Health Insurance Reform Washington Update

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

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

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

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

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

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

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

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

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Current Health Insurance Reform Issues

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

Federal

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

States

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

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

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

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

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

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

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

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

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

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

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

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

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Individual Health Insurance Reform Future Proceedings Easy To Insure ME

MARCH 26, 2010

This Week in Health Insurance Reform

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

Health Care Reform Negotiations

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

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

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

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

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

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

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

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

Additional Activities

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

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

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

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

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

Public Opinion

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

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

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

Looking Ahead

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

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Individual Health Insurance Reform Weekly: EasyToInsureME : 08/17/09

Week of August 17, 2009 : EasyToInsureME

The highly charged health care reform debate continues to get extensive news coverage, and Members of Congress are clearly feeling the heat. Senate Finance Committee Ranking Member Senator Charles Grassley (R-IA) took the unusual step of issuing a statement last week to reassure voters that a Finance Committee bill will not have end-of-life provisions -- one of the more controversial topics at town hall meetings this summer. A Finance Committee bill has yet to emerge, as Committee members search for an approach that can net bipartisan support. But Grassley provided a small glimpse of the Committee's thinking when he disclosed that the panel "dropped end-of-life provisions from consideration entirely because of the way they could be misinterpreted and implemented incorrectly." Distancing himself and the Finance Committee from the House bill, Grassley went on to say House legislation is "poorly cobbled together" and could invite unintended consequences.

Federal

With Congress in recess, there is no federal report this week.

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States

NEW JERSEY: Newly enacted legislation requires installment payment for maternity services, and it mandates the Department of Banking & Insurance to promulgate a payment schedule for provider services rendered in advance of child delivery. Through the New Jersey Association of Health Plans, Aetna and other carriers will meet with stakeholders to assist the department in implementing this statute. Also enacted into law was an autism coverage mandate. Under the new statute, insurance carriers must extend coverage for medically necessary treatment including speech, occupational, and behavioral therapy. The coverage benefit is capped at $36,000 annually. Also, the state Supreme Court has denied an appeal for stay of approved rider filings by the Small Employer Health Benefits board. A coalition of health care providers, primarily ambulatory surgery centers, sought to delay implementation of an approved rider filed by Horizon Blue Cross Blue Shield of NJ, which limits out-of-network ASC benefits at $2,000. The newly appointed Commissioner of Banking & Insurance denied the providers’ appeal for stay. The coalition's emergency request for delay was denied by the Appellate Division and finally the Supreme Court upheld the denial.

NORTH CAROLINA: The Governor has signed the proposed budget with no premium tax increase to insurers, thanks to the input of Aetna and many other industry leaders, business leaders and trade groups. Previous budget proposals included increases from 1.9 to 2.25 percent, effective January 2011.

PENNSYLVANIA Health Insurance : Governor Ed Rendell signed a budget bill after exercising his line item veto to strike most appropriations other than those necessary to pay state employees. The bill, introduced by Senate Appropriations Committee Chairman Jake Corman (R-Centre), was passed without amendment so that it could go to the Governor. The 2 percent managed care organization tax remains the big open issue for the budget. Moving the current MA MCO assessment under the sales and use tax is supported by some, but the administration is pushing the added 2 percent tax on all managed care premiums.

Health Insurance Quote Reform Weekly : EasyToInsureME : 8/14/09

With Congressional lawmakers back in their districts for summer recess, the health reform debate is heating up. The national discussion on reform has shifted away from Washington, as members of Congress convene town hall meetings across the country. Many of these meetings have been filled with loud outbursts, heated debates and hot tempers, largely from opponents of reform proposals. In addition, the partisan messaging battle continues.

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Health Reform Activities

President Obama Holds Town Hall Meetings: In Portsmouth, NH, on Tuesday, President Obama sought to reassure the public about health care reform at his first health reform town hall meeting. Compared to other town hall meetings, the crowd of 1,800 was less contentious. Despite the relative calm at the meeting itself, approximately 2,000 demonstrators from both sides of the debate gathered outside the facility. President Obama spent much of the forum debunking misconceptions about reform proposals to those who fear their current coverage will be jeopardized.

President Obama will hold two more town hall meetings within the next week: today in Bozeman, MT, and Saturday in Grand Junction, CO.

Pelosi and Hoyer Criticize Protesters as "Un-American": On Monday, a USA Today editorial co-authored by House Speaker Nancy Pelosi and Majority Leader Steny Hoyer denounced ongoing town hall protests as "un-American." President Obama sought to distance himself from these comments.

Hot Tempers Continue at Town Hall Meetings: Because of the growing number of protests, some legislators increased security at meetings this week, while others opted to facilitate meetings via teleconference. In an effort to prepare lawmakers for the protests, House Democrat leaders set up a so-called "War Room" to answer lawmakers' policy questions and help prepare them for potential disruptions. Organizing for America, which earlier served as President Obama's election campaign group, launched a campaign aimed at encouraging supporters of Obama's reform legislation to visit their lawmakers' offices to express support.

President Obama Confronts Health Care "Rumors": White House officials have undertaken aggressive tactics to dispel public misperceptions about reform legislation. During Saturday's weekly radio and Internet address, he confronted the rumors directly. "Let me start by dispelling the outlandish rumors that reform will promote euthanasia, or cut Medicaid, or bring about a government take over of health care," said President Obama. "That's simply not true."

To further grassroots marketing efforts, White House officials on Monday launched "Reality Check," a website that provides information with viral marketing tools, allowing users to share that information on social networking sites.

Opinion Polls

Public Polls Show Division: A July USA TODAY/Gallup Poll indicates that while Americans are divided about health care reform, the divide doesn't appear to be drawn along party lines. According to the poll, Americans appear to disagree about both the primary goal and the urgency of reform legislation. Seniors are the most resistant to reform, and fewer than half of seniors polled want reform enacted this year.

Advertising Activities

New Coalition Sponsors Support Ads in Select States: On Thursday, Americans for Stable Quality Care launched a $12 million television ad campaign in support of President Obama's health reform plan. The new group, which is expected to be the largest spender in support of health reform, is primarily funded by the Pharmaceutical Research and Manufacturers of America, with assistance from the American Medical Association, FamiliesUSA, the Federation of American Hospitals, and the Service Employees International Union. The coalition seeks to counter increasingly aggressive protests at town hall meetings while solidifying support from swing senators and Blue Dog Democrats.

Financing the Plans

Congressional Budget Office (CBO) Indicates Cost of Preventive Care Outweighs Savings: The CBO announced Friday that even though public health may improve with expanding preventive medical services - including cancer screenings, cholesterol management, vaccinations and wellness training - the costs of such expansions will offset any savings ultimately generated.

Looking Ahead

The intense national debate is likely to continue throughout the month as President Obama and legislators continue to hold town hall meetings across the country. Lawmakers are slated to return to Washington on September 8.

Health Insurance Care Reform 7/9/09 EasyToInsureME

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

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

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

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

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

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

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

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

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

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