into the Sunday interviews, a Siegel+Gale poll showed that, following President Obama's televised address to a joint session of Congress earlier this month, only 36.9% of Americans said they understood the President's reform plan. Of those who actually watched the President's address to Congress, 57.9% claimed to understand his platform.
Democrats Woo Seniors: White House officials and Democrats have focused on convincing skeptical seniors to support the administration's reform legislation. On Wednesday, Vice President Joe Biden visited a retirement community in Maryland to deliver the Democratic health care reform message and to reassure seniors that they will not see cuts in their Medicare coverage.
Additional Activities
First Lady Enters Health Care Debate: Working to galvanize women around health care reform, First Lady Michelle Obama jumped into the debate last week at a meeting of the newly formed White House Council on Women and Girls. Michelle Obama urged women to mobilize behind the President's plan. Meeting attendees included members of the Business and Professional Women, the YWCA, the Women's Chamber of Commerce and the National Council of Negro Women.
President Obama Speeds Up Tort Reform: Last Thursday, President Obama sought to ease tensions this week among physicians whose concerns over malpractice costs and Medicare reimbursement were modestly addressed in the Finance Committee bill. The President moved to accelerate a $25 million grant program aimed at addressing medical malpractice lawsuits.
Looking Ahead
Sen. Baucus plans to steer his health care reform bill through the Finance Committee by the end of the week. Once the Finance Committee votes and approves the bill, Senate leaders will then combine it with another bill approved by the Health, Education, Labor and Pensions Committee in July.
A similar process is also occurring in the House with bills passed by three committees: Energy and Commerce; Education and Labor, and Ways and Means. House Speaker Nancy Pelosi (D-CA) has indicated that she hopes to have a single, final version of the House bill by the end of next week.
White House Budget Director Peter Orszag anticipates completion of health care legislation by mid-November. He also believes that the final version will be largely based on the Senate Finance Committee bill.
Thursday, September 24, 2009
Individual Health Insurance Reform Weekly : EasyToInsureME
Week of September 21, 2009
While the proposals being considered by Congress to help reform the health care system could make significant strides in addressing health care access problems, many remain concerned that the proposals made to date do not do enough to take on the overarching problem of rapidly rising health care costs. To help draw more attention to this daunting problem, Aetna and the Aetna Foundation recently were the major sponsors of the September/October edition of the journal Health Affairs, which is devoted to "bending the cost curve." The current issue and the launch event highlighted innovative solutions that could have a significant impact on the future cost of health care. Bending the cost curve is the key -- if we don’t make health care more affordable, other reforms will have little value.
Federal
Senate Finance Committee Chairman Max Baucus released his "mark," which is the Senator's offering to the full Committee of the legislative pathway he thinks the Committee should follow to pass health care reform. While those on both the left (Senator Rockefeller) and on the right (Senator Grassley) expressed negative views on the mark, all the headline posturing ceases when the committee officially begins to review and amend the mark this week. The key for Chairman Baucus is to garner sufficient support to pass the bill out of committee in a fashion that bodes well for floor passage. Right now the prospects are far from certain.
States
ARIZONA Health Insurance : The Department of Insurance has issued a bulletin summarizing several insurance-related bills enacted during the 2009 legislative session. The bulletin expressly notes: the revision of the acceptable medical references an insurer may use in its determination of whether a drug has been found to be safe and effective for treatment of a specific type of cancer and the amended definition of "network plan" to include a plan under which the financing and delivery of health care services are provided through a defined set of providers under contract with a hospital, medical, dental or optometric service corporation; the ability of service corporations to issue subscription contracts free of many state-mandated benefits and also reduce the allowable uninsured period for small groups to qualify for state vouchers for free coverage; and the permissibility of issuing coverage to uninsured individuals without being subjected to many of the state's mandated benefits.
CALIFORNIA Health Insurance : Proponents of a new statewide initiative to return the legislature back to a part-time status are attempting to collect the 700,000 signatures necessary to qualify for the ballot in 2010. The measure would cut the current legislative calendar to 90 days. Supporters of the initiative say that the full-time legislature, authorized by voters in 1966, has failed to produce the results promised. After another rocky legislative year marked by a soaring budget deficit and a failure to address education spending and health reform issues, broad support for the measure seems likely. However, a bipartisan group of three former state lawmakers have formed an alliance to fight the effort, arguing that it would not allow the legislature sufficient time to address the state's serious problems.
CONNECTICUT Health Insurance : The General Assembly is holding September 23 and 24 to take up several bills needed to implement the new, two-year budget that took effect September 8. The “implementer bills” are required to put in statute the policy changes necessitated by passage of the budget. The session bears watching because of a trend of late to attempt to include non-budget-related proposals in these implementer bills. In the past, ideas that died in the regular session came back to life during an implementer session, only to expire again once they were publicized.
FLORIDA Health Insurance : The Agency for Healthcare Administration has asked carriers to participate in a workgroup regarding Explanation of Benefits (EOB) sent to members. The goal of the workgroup is to develop best practices for information contained on an EOB and assure the EOB is clear to consumers. Aetna is participating along with other carriers.
ILLINOIS: The Department of Insurance's (DOI) proposed rules for preferred provider programs and networks were heard last week by a legislative panel. These rules would affect both insurers and network administrators that offer incentives to insureds to utilize the services of contracted providers. At the hearing DOI agreed to remove objectionable language to business and insurance groups that would have limited a consumer's exposure to 50 percent of out-of-network billed costs by a provider. The DOI Director was given discretion on the rest of the proposed rule and agreed to hold it for 30 days and meet with the industry to discuss other objections. The two major issues that remain for business and insurance groups are: a provision stating that a provider's written approval must be obtained whenever an insurer or administrator buys another network, if it represents a material change to the contract; and the effect of language that would require insurers and administrators to hold beneficiaries harmless for out-of-network physician costs. The industry is preparing for meetings with DOI.
MASSACHUSETTS: The Division of Health Care Finance and Policy (DHFP) has introduced amendments to the Employer Fair Share Contribution regulation. The proposed amendments clarify that to be considered a contributing employer, an employer must maintain a written plan document for its group health plan. In addition, the employer must be able to document in writing its offer to employees to make a percentage premium contribution and the minimum number of hours that the employees are required to work to be eligible for full-time benefits. The amendments also clarify that a Premium Reimbursement Arrangement (in which an employee enrolls in an individual plan and is reimbursed by the employer for a portion of the premium expense) may qualify as a group health plan, provided there is written plan documentation that designates a particular plan for use by employees.
NEW JERSEY: Legislation requiring disclosure of certain serious reportable events was recently enacted by Governor Jon Corzine. Under the new law, the Department of Health and Senior Services will annually issue a report of specific hospital Patient Safety Indicators (PSI) as enumerated under federal guidelines by CMS. Additionally the law prohibits hospitals from charging for certain "never events." These events, for which reimbursement cannot be sought, include: transfusion reaction; air embolism; foreign body left in during a procedure; surgery on wrong side, body part, or person; and performing the wrong procedure on a patient. Also, the Department of Banking & Insurance adopted regulations establishing minimum benefits standards for health benefits plans, dental plans, and prescription drug plans. The regulations, among other things, set maximum cost-sharing and network copayment limits.
SOUTH DAKOTA: The Division of Insurance has issued a three-sentence, proposed regulation addressing the relationship between Centers of Excellence and access plans. The proposed regulation currently states that each contracted Center of Excellence and each contracted network of a Center of Excellence must be included in a health carrier’s access plan. For purposes of network adequacy, the health carrier’s entire Center of Excellence network, including both direct–contracted Centers of Excellence and contracted networks, shall be considered. A health carrier may not contract with a Center of Excellence network or any other network that is not registered pursuant to South Dakota law. When originally circulated, this regulation also contained a definition of Centers of Excellence, placed restrictions on carriers with Centers of Excellence for transplant services, and required “closed plans” to have certificates of authority to operate as HMOs. The new language is strongly preferable. A hearing regarding these proposed regulations is scheduled for October 21, 2009. Aetna will attend the hearing to discuss any proposed changes.
UTAH: The Utah Insurance Department (UID) has issued amendments to the state's requirements for the Basic Health Care Plan to bring the rules into compliance with new statutory requirements that were enacted in 2008 and 2009. Individual and small group health insurers are required to offer the Plan until January 1, 2010. The Plan includes the following maximum benefit limitations: 1) a lifetime maximum of no less than $1 million per person, 2) a minimum $250,000 annual maximum per person, and 3) out-of-pocket maximums on various cost-sharing obligations. After January 1, 2010, the Plan will be replaced with a new basic health care plan that is defined as: 1) a federally qualified, high-deductible health plan (HDHP), 2) has the lowest deductible that qualifies as an HDHP, and 3) has an out-of-pocket maximum no greater than three times the annual deductible.
While the proposals being considered by Congress to help reform the health care system could make significant strides in addressing health care access problems, many remain concerned that the proposals made to date do not do enough to take on the overarching problem of rapidly rising health care costs. To help draw more attention to this daunting problem, Aetna and the Aetna Foundation recently were the major sponsors of the September/October edition of the journal Health Affairs, which is devoted to "bending the cost curve." The current issue and the launch event highlighted innovative solutions that could have a significant impact on the future cost of health care. Bending the cost curve is the key -- if we don’t make health care more affordable, other reforms will have little value.
Federal
Senate Finance Committee Chairman Max Baucus released his "mark," which is the Senator's offering to the full Committee of the legislative pathway he thinks the Committee should follow to pass health care reform. While those on both the left (Senator Rockefeller) and on the right (Senator Grassley) expressed negative views on the mark, all the headline posturing ceases when the committee officially begins to review and amend the mark this week. The key for Chairman Baucus is to garner sufficient support to pass the bill out of committee in a fashion that bodes well for floor passage. Right now the prospects are far from certain.
States
ARIZONA Health Insurance : The Department of Insurance has issued a bulletin summarizing several insurance-related bills enacted during the 2009 legislative session. The bulletin expressly notes: the revision of the acceptable medical references an insurer may use in its determination of whether a drug has been found to be safe and effective for treatment of a specific type of cancer and the amended definition of "network plan" to include a plan under which the financing and delivery of health care services are provided through a defined set of providers under contract with a hospital, medical, dental or optometric service corporation; the ability of service corporations to issue subscription contracts free of many state-mandated benefits and also reduce the allowable uninsured period for small groups to qualify for state vouchers for free coverage; and the permissibility of issuing coverage to uninsured individuals without being subjected to many of the state's mandated benefits.
CALIFORNIA Health Insurance : Proponents of a new statewide initiative to return the legislature back to a part-time status are attempting to collect the 700,000 signatures necessary to qualify for the ballot in 2010. The measure would cut the current legislative calendar to 90 days. Supporters of the initiative say that the full-time legislature, authorized by voters in 1966, has failed to produce the results promised. After another rocky legislative year marked by a soaring budget deficit and a failure to address education spending and health reform issues, broad support for the measure seems likely. However, a bipartisan group of three former state lawmakers have formed an alliance to fight the effort, arguing that it would not allow the legislature sufficient time to address the state's serious problems.
CONNECTICUT Health Insurance : The General Assembly is holding September 23 and 24 to take up several bills needed to implement the new, two-year budget that took effect September 8. The “implementer bills” are required to put in statute the policy changes necessitated by passage of the budget. The session bears watching because of a trend of late to attempt to include non-budget-related proposals in these implementer bills. In the past, ideas that died in the regular session came back to life during an implementer session, only to expire again once they were publicized.
FLORIDA Health Insurance : The Agency for Healthcare Administration has asked carriers to participate in a workgroup regarding Explanation of Benefits (EOB) sent to members. The goal of the workgroup is to develop best practices for information contained on an EOB and assure the EOB is clear to consumers. Aetna is participating along with other carriers.
ILLINOIS: The Department of Insurance's (DOI) proposed rules for preferred provider programs and networks were heard last week by a legislative panel. These rules would affect both insurers and network administrators that offer incentives to insureds to utilize the services of contracted providers. At the hearing DOI agreed to remove objectionable language to business and insurance groups that would have limited a consumer's exposure to 50 percent of out-of-network billed costs by a provider. The DOI Director was given discretion on the rest of the proposed rule and agreed to hold it for 30 days and meet with the industry to discuss other objections. The two major issues that remain for business and insurance groups are: a provision stating that a provider's written approval must be obtained whenever an insurer or administrator buys another network, if it represents a material change to the contract; and the effect of language that would require insurers and administrators to hold beneficiaries harmless for out-of-network physician costs. The industry is preparing for meetings with DOI.
MASSACHUSETTS: The Division of Health Care Finance and Policy (DHFP) has introduced amendments to the Employer Fair Share Contribution regulation. The proposed amendments clarify that to be considered a contributing employer, an employer must maintain a written plan document for its group health plan. In addition, the employer must be able to document in writing its offer to employees to make a percentage premium contribution and the minimum number of hours that the employees are required to work to be eligible for full-time benefits. The amendments also clarify that a Premium Reimbursement Arrangement (in which an employee enrolls in an individual plan and is reimbursed by the employer for a portion of the premium expense) may qualify as a group health plan, provided there is written plan documentation that designates a particular plan for use by employees.
NEW JERSEY: Legislation requiring disclosure of certain serious reportable events was recently enacted by Governor Jon Corzine. Under the new law, the Department of Health and Senior Services will annually issue a report of specific hospital Patient Safety Indicators (PSI) as enumerated under federal guidelines by CMS. Additionally the law prohibits hospitals from charging for certain "never events." These events, for which reimbursement cannot be sought, include: transfusion reaction; air embolism; foreign body left in during a procedure; surgery on wrong side, body part, or person; and performing the wrong procedure on a patient. Also, the Department of Banking & Insurance adopted regulations establishing minimum benefits standards for health benefits plans, dental plans, and prescription drug plans. The regulations, among other things, set maximum cost-sharing and network copayment limits.
SOUTH DAKOTA: The Division of Insurance has issued a three-sentence, proposed regulation addressing the relationship between Centers of Excellence and access plans. The proposed regulation currently states that each contracted Center of Excellence and each contracted network of a Center of Excellence must be included in a health carrier’s access plan. For purposes of network adequacy, the health carrier’s entire Center of Excellence network, including both direct–contracted Centers of Excellence and contracted networks, shall be considered. A health carrier may not contract with a Center of Excellence network or any other network that is not registered pursuant to South Dakota law. When originally circulated, this regulation also contained a definition of Centers of Excellence, placed restrictions on carriers with Centers of Excellence for transplant services, and required “closed plans” to have certificates of authority to operate as HMOs. The new language is strongly preferable. A hearing regarding these proposed regulations is scheduled for October 21, 2009. Aetna will attend the hearing to discuss any proposed changes.
UTAH: The Utah Insurance Department (UID) has issued amendments to the state's requirements for the Basic Health Care Plan to bring the rules into compliance with new statutory requirements that were enacted in 2008 and 2009. Individual and small group health insurers are required to offer the Plan until January 1, 2010. The Plan includes the following maximum benefit limitations: 1) a lifetime maximum of no less than $1 million per person, 2) a minimum $250,000 annual maximum per person, and 3) out-of-pocket maximums on various cost-sharing obligations. After January 1, 2010, the Plan will be replaced with a new basic health care plan that is defined as: 1) a federally qualified, high-deductible health plan (HDHP), 2) has the lowest deductible that qualifies as an HDHP, and 3) has an out-of-pocket maximum no greater than three times the annual deductible.
Friday, September 18, 2009
Health Insurance Quote Reform Weekly EasyToInsureME
Sept. 18, 2009
This Week in Health Care Reform
Lawmakers continued to negotiate health care reform legislation this week. On Wednesday, Sen. Max Baucus (D-MT), chairman of the Senate Finance Committee, revealed his proposed reform legislation despite ongoing concerns from both Republicans and Democrats.
EasyToInsureME.com offers clients the easiest way to buy individual health insurance. Free services include instant online health insurance quotes,custom proposals for each client, free phone consultation, and 10-minute application by phone. Nobody does what we do for our clients!
Senate Negotiations
Sen. Baucus Unveils Proposed Legislation: On Wednesday, after months of negotiations to develop a bipartisan reform proposal, Sen. Baucus unveiled a major health care reform bill. The GOP, to date, has withheld its support of the bill.
With an expected price tag of $856 billion , the bill proposes insurance cooperatives, individual mandates, taxes on high-end insurance plans, fees on industry players, Medicaid expansions and government subsidies for qualifying families. It would also prohibit insurance companies from dropping or denying coverage based on preexisting conditions. The bill is deficit-neutral and less costly than prior proposed bills. In addition, the Congressional Budget Office (CBO) reports that the bill will trim federal deficits by $49 billion over 10 years.
Sen. Baucus has indicated he will continue to work to forge bipartisan consensus, saying that the bipartisan talks could continue even as the Finance Committee begins its formal bill drafting and voting session next week. With concerns voiced from both sides of the aisle, however, it is not clear whether the bill will receive enough support.
Republicans question the states' role in paying for Medicaid expansion, an individual requirement to purchase coverage, and fees on health insurance companies, clinical laboratories and medical device manufacturers. In addition, they want to include specific language restricting the use of federal dollars for abortion.
Democrats believe there are excessive cost burdens placed on some families and have concerns about the financing of the plan. Interested parties, from consumers to employers to industry groups, are still digesting what Sen. Baucus's reform bill will mean for them.
Public Plan
American Opposition Drops if Public Option Dropped: A recent Washington Post-ABC News poll, conducted in the days following President Obama's televised address to a joint session of Congress, found that 46 percent of those polled favor proposed changes to the nation's health care system, while 48 percent are opposed. Public opinion appears to shift if the public option is dropped from the reform package, though, with opposition dropping 6 percent. About 55 percent of those polled like the idea of a public option.
Additional Activities
Industry Groups Give Support Following President Obama's Speech: Following the President's presentation of a health care reform blueprint to a joint session of Congress, industry groups expressed support for the proposed reform plans . The Americas Health Insurance Plans (AHIP), the American Medical Association (AMA), the Pharmaceutical Research and Manufacturers Association (PhRMA) and the American Association of Retired Persons (AARP), endorsed President Obama's calls for change, saying they remain open to major reform for availability, financing and regulation of health care.
Debate Swirls Around Illegal Immigrants and Health Care: House Democrats asked White House officials to clarify statements made by Press Secretary Robert Gibbs last week indicating that President Obama would bar illegal immigrants from directly buying health insurance from a government-created insurance exchange. Democrats believe that the health care proposals were developed to prevent illegal immigrants from getting tax-supported subsidies to buy health insurance, but not to prevent them from using their own money for private insurance.
White House officials clarified that illegal immigrants could use their own money to buy coverage from the few private insurance companies that will be permitted to sell insurance outside the exchange. Rep. Lamar Smith (R-TX) accused the Administration of providing coverage to illegal immigrants with this arrangement.
Looking Ahead
The Senate Finance Committee is expected to begin mark-up on Tuesday, preparing the bill for debate in the full Senate next month. The full committee will meet on Thursday to discuss the proposal, with any amendments due by end of the day Friday.
This Week in Health Care Reform
Lawmakers continued to negotiate health care reform legislation this week. On Wednesday, Sen. Max Baucus (D-MT), chairman of the Senate Finance Committee, revealed his proposed reform legislation despite ongoing concerns from both Republicans and Democrats.
EasyToInsureME.com offers clients the easiest way to buy individual health insurance. Free services include instant online health insurance quotes,custom proposals for each client, free phone consultation, and 10-minute application by phone. Nobody does what we do for our clients!
Senate Negotiations
Sen. Baucus Unveils Proposed Legislation: On Wednesday, after months of negotiations to develop a bipartisan reform proposal, Sen. Baucus unveiled a major health care reform bill. The GOP, to date, has withheld its support of the bill.
With an expected price tag of $856 billion , the bill proposes insurance cooperatives, individual mandates, taxes on high-end insurance plans, fees on industry players, Medicaid expansions and government subsidies for qualifying families. It would also prohibit insurance companies from dropping or denying coverage based on preexisting conditions. The bill is deficit-neutral and less costly than prior proposed bills. In addition, the Congressional Budget Office (CBO) reports that the bill will trim federal deficits by $49 billion over 10 years.
Sen. Baucus has indicated he will continue to work to forge bipartisan consensus, saying that the bipartisan talks could continue even as the Finance Committee begins its formal bill drafting and voting session next week. With concerns voiced from both sides of the aisle, however, it is not clear whether the bill will receive enough support.
Republicans question the states' role in paying for Medicaid expansion, an individual requirement to purchase coverage, and fees on health insurance companies, clinical laboratories and medical device manufacturers. In addition, they want to include specific language restricting the use of federal dollars for abortion.
Democrats believe there are excessive cost burdens placed on some families and have concerns about the financing of the plan. Interested parties, from consumers to employers to industry groups, are still digesting what Sen. Baucus's reform bill will mean for them.
Public Plan
American Opposition Drops if Public Option Dropped: A recent Washington Post-ABC News poll, conducted in the days following President Obama's televised address to a joint session of Congress, found that 46 percent of those polled favor proposed changes to the nation's health care system, while 48 percent are opposed. Public opinion appears to shift if the public option is dropped from the reform package, though, with opposition dropping 6 percent. About 55 percent of those polled like the idea of a public option.
Additional Activities
Industry Groups Give Support Following President Obama's Speech: Following the President's presentation of a health care reform blueprint to a joint session of Congress, industry groups expressed support for the proposed reform plans . The Americas Health Insurance Plans (AHIP), the American Medical Association (AMA), the Pharmaceutical Research and Manufacturers Association (PhRMA) and the American Association of Retired Persons (AARP), endorsed President Obama's calls for change, saying they remain open to major reform for availability, financing and regulation of health care.
Debate Swirls Around Illegal Immigrants and Health Care: House Democrats asked White House officials to clarify statements made by Press Secretary Robert Gibbs last week indicating that President Obama would bar illegal immigrants from directly buying health insurance from a government-created insurance exchange. Democrats believe that the health care proposals were developed to prevent illegal immigrants from getting tax-supported subsidies to buy health insurance, but not to prevent them from using their own money for private insurance.
White House officials clarified that illegal immigrants could use their own money to buy coverage from the few private insurance companies that will be permitted to sell insurance outside the exchange. Rep. Lamar Smith (R-TX) accused the Administration of providing coverage to illegal immigrants with this arrangement.
Looking Ahead
The Senate Finance Committee is expected to begin mark-up on Tuesday, preparing the bill for debate in the full Senate next month. The full committee will meet on Thursday to discuss the proposal, with any amendments due by end of the day Friday.
Thursday, September 17, 2009
Health Insurance Reform : EasyToInsureMe
September 16, 2009
This Week in Health Reform
EasyToInsureME.com offers clients the easiest way to buy individual health insurance. Free services include instant online health insurance quotes,custom proposals for each client, free phone consultation, and 10-minute application by phone. Nobody does what we do for our clients!
Federal Legislative Overview:
Last week Congress returned from its August recess with an incredibly busy schedule on health care reform. Max Baucus (D-MT), Chairman of the Senate Finance Committee, released the Finance Committee's $856 billion health care reform bill and will proceed with amendments due no later then this Friday, September 18, and opening statements and markup beginning September 21.
The Senate Health, Education, Labor and Pensions (HELP) Committee also released the final legislative language for its health care reform bill, “Affordable Health Choices Act” initially approved by the Committee on July 15
Senator Tom Harkin (D-IA) will assume the Chairmanship of the Senate HELP Committee vacated by Senator Edward Kennedy (D-MA) upon his death late last month. Former Acting Chairman, Christopher Dodd (D-CT) will continue to lead the Committee’s health care reform efforts over the next few months.
Overview: President Barack Obama Addresses a Joint Session of Congress on Health Care Reform
President Obama delivered a speech to the full Congress on Wednesday, September 9 laying out his goals for health care reform and reiterating that reform measures must happen this year and that it would take the combined efforts of both sides of Congress to make it happen. President Obama called for more stability and security for people who have health insurance; access to quality, affordable insurance for those who don’t by creating a new health insurance marketplace exchange; and control of the cost of health care by ending existing waste, implementing reforms and adding employer responsibility requirements.
BCBSTX’s statement on President Obama’s remarks is below:
Blue Cross and Blue Shield of Texas (BCBSTX) shares President Obama’s desire to achieve bipartisan health care reform. That is why we joined with other health insurers last year to support guaranteed coverage to all Americans including those with pre-existing medical conditions, coupled with an effective coverage requirement. Additionally, we were pleased to hear the President say that reform should build on what already works in the health care system and fix what doesn’t. That has been our position since 2006.
However, we do not agree that a new government-run health plan is necessary to achieve health care reform. In fact, it will have unintended harmful consequences to reform goals. We also would like to see a greater emphasis on wellness in all the reform proposals. With 75 percent of the health care spending in the United States going to chronic disease treatment, we must pay more attention to the main drivers of these diseases by encouraging all Americans to eat better, exercise more and smoke less.
We also believe there should be greater emphasis on using health information technology to help doctors and hospitals improve the delivery of care, and employers, individuals and government spend their health care dollars more wisely.
Finally, we agree that this historic opportunity to improve our health care system should not be lost. And so we urge the President and members of Congress from both parties to find common ground and move ahead on health care reform.
Fact vs. Fiction: Health Insurance Reform
Claim: There is inadequate competition in the insurance market and insurer profits are high
Fact: There is significant competition in local health insurance markets. There is a median of 27 carriers serving the small group market in each state, with a range varying from four insurers in Hawaii to more than 300 in Indiana (GAO, 2009). Moreover, health plan profits are much lower than most other industries – averaging 2-3 percent per year. Health plan profits have declined in 2009.
Claim: A high percentage of premium dollars go towards private plans’ administrative costs.
Fact: Private health plans’ administrative expenses are much lower than commonly perceived. Based on 2007 data from Sherlock Co., administrative expenses represented 9 percent of premiums and costs for small employers and individual insurance were 11 percent and 16 percent of premiums respectively, amounts that are two to three times lower than commonly cited.
Additionally, according to a PriceWaterhouse Coopers report, the health care premium increases between 2004 and 2005 were driven by increased utilization (43 percent), general inflation (27percent) and health care price increases in excess of inflation (30 percent). The last category was driven by increased costs of labor, higher-priced technologies, provider consolidation and movement among purchaser toward broader-access health plans. Administrative costs are not cited as a cost driver.
This Week in Health Reform
EasyToInsureME.com offers clients the easiest way to buy individual health insurance. Free services include instant online health insurance quotes,custom proposals for each client, free phone consultation, and 10-minute application by phone. Nobody does what we do for our clients!
Federal Legislative Overview:
Last week Congress returned from its August recess with an incredibly busy schedule on health care reform. Max Baucus (D-MT), Chairman of the Senate Finance Committee, released the Finance Committee's $856 billion health care reform bill and will proceed with amendments due no later then this Friday, September 18, and opening statements and markup beginning September 21.
The Senate Health, Education, Labor and Pensions (HELP) Committee also released the final legislative language for its health care reform bill, “Affordable Health Choices Act” initially approved by the Committee on July 15
Senator Tom Harkin (D-IA) will assume the Chairmanship of the Senate HELP Committee vacated by Senator Edward Kennedy (D-MA) upon his death late last month. Former Acting Chairman, Christopher Dodd (D-CT) will continue to lead the Committee’s health care reform efforts over the next few months.
Overview: President Barack Obama Addresses a Joint Session of Congress on Health Care Reform
President Obama delivered a speech to the full Congress on Wednesday, September 9 laying out his goals for health care reform and reiterating that reform measures must happen this year and that it would take the combined efforts of both sides of Congress to make it happen. President Obama called for more stability and security for people who have health insurance; access to quality, affordable insurance for those who don’t by creating a new health insurance marketplace exchange; and control of the cost of health care by ending existing waste, implementing reforms and adding employer responsibility requirements.
BCBSTX’s statement on President Obama’s remarks is below:
Blue Cross and Blue Shield of Texas (BCBSTX) shares President Obama’s desire to achieve bipartisan health care reform. That is why we joined with other health insurers last year to support guaranteed coverage to all Americans including those with pre-existing medical conditions, coupled with an effective coverage requirement. Additionally, we were pleased to hear the President say that reform should build on what already works in the health care system and fix what doesn’t. That has been our position since 2006.
However, we do not agree that a new government-run health plan is necessary to achieve health care reform. In fact, it will have unintended harmful consequences to reform goals. We also would like to see a greater emphasis on wellness in all the reform proposals. With 75 percent of the health care spending in the United States going to chronic disease treatment, we must pay more attention to the main drivers of these diseases by encouraging all Americans to eat better, exercise more and smoke less.
We also believe there should be greater emphasis on using health information technology to help doctors and hospitals improve the delivery of care, and employers, individuals and government spend their health care dollars more wisely.
Finally, we agree that this historic opportunity to improve our health care system should not be lost. And so we urge the President and members of Congress from both parties to find common ground and move ahead on health care reform.
Fact vs. Fiction: Health Insurance Reform
Claim: There is inadequate competition in the insurance market and insurer profits are high
Fact: There is significant competition in local health insurance markets. There is a median of 27 carriers serving the small group market in each state, with a range varying from four insurers in Hawaii to more than 300 in Indiana (GAO, 2009). Moreover, health plan profits are much lower than most other industries – averaging 2-3 percent per year. Health plan profits have declined in 2009.
Claim: A high percentage of premium dollars go towards private plans’ administrative costs.
Fact: Private health plans’ administrative expenses are much lower than commonly perceived. Based on 2007 data from Sherlock Co., administrative expenses represented 9 percent of premiums and costs for small employers and individual insurance were 11 percent and 16 percent of premiums respectively, amounts that are two to three times lower than commonly cited.
Additionally, according to a PriceWaterhouse Coopers report, the health care premium increases between 2004 and 2005 were driven by increased utilization (43 percent), general inflation (27percent) and health care price increases in excess of inflation (30 percent). The last category was driven by increased costs of labor, higher-priced technologies, provider consolidation and movement among purchaser toward broader-access health plans. Administrative costs are not cited as a cost driver.
Individual Health Insurance Reform Weekly : EasyToInsureME
Week of September 14, 2009
Congress returned to Washington last week, immediately gathering for President Obama's Wednesday night address on health care reform. For the first time, the President outlined his plans for reform, including support for a government option. He also addressed some of the most incendiary points of the August Town Hall reform debates and promised to call out those who "have made the calculation that it's better politics to kill this plan than to improve it." He tried to reach across the aisle to show where there is agreement, citing previous and proposed legislation by key Republicans in an effort to salvage some semblance of bipartisanship. Though the speech was successful in demonstrating the President's unwavering dedication to getting reform passed this year, many watching came away feeling that costs and affordability still seem to be taking a back seat to access issues.
EasyToInsureME offers clients the easiest way to buy individual health insurance. Nobody does what we do for our clients!
Federal
Congress returned to town amid a flurry of activity designed to inspire Congress to move quickly on passage of health care reform. The mere announcement of a prime-time Presidential speech on reform was enough to force the hand of Senator Baucus (Chair of the Senate Finance Committee and a member of the "Gang of Six") in two ways. First, over the weekend he cobbled together an 18-page outline of a bill and offered it up (as his vision of reform) to the other five members of the Gang of Six and to the rest of the Finance Committee. Second, Baucus announced that the Committee would indeed "mark-up" a bill next week and that the Gang of Six was still forging ahead. The President's speech itself actually did not really expand on any policy specifics; it was more a rallying cry to the troops (the Congress and to the American public) to pass health care reform despite the Town Hall backlash or the absence of some of the details. The key takeaway from the speech is probably that the President has officially stamped the bills moving through Congress as "my plan," which certainly puts him much more in the driver's seat for the Fall debate.
States
ARIZONA: The Arizona Health Care Cost Containment System (AHCCCS) is abolishing KidsCare Parents, effective October 1, due to funding cuts mandated by the recently enacted budget bill. KidsCare Parents, an extension of the state's Children's Health Insurance Program (CHIP), provides health coverage to nearly 10,000 parents earning up to 200 percent of the federal poverty level. Children covered by the state's CHIP, known as KidsCare, will keep their coverage. Other health-related provisions include: freezing hospital inpatient and outpatient reimbursement rates; rolling over one month's capitation payment to AHCCCS health plans to the next fiscal year; requiring AHCCCS to comply with the Federal False Claims Act; requiring AHCCCS to prepare a report on provider assessment to increase federal matching funds; maintaining a 5 percent reduction in reimbursement rates to noninstitutional providers; and implementing total cuts of $29.4 million to AHCCCS, $26.1 million to the Department of Health Services, and $737,000 to the Department of Insurance.
CALIFORNIA: As expected, the legislature approved a measure designed to restrict an insurer's ability to rescind an individual’s health insurance policy unless the insurer can demonstrate that the member intentionally misrepresented facts on the original medical questionnaire. The legislation would also require development of regulations to standardize applications and use of health questions, require extensive medical background checks and create an independent third-party review of any potential policy rescission. Governor Schwarzenegger vetoed a similar bill last year but has not indicated his stance on this year’s legislation.
CONNECTICUT: The General Assembly passed a new, two-year state budget that relies heavily on one-time revenue sources including the Rainy Day Fund, federal stimulus dollars, tax changes and many state fee increases. Governor Rell let the bill become law without her signature. Premium taxes on health insurance were not increased; however, the new budget contains a very significant reduction of 6 percent in Medicaid Managed Care Organization reimbursements. This cut will negatively impact the ability of Connecticut to maintain a competitive, sustainable Medicaid Managed Care market. Retaliatory taxes are also a possibility as state licensing, certification and registration fees to most agencies are increased to at least $15; doubled if under $150; hiked by 25 percent if between $150 and $1,000; and increased by $250 if over $1,000. Legislators plan to return on Sept 23 and 24 to pass the necessary budget implementer bills.
GEORGIA Health Insurance: The hearing took place on September 9th to finalize regulations that would allow health plans to include health status as a factor in the rating of small groups on their renewal date. Previously, this was only permitted for new business and is very important to the small group segment. The Georgia Association of Health Plans and AHIP have been working with the Georgia Department of Insurance on this issue for some time and appeared at the hearing along with many carriers. No opposition was stated at the hearing so we expect the regulations to be promulgated permanently very shortly.
KANSAS: Efforts to get more uninsured Kansans enrolled in Medicaid and the State Children’s Health Insurance Program (SCHIP) got a big boost this week with the announcement of a five-year, $40.3 million grant from the U.S. Department of Health and Human Services. The grant from HHS’s Health Resources and Services Administration (HRSA) will be used to fund a new technology for the state’s enrollment system, replacing a computer system that’s more than 20 years old, as well as outreach efforts aimed at getting more people who are eligible for Medicaid and SCHIP to sign up for benefits. The timing is beneficial since the state is gearing up to implement an expansion of SCHIP that the legislature authorized this year. Beginning in January, the income limit for SCHIP eligibility in Kansas will increase from 200 percent to 250 percent of the 2008 federal poverty level, or $44,000 per year for a family of three. The grant and the enrollment efforts it will fund were made possible through the support of the Kansas Health Foundation, the Kansas Association for the Medically Underserved, Kansas Action for Children, the Kansas Health Institute and the Department of Social and Rehabilitation Services.
OHIO Health Insurance : Implementation of Open Enrollment Health Care Reform Provisions in HB1. Insurers recently met with the Ohio Department of Insurance (ODI) regarding the health care reform provisions of HB1 that made significant changes to laws affecting insurance. As a result of the meeting and questions with respect to implementation, ODI put out further guidance last week to insurers and health insuring corporations (HICs) as well as the variable effective dates of different portions of the bill. The new guidance document is intended to answer questions about open enrollment changes, rate filing questions, data reporting and miscellaneous topics from the budget bill. Recall, Ohio law requires carriers to accept applicants for individual coverage during an annual open enrollment period. Ohio HB1 amended the existing individual open enrollment requirements. In addition to the new guidance document, the ODI published draft regulations last week regarding open enrollment, advertisement and data collection rules under the new law. Aetna is evaluating and commenting upon the draft regulations and expects that a number of other guidance materials and rules will be put forth as other sections of the law are implemented.
TEXAS Health Insurance : The Department of Insurance held a stakeholder meeting last week to discuss proposed rules implementing a mediation process for balance billing disputes. The new law putting this option in place went into effect September 1 and has not yet been tested. Once triggered by the member for any balance bill over $1,000, the process would require the health plan and facility-based providers to attend mediation in an attempt to resolve the disputed amount. A physician may avoid the terms of the bill by disclosing in advance that he is an out-of-network provider, providing an estimated amount the patient may owe for services, and the circumstances under which the enrollee would be responsible for those amounts. No mediation can be required as long as the actual costs of the services are less than the estimated amount in the disclosure. Stakeholders also discussed a section of the legislation requiring Texas Department of Insurance to adopt network adequacy standards. Those standards must adapt to local markets in which a health plan operates, ensure availability of, and accessibility to, a full range of health care practitioners to provide health care services to patients, and consider situations in which no provider in a field of practice in a local market agree to contract with a plan at a reasonable rate of reimbursement. Aetna is participating in these stakeholder discussions and will continue to do so as the rulemaking process continues.
UTAH: Industry comments have been submitted to the Office of Health Care Statistics and the Department of Health regarding a proposed regulation requiring all carriers in Utah, including third-party administrators, dental plans and self-insured plans, to submit data on enrollment and medical and pharmacy claims. The initial submission covers claims from January 1, 2007, through December 31, 2008, which are paid through September 30, 2009. Subsequent submissions are to be done monthly. Among the problems identified are the need for uniformity in data collection criteria across states; privacy concerns arising from the member specific data requested; the need for additional time to implement the collection and reporting process; the value of a pilot period to determine the need for any adjustments; the financial burden of monthly reporting and an excessive penalty of $10,000 per day for failure to timely submit a report.
Congress returned to Washington last week, immediately gathering for President Obama's Wednesday night address on health care reform. For the first time, the President outlined his plans for reform, including support for a government option. He also addressed some of the most incendiary points of the August Town Hall reform debates and promised to call out those who "have made the calculation that it's better politics to kill this plan than to improve it." He tried to reach across the aisle to show where there is agreement, citing previous and proposed legislation by key Republicans in an effort to salvage some semblance of bipartisanship. Though the speech was successful in demonstrating the President's unwavering dedication to getting reform passed this year, many watching came away feeling that costs and affordability still seem to be taking a back seat to access issues.
EasyToInsureME offers clients the easiest way to buy individual health insurance. Nobody does what we do for our clients!
Federal
Congress returned to town amid a flurry of activity designed to inspire Congress to move quickly on passage of health care reform. The mere announcement of a prime-time Presidential speech on reform was enough to force the hand of Senator Baucus (Chair of the Senate Finance Committee and a member of the "Gang of Six") in two ways. First, over the weekend he cobbled together an 18-page outline of a bill and offered it up (as his vision of reform) to the other five members of the Gang of Six and to the rest of the Finance Committee. Second, Baucus announced that the Committee would indeed "mark-up" a bill next week and that the Gang of Six was still forging ahead. The President's speech itself actually did not really expand on any policy specifics; it was more a rallying cry to the troops (the Congress and to the American public) to pass health care reform despite the Town Hall backlash or the absence of some of the details. The key takeaway from the speech is probably that the President has officially stamped the bills moving through Congress as "my plan," which certainly puts him much more in the driver's seat for the Fall debate.
States
ARIZONA: The Arizona Health Care Cost Containment System (AHCCCS) is abolishing KidsCare Parents, effective October 1, due to funding cuts mandated by the recently enacted budget bill. KidsCare Parents, an extension of the state's Children's Health Insurance Program (CHIP), provides health coverage to nearly 10,000 parents earning up to 200 percent of the federal poverty level. Children covered by the state's CHIP, known as KidsCare, will keep their coverage. Other health-related provisions include: freezing hospital inpatient and outpatient reimbursement rates; rolling over one month's capitation payment to AHCCCS health plans to the next fiscal year; requiring AHCCCS to comply with the Federal False Claims Act; requiring AHCCCS to prepare a report on provider assessment to increase federal matching funds; maintaining a 5 percent reduction in reimbursement rates to noninstitutional providers; and implementing total cuts of $29.4 million to AHCCCS, $26.1 million to the Department of Health Services, and $737,000 to the Department of Insurance.
CALIFORNIA: As expected, the legislature approved a measure designed to restrict an insurer's ability to rescind an individual’s health insurance policy unless the insurer can demonstrate that the member intentionally misrepresented facts on the original medical questionnaire. The legislation would also require development of regulations to standardize applications and use of health questions, require extensive medical background checks and create an independent third-party review of any potential policy rescission. Governor Schwarzenegger vetoed a similar bill last year but has not indicated his stance on this year’s legislation.
CONNECTICUT: The General Assembly passed a new, two-year state budget that relies heavily on one-time revenue sources including the Rainy Day Fund, federal stimulus dollars, tax changes and many state fee increases. Governor Rell let the bill become law without her signature. Premium taxes on health insurance were not increased; however, the new budget contains a very significant reduction of 6 percent in Medicaid Managed Care Organization reimbursements. This cut will negatively impact the ability of Connecticut to maintain a competitive, sustainable Medicaid Managed Care market. Retaliatory taxes are also a possibility as state licensing, certification and registration fees to most agencies are increased to at least $15; doubled if under $150; hiked by 25 percent if between $150 and $1,000; and increased by $250 if over $1,000. Legislators plan to return on Sept 23 and 24 to pass the necessary budget implementer bills.
GEORGIA Health Insurance: The hearing took place on September 9th to finalize regulations that would allow health plans to include health status as a factor in the rating of small groups on their renewal date. Previously, this was only permitted for new business and is very important to the small group segment. The Georgia Association of Health Plans and AHIP have been working with the Georgia Department of Insurance on this issue for some time and appeared at the hearing along with many carriers. No opposition was stated at the hearing so we expect the regulations to be promulgated permanently very shortly.
KANSAS: Efforts to get more uninsured Kansans enrolled in Medicaid and the State Children’s Health Insurance Program (SCHIP) got a big boost this week with the announcement of a five-year, $40.3 million grant from the U.S. Department of Health and Human Services. The grant from HHS’s Health Resources and Services Administration (HRSA) will be used to fund a new technology for the state’s enrollment system, replacing a computer system that’s more than 20 years old, as well as outreach efforts aimed at getting more people who are eligible for Medicaid and SCHIP to sign up for benefits. The timing is beneficial since the state is gearing up to implement an expansion of SCHIP that the legislature authorized this year. Beginning in January, the income limit for SCHIP eligibility in Kansas will increase from 200 percent to 250 percent of the 2008 federal poverty level, or $44,000 per year for a family of three. The grant and the enrollment efforts it will fund were made possible through the support of the Kansas Health Foundation, the Kansas Association for the Medically Underserved, Kansas Action for Children, the Kansas Health Institute and the Department of Social and Rehabilitation Services.
OHIO Health Insurance : Implementation of Open Enrollment Health Care Reform Provisions in HB1. Insurers recently met with the Ohio Department of Insurance (ODI) regarding the health care reform provisions of HB1 that made significant changes to laws affecting insurance. As a result of the meeting and questions with respect to implementation, ODI put out further guidance last week to insurers and health insuring corporations (HICs) as well as the variable effective dates of different portions of the bill. The new guidance document is intended to answer questions about open enrollment changes, rate filing questions, data reporting and miscellaneous topics from the budget bill. Recall, Ohio law requires carriers to accept applicants for individual coverage during an annual open enrollment period. Ohio HB1 amended the existing individual open enrollment requirements. In addition to the new guidance document, the ODI published draft regulations last week regarding open enrollment, advertisement and data collection rules under the new law. Aetna is evaluating and commenting upon the draft regulations and expects that a number of other guidance materials and rules will be put forth as other sections of the law are implemented.
TEXAS Health Insurance : The Department of Insurance held a stakeholder meeting last week to discuss proposed rules implementing a mediation process for balance billing disputes. The new law putting this option in place went into effect September 1 and has not yet been tested. Once triggered by the member for any balance bill over $1,000, the process would require the health plan and facility-based providers to attend mediation in an attempt to resolve the disputed amount. A physician may avoid the terms of the bill by disclosing in advance that he is an out-of-network provider, providing an estimated amount the patient may owe for services, and the circumstances under which the enrollee would be responsible for those amounts. No mediation can be required as long as the actual costs of the services are less than the estimated amount in the disclosure. Stakeholders also discussed a section of the legislation requiring Texas Department of Insurance to adopt network adequacy standards. Those standards must adapt to local markets in which a health plan operates, ensure availability of, and accessibility to, a full range of health care practitioners to provide health care services to patients, and consider situations in which no provider in a field of practice in a local market agree to contract with a plan at a reasonable rate of reimbursement. Aetna is participating in these stakeholder discussions and will continue to do so as the rulemaking process continues.
UTAH: Industry comments have been submitted to the Office of Health Care Statistics and the Department of Health regarding a proposed regulation requiring all carriers in Utah, including third-party administrators, dental plans and self-insured plans, to submit data on enrollment and medical and pharmacy claims. The initial submission covers claims from January 1, 2007, through December 31, 2008, which are paid through September 30, 2009. Subsequent submissions are to be done monthly. Among the problems identified are the need for uniformity in data collection criteria across states; privacy concerns arising from the member specific data requested; the need for additional time to implement the collection and reporting process; the value of a pilot period to determine the need for any adjustments; the financial burden of monthly reporting and an excessive penalty of $10,000 per day for failure to timely submit a report.
Subscribe to:
Posts (Atom)
