JANUARY 29, 2010
This Week in Health Care Reform
Following the election of Republican Scott Brown to the Massachusetts State Senate last week and the resulting loss of Senate Democrats' supermajority, lawmakers continue to pave the way for health care reform - with limited progress. In addition, polls indicate that the public would rather lawmakers focus more on the economy than on health care.
State of the Union Address
President Obama Gives State of the Union Address: On Wednesday evening, President Barack Obama delivered his first State of the Union address before a joint session of Congress. Having hoped to have a health care reform bill on his desk prior to his address, the President instead used his speech to encourage Congress to push forward on health care reform. Yet, he did not give specific guidance as to how to proceed with the legislation. Instead, he made it clear that his primary focus would be on jobs and the economy.
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Health Care Reform Negotiations
Democrats Still Seek Way Forward: While vowing not to give up, Democratic Senate leaders indicated Tuesday that they no longer felt pressure to move quickly on health care reform; and, in the wake of the Massachusetts election and in reaction to public opinion, they shifted focus to jobs and the economy. Senate Majority Leader Harry Reid (D-NV) commented that there is "no rush" on health care and said that he and Speaker of the House Nancy Pelosi (D-CA) were working to map out a way to complete health care reform in the coming months. On Wednesday, Sen. Pelosi floated a two-pronged strategy to pass incremental changes now and pursue comprehensive reform later.
Some lawmakers have considered breaking up the legislation into smaller pieces that have bipartisan support. However, this option will prove challenging given the complexities and interdependencies of the measures. For example, lawmakers would like to include a measure that requires all insurance companies to insure those with pre-existing conditions; however, premiums will most likely increase unless there is an individual mandate.
Earlier this week, Democrats appeared to be coalescing around a different strategy through which Senate lawmakers would make changes to their bill to appease members of the House. The Senate would then pass the revised bill via reconciliation, which only requires 51 votes. Following that, the House would approve the revised bill, giving it to President Obama for his review. However, movement on this strategy stalled Tuesday when two centrist Senators, Sens. Evan Bayh (D-IN) and Blanche Lincoln (D-AK), indicated that they would oppose using reconciliation to bypass Republican support. Others, including Sen. Joe Lieberman (I-CT) and Sen. Dianne Feinstein (D-CA), have suggested a "time out" on health care reform until there is a clear path forward.
In the GOP response to President Obama's State of the Union address, Virginia Governor Robert McDonnell said that Republicans share the Democrats' desire for health care reform, but do not agree with their proposed solutions. Republicans suggest that Democrats scrap the current proposals and start over with more Republican input on issues such as medical malpractice reform and selling insurance policies across state lines.
Republicans Call for Transparency: On Wednesday, the House Energy and Commerce Committee marked up a resolution presented by Rep. Michael Burgess (R-TX) which requested that the administration divulge documentation regarding the health care reform deals made with trade associations and a labor union. Committee Chairman Henry Waxman (D-CA) said that while details remained to be worked out, he would support a narrowed version of the Republican request for White House records.
President Obama to Speak with House Republicans: President Obama will meet with House Republicans on Friday in response to an invitation to speak at their annual retreat in Baltimore that begins Thursday and ends Saturday. The meeting comes just after the President's State of the Union address, and members of the news media speculate that the meeting may spur more bipartisanship or potentially lead to even more tension between the two parties.
Interest Groups Call for Reform: With health care reform's fate in jeopardy, interest groups have voiced their support, encouraging Democrats to push forward with legislation. The AARP, American Cancer Society Cancer Action Network, Consumers Union, Families USA and Service employees International Union sent a joint letter last Thursday urging Congress not to abandon comprehensive health care reform. Further, the United States Conference of Catholic Bishops also sent a letter to Congress urging a push for reform.
Public Opinion
Polls Show Concern with Health Care Reform; More Focus on Jobs and Economy: Several polls were released this week that highlight the public's disenchantment with health care reform and anxiety around the struggling economy.
A new CNN/Opinion Research poll released Tuesday shows that only three in ten Americans say they want Congress to pass legislation similar to the bills currently being discussed in Congress. Forty-eight percent of Americans would like lawmakers to start again on a new bill, and 21 percent believe Congress should not work on bills that would change the current health care system. Further, a Wall Street Journal/NBC poll released Wednesday found that 51 percent of Americans believe President Obama has paid "too little attention" to the economy and that 44 percent feel he has paid "too much attention" to his proposed health care overall.
In addition, a new USA Today/Gallup poll released late last week finds that most Americans call for a more bipartisan effort in health reform. A 55 percent majority of Americans say that President Obama and Congressional Democrats should suspend movement on health care reform and consider alternatives that would increase Republican support.
A poll released last weekend by the Washington Post , Henry J. Kaiser Family Foundation and Harvard University's School of Public Health indicated that dissatisfaction with the direction of the country, including the Democrats' health care reform proposals, drove the outcome of the Massachusetts election. The post-election survey of Massachusetts state voters showed that overall 43 percent say they support the health care reform proposals advanced by President Obama and Congressional Democrats, while 48 percent oppose them.
A new poll released Monday from the Robert Wood Johnson Foundation found that fears regarding the health care reform package increased significantly in December as members of the Senate finalized their bill. Thirty-three percent of respondents said they believed their access to care would worsen if the legislation passed, up from 25 percent in November. Forty-two percent said the country's finances would suffer under reform, compared with 34.6 percent in November.
Looking Ahead
Next week, the President will present his Budget to Congress (which includes health programs), after which Congressional hearings will commence. We expect health reform to be discussed in these sessions. While there remains no clear path forward for health care reform, Congressional leaders will continue to work to find a solution.
Chad Levin EasyToInsureME.com | Work: 866-492-3905 Fax: 215-364-3990 easytoinsureme@yahoo.com  |  |
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Showing posts with label quotes. Show all posts
Showing posts with label quotes. Show all posts
Sunday, January 31, 2010
Friday, January 8, 2010
This Week in Health Insurance Quotes Reform : EasyToInsureME
JANUARY 8, 2010
This Week in Health Care Reform
While still technically in recess, members of Congress trickled back to Washington, D.C. this week to get a jump start on reconciling the health care reform bills passed by the House and Senate last year.
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On Tuesday, Democratic leaders began conversations around a final package, pledging to overcome differences and aiming to have a bill passed by the President Barack Obama's State of the Union Address, anticipated in early February. Members of the news media, however, have highlighted the difficult negotiations ahead, given some major differences in the proposed packages and the time pressure being imposed by President Obama.
We continue to encourage you and others to engage members of Congress during this debate by visiting the Health Action Network.
Health Reform Negotiations
Senate Passes Reform Bill: At 7:05 a.m. on Christmas Eve, Senate Majority Leader Harry Reid (D-NV), along with 59 other Senate members, voted to pass reform legislation that, according to the Congressional Budget Office (CBO), would expand health coverage to approximately 31 million people at a cost of $871 billion over 10 years. The bill passed on party lines (60-39), without a single Republican vote in favor. Republicans believe the bill would impose many regulatory and financial burdens on taxpayers and businesses while increasing government debt.
Reconciliation Poses Difficult Road Ahead: Before lawmakers can present a final health care reform bill to President Obama, the approved Senate bill needs to be merged with the House version passed in November 2009, which extends coverage to 36 million Americans at a cost of about $1 trillion. However, the bills have some major differences that will need to be addressed as lawmakers shape the final package, including:
* Insurance market reform and exchanges - Both bills would bar insurers from denying coverage to those with pre-existing conditions and from dropping coverage for those who get sick. Both would also create insurance exchanges through which small businesses and individuals could shop for insurance. The Senate bill would create state-based exchanges, however, whereas the House bill would create a national exchange with an option for states to run state-based programs if they meet certain requirements.
* The government-run plan - A government-run plan was a central component to the House bill. The Senate bill would instead direct the U.S. Office of Personnel Management to contract with private insurance companies to offer policies on the exchanges. Despite much commotion over the need to include the public option, House leaders conceded Tuesday that they may be willing to agree to a bill without a public option if other parts of the bill fulfill the same goals, with the hope of expanding available subsidies.
* Reform financing - Members of the House would pay for the reform effort - which carries a price tag of about $1 trillion - through a 5.4 percent surtax on individuals making more than $500,000 a year and couples making more than $1 million and by imposing a 2.5 percent excise tax on medical devices. Members of the Senate, on the other hand, plan to pay for their $871 billion plan through several measures:
- a 40 percent excise tax on high-cost health insurance plans;
- an increase in payroll taxes for Medicare on individuals making more than $200,000 a year and couples making more than $250,000 per year;
- fees on insurers, medical device manufacturers and drug companies;
- and, a 10 percent tax on indoor tanning salons.
On Wednesday, President Obama expressed his preference for the insurance tax contained in the Senate bill, but the excise tax is strongly opposed by labor unions.
* Coverage Mandates - Both bills require that individuals obtain health insurance and impose a penalty on those who do not. The House bill also includes an employer mandate for companies with payrolls above $750,000. The Senate bill does not include this mandate but would require companies with more than 50 employees to pay a fine if employees obtain federally subsidized coverage on the insurance exchange.
* Medicaid expansion - Both bills expand Medicaid. The Senate bill makes Medicaid available to those with incomes up to 133 percent of the poverty level, whereas the House allows for coverage for those with incomes up to 150 percent of the poverty level.
* Abortion - While both bills bar the use of federal funds for abortions, the House bill includes stricter language requiring anyone seeking abortion coverage to buy separate insurance riders. The Senate bill would let the states choose whether or not to include plans with abortion coverage in the insurance exchange and would require those with abortion coverage to write a separate check for this insurance.
President Obama Pushes Swift Action: In a meeting at the White House Tuesday, President Obama encouraged House Speaker Nancy Pelosi (D-CA) and House Majority Leader Steny Hoyer (D-MD), as well as Senate Majority Leader Harry Reid and Sen. Dick Durbin (D-IL), who participated via phone, to bypass the traditional conference committee used to negotiate reconciliation, in the interest of time. The move, which creates a three-way negotiating construct involving top Democrats in the House and Senate and the White House, will exclude Republican lawmakers from the debate and reduce their ability to delay the voting.
Further, President Obama indicated that he would be taking a hands-on approach to the final stages of the negotiations. The President held another meeting with leading Democrats on Wednesday to help iron out differences between the House and Senate bills. Democrats also held a noon meeting and conference call on Thursday to discuss how reconciliation will proceed and some of the priorities for the final bill.
Additional Activities
C-SPAN Calls for Transparency: Noting that President Obama mentioned several times during his campaign that health care negotiations would be transparent and broadcasted on C-SPAN, Brian Lamb, C-SPAN CEO, sent a letter to House and Senate leaders on December 30 asking for negotiations to be opened up for public viewing. Republicans pointed out that the most critical discussions on health reform have taken place behind closed doors so far. Top House Democrats deflected the C-SPAN request, saying the process has been highly transparent through more than 100 public hearings held by the House. They pledged to make the final stages transparent in part via the Internet.
Opponents Question Constitutionality: On Wednesday, December 30, Republican attorneys general in 13 states - including Colorado, Florida, Idaho, Michigan and Virginia - sent a letter to Sens. Nancy Pelosi and Harry Reid stating that Congressional leaders must remove the amendment exempting Nebraska from having to pay for the state's Medicaid expansion. The prosecutors are calling the deal unconstitutional and threatened legal action. Members of the news media report that South Carolina Attorney General Henry McMaster and Oklahoma top prosecutor Drew Edmondson are asking attorneys general across the country to call on Sens. Pelosi and Reid to remove the provision.
In addition, a contingency of legal scholars as well as many Republican lawmakers are calling the measures passed by both the House and the Senate unconstitutional , primarily due to the inclusion of an individual mandate. "In the history of this country, the federal government has never required every American to enter into a contract with a private company," said Randy Barnett, a professor of constitutional law at Georgetown University Law Center.
Looking Ahead
Formal sessions in Congress are scheduled to begin January 19, 2010. Sen. Pelosi, however, plans to continue to work with key committee chairs and other Democratic leaders prior to the official sessions..
This Week in Health Care Reform
While still technically in recess, members of Congress trickled back to Washington, D.C. this week to get a jump start on reconciling the health care reform bills passed by the House and Senate last year.
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Health insurance
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On Tuesday, Democratic leaders began conversations around a final package, pledging to overcome differences and aiming to have a bill passed by the President Barack Obama's State of the Union Address, anticipated in early February. Members of the news media, however, have highlighted the difficult negotiations ahead, given some major differences in the proposed packages and the time pressure being imposed by President Obama.
We continue to encourage you and others to engage members of Congress during this debate by visiting the Health Action Network.
Health Reform Negotiations
Senate Passes Reform Bill: At 7:05 a.m. on Christmas Eve, Senate Majority Leader Harry Reid (D-NV), along with 59 other Senate members, voted to pass reform legislation that, according to the Congressional Budget Office (CBO), would expand health coverage to approximately 31 million people at a cost of $871 billion over 10 years. The bill passed on party lines (60-39), without a single Republican vote in favor. Republicans believe the bill would impose many regulatory and financial burdens on taxpayers and businesses while increasing government debt.
Reconciliation Poses Difficult Road Ahead: Before lawmakers can present a final health care reform bill to President Obama, the approved Senate bill needs to be merged with the House version passed in November 2009, which extends coverage to 36 million Americans at a cost of about $1 trillion. However, the bills have some major differences that will need to be addressed as lawmakers shape the final package, including:
* Insurance market reform and exchanges - Both bills would bar insurers from denying coverage to those with pre-existing conditions and from dropping coverage for those who get sick. Both would also create insurance exchanges through which small businesses and individuals could shop for insurance. The Senate bill would create state-based exchanges, however, whereas the House bill would create a national exchange with an option for states to run state-based programs if they meet certain requirements.
* The government-run plan - A government-run plan was a central component to the House bill. The Senate bill would instead direct the U.S. Office of Personnel Management to contract with private insurance companies to offer policies on the exchanges. Despite much commotion over the need to include the public option, House leaders conceded Tuesday that they may be willing to agree to a bill without a public option if other parts of the bill fulfill the same goals, with the hope of expanding available subsidies.
* Reform financing - Members of the House would pay for the reform effort - which carries a price tag of about $1 trillion - through a 5.4 percent surtax on individuals making more than $500,000 a year and couples making more than $1 million and by imposing a 2.5 percent excise tax on medical devices. Members of the Senate, on the other hand, plan to pay for their $871 billion plan through several measures:
- a 40 percent excise tax on high-cost health insurance plans;
- an increase in payroll taxes for Medicare on individuals making more than $200,000 a year and couples making more than $250,000 per year;
- fees on insurers, medical device manufacturers and drug companies;
- and, a 10 percent tax on indoor tanning salons.
On Wednesday, President Obama expressed his preference for the insurance tax contained in the Senate bill, but the excise tax is strongly opposed by labor unions.
* Coverage Mandates - Both bills require that individuals obtain health insurance and impose a penalty on those who do not. The House bill also includes an employer mandate for companies with payrolls above $750,000. The Senate bill does not include this mandate but would require companies with more than 50 employees to pay a fine if employees obtain federally subsidized coverage on the insurance exchange.
* Medicaid expansion - Both bills expand Medicaid. The Senate bill makes Medicaid available to those with incomes up to 133 percent of the poverty level, whereas the House allows for coverage for those with incomes up to 150 percent of the poverty level.
* Abortion - While both bills bar the use of federal funds for abortions, the House bill includes stricter language requiring anyone seeking abortion coverage to buy separate insurance riders. The Senate bill would let the states choose whether or not to include plans with abortion coverage in the insurance exchange and would require those with abortion coverage to write a separate check for this insurance.
President Obama Pushes Swift Action: In a meeting at the White House Tuesday, President Obama encouraged House Speaker Nancy Pelosi (D-CA) and House Majority Leader Steny Hoyer (D-MD), as well as Senate Majority Leader Harry Reid and Sen. Dick Durbin (D-IL), who participated via phone, to bypass the traditional conference committee used to negotiate reconciliation, in the interest of time. The move, which creates a three-way negotiating construct involving top Democrats in the House and Senate and the White House, will exclude Republican lawmakers from the debate and reduce their ability to delay the voting.
Further, President Obama indicated that he would be taking a hands-on approach to the final stages of the negotiations. The President held another meeting with leading Democrats on Wednesday to help iron out differences between the House and Senate bills. Democrats also held a noon meeting and conference call on Thursday to discuss how reconciliation will proceed and some of the priorities for the final bill.
Additional Activities
C-SPAN Calls for Transparency: Noting that President Obama mentioned several times during his campaign that health care negotiations would be transparent and broadcasted on C-SPAN, Brian Lamb, C-SPAN CEO, sent a letter to House and Senate leaders on December 30 asking for negotiations to be opened up for public viewing. Republicans pointed out that the most critical discussions on health reform have taken place behind closed doors so far. Top House Democrats deflected the C-SPAN request, saying the process has been highly transparent through more than 100 public hearings held by the House. They pledged to make the final stages transparent in part via the Internet.
Opponents Question Constitutionality: On Wednesday, December 30, Republican attorneys general in 13 states - including Colorado, Florida, Idaho, Michigan and Virginia - sent a letter to Sens. Nancy Pelosi and Harry Reid stating that Congressional leaders must remove the amendment exempting Nebraska from having to pay for the state's Medicaid expansion. The prosecutors are calling the deal unconstitutional and threatened legal action. Members of the news media report that South Carolina Attorney General Henry McMaster and Oklahoma top prosecutor Drew Edmondson are asking attorneys general across the country to call on Sens. Pelosi and Reid to remove the provision.
In addition, a contingency of legal scholars as well as many Republican lawmakers are calling the measures passed by both the House and the Senate unconstitutional , primarily due to the inclusion of an individual mandate. "In the history of this country, the federal government has never required every American to enter into a contract with a private company," said Randy Barnett, a professor of constitutional law at Georgetown University Law Center.
Looking Ahead
Formal sessions in Congress are scheduled to begin January 19, 2010. Sen. Pelosi, however, plans to continue to work with key committee chairs and other Democratic leaders prior to the official sessions..
Thursday, December 24, 2009
Cobra Health Insurance Subsidy Continued EasyToInsureME
COBRA, state continuation subsidies extended
On December 19, 2009, President Barack Obama signed an extension of the COBRA subsidy program originally introduced under the American Recovery and Reinvestment Act of 2009 (ARRA).
ARRA provides for a federal subsidy of 65 percent of the COBRA continuation coverage premiums for qualified beneficiaries receiving COBRA continuation coverage due to involuntary termination of employment between September 1, 2008, and December 31, 2009. These individuals, referred to as "assistance-eligible individuals" or "AEIs," were entitled to receive the subsidy for up to nine months.
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Under the new COBRA subsidy extension provision:
* The end date of eligibility for the premium subsidy changes from December 31, 2009, to February 28, 2010.
* The ARRA premium subsidy period expands to 15 months, increased from current nine months.
* Those who have lost their subsidy by completing their nine months in November or later are grandfathered in under the new law and may receive six additional months of the subsidy.
* Employees who are involuntary terminated on or before February 28, 2010, are eligible for the subsidy, regardless of when their COBRA eligibility period begins. This addresses a congressional oversight in the original bill pertaining to December 31, 2009, qualifying events.
* Additional notices will be sent regarding the amendments to assistance-eligible individuals, as well as those who qualify for COBRA due to termination of employment.
* The provision also allows a period for the retroactive payment of premiums for assistance-eligible individuals whose subsidy period expired on November 16, 2009, and who failed to continue to pay their premiums.
* The same refund and credit rules under the original ARRA bill apply to any assistance-eligible individual whose subsidy expired in November and who has since paid the full COBRA premium.
Impact on state continuation coverage:
* The premium subsidy program also applies to group health plans subject to state continuation "mini-COBRA" requirements that are regulated by state departments of insurance.
* The subsidy period for state continuation will vary by state but cannot exceed 15 months regardless of state continuation rules.
On December 19, 2009, President Barack Obama signed an extension of the COBRA subsidy program originally introduced under the American Recovery and Reinvestment Act of 2009 (ARRA).
ARRA provides for a federal subsidy of 65 percent of the COBRA continuation coverage premiums for qualified beneficiaries receiving COBRA continuation coverage due to involuntary termination of employment between September 1, 2008, and December 31, 2009. These individuals, referred to as "assistance-eligible individuals" or "AEIs," were entitled to receive the subsidy for up to nine months.
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Under the new COBRA subsidy extension provision:
* The end date of eligibility for the premium subsidy changes from December 31, 2009, to February 28, 2010.
* The ARRA premium subsidy period expands to 15 months, increased from current nine months.
* Those who have lost their subsidy by completing their nine months in November or later are grandfathered in under the new law and may receive six additional months of the subsidy.
* Employees who are involuntary terminated on or before February 28, 2010, are eligible for the subsidy, regardless of when their COBRA eligibility period begins. This addresses a congressional oversight in the original bill pertaining to December 31, 2009, qualifying events.
* Additional notices will be sent regarding the amendments to assistance-eligible individuals, as well as those who qualify for COBRA due to termination of employment.
* The provision also allows a period for the retroactive payment of premiums for assistance-eligible individuals whose subsidy period expired on November 16, 2009, and who failed to continue to pay their premiums.
* The same refund and credit rules under the original ARRA bill apply to any assistance-eligible individual whose subsidy expired in November and who has since paid the full COBRA premium.
Impact on state continuation coverage:
* The premium subsidy program also applies to group health plans subject to state continuation "mini-COBRA" requirements that are regulated by state departments of insurance.
* The subsidy period for state continuation will vary by state but cannot exceed 15 months regardless of state continuation rules.
Tuesday, December 22, 2009
Health Insurance Quotes Reform Final Vote EasyToInsureME
In the past week, the Senate’s health care reform legislation has run the political gauntlet, with Republicans trying to filibuster other legislation to create a roadblock, liberal Democrats complaining loudly about the loss of some favorite provisions, and independent-minded Democrats forcing some significant changes. But the holiday break and the President’s stated goals have given Senate Democrats powerful motivation to get health care reform to a vote this week. Regardless of what happens in the Senate this week, the House has adjourned, which means that the health reform debate will certainly carry over into 2010. Conference committee deliberations between House and Senate leaders are expected to be difficult. (Read the rest of Health Insurance Quotes Reform Final Vote here)
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Thursday, December 17, 2009
Health Insurance Quotes Reform Weekly EasyToInsureME
Week of December 14, 2009
Health care reform provisions are changing fast as the Senate considers numerous amendments on the floor, and there is no better example of how fast than the much-reported government plan option. Senate leaders announced last week that a deal had been struck to remove the public plan from the bill in favor of a not-for-profit private insurance option and an expansion of Medicare to allow people 55 or older to buy in. The deal was quickly lauded by the White House and others, but concerns soon emerged about the new approach from various sectors of the health care system. A day or two later, the Associated Press reported that Senate Democrats were changing the "breakthrough" provisions in response to those concerns. The anticipated impact of the reform bill (especially its raft of proposed health care sector taxes and fees) on costs continues to be the focus of most critics, from labor unions to hospitals.
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Federal
The Senate last week barely moved forward on health care reform. Although the Senate focused on health care issues the entire week, there were no votes past Tuesday and the key amendment of the week (reimportation of cheaper drugs from Canada and overseas) is in limbo though the amendment clearly has majority support. Off the floor the action is more intense and meaningful. Earlier in the week Majority Leader Harry Reid announced a "deal" on the public plan. As it turned out the deal was among 10 Democrats only, and no details of any consequence were released. Reid himself was closed-mouthed claiming everyone had to wait until the CBO had a chance to "score" this newest iteration of health reform. The deal is in three parts: 1) use of the Federal Employee Health Benefit Plan model in which a federal agency would administer a national plan with private carriers in the mix; 2) triggering a true public plan if too few carriers participate in this national plan; and 3) allowing seniors 55 to 64 years old to buy in to Medicare. Even before the CBO score is back we already know that Senator Joseph Lieberman (D-CT) is opposed to the Medicare piece alone, if not the rest, and would filibuster the overall bill; Senator Ben Nelson (D-NE) is not far behind. And, if the score is bad and turns away additional moderate Democrats, Reid may have to go back to the drawing board for yet another twist to the never-ending saga of health care reform.
States
FLORIDA: A final draft of the voluntary compact regarding coverage for cancer clinical trials was circulated to interested parties late last week by legislative leadership. Aetna has been working with leadership, both directly and through the Florida Association of Health Plans, to assure the language follows current coverage guidelines. Aetna anticipates being a signatory to the compact.
MASSACHUSETTS: The Massachusetts Joint Health Care Financing Committee held a hearing on legislation requiring every full-and part-time college student in Massachusetts to have at least the basic level of health insurance required under the state's 2006 health reform law. If enacted, the new law would require students to carry the minimum credible coverage to be considered insured. Universities and colleges that fail to carry out their "responsibilities" to ensure student compliance would be fined a penalty of $1 per student for every day their "failure" continues. The bill also would require the Division of Insurance to issue regulations establishing procedures for implementation and monitoring of compliance. Massachusetts' existing individual mandate applies to students age 18 or older who pay in-state tuition rates for themselves at a Massachusetts community college, state college, or university.
MISSOURI: The pre-filing of bills for the second regular session of the Missouri 95th General Assembly began on December 1, and several new bills concern federal health care reform. Several pre-filed bills that failed to pass in the first regular session included an autism spectrum disorder mandate as well as a bill to amend the current prompt-pay statute. Both are expected to continue to be debated again in 2010. New to the Assembly are bills to pursue a constitutional amendment to prohibit compelling a patient, employer or health care provider to participate in any government- or privately run health system and to prohibit banning a person or employer from paying directly for legal health care services. Another new bill would pursue a constitutional amendment to penalize a political subdivision for participating in a health insurance option sponsored by the federal government. New also is a bill to provide premium refunds for consumers with cancelled long-term care and/or Medicare supplement policies and to make it an unfair trade practice to engage in certain practices when selling Medicare products. Aetna will continue to monitor the pre-filing of bills through the start of the next legislative session in January 2010.
NEW YORK: In a press release issued last week, Governor David Paterson is calling for the reinstatement of prior approval of insurance premium rates. The Governor introduced a bill during 2009 that would have given the Superintendent of Insurance sole authority to approve rates at his or her discretion, but that bill failed to pass. Given this latest press statement, it is expected that the Governor will ask the legislature to re-introduce his program bill for 2010. The Governor tied his support for the prior approval of rates to plans' dividend requests. The dividend requests were $800 million from Oxford (18.7 percent of 2008 New York premiums), $200 million from Empire (2.5 percent) and $134 million from Aetna (16 percent). The state's insurance lobby, the HPA, responded that the dividends reflect multiple years' earnings, and the plans' margins are in the 2 percent to 3 percent range.
OHIO: Resolutions continue to be introduced in Ohio with respect to implementation of anticipated federal health care reform. Specifically, a new resolution was recently introduced requesting all members of the General Assembly to support the public plan option as part of national health care reform. This resolution adds to other pending resolutions on health care reform, such as one supporting rights for people to enter into private contracts with health care providers for health care services and to purchase private health care coverage; and another to amend Ohio's Constitution to prohibit a law or rule from compelling a person, employer, or health care provider to participate in a health care system. They are not expected to pass, as the legislature continues to focus mainly on budgetary matters.
OKLAHOMA: While testifying at a hearing before the House Appropriations and Budget Subcommittee, the Oklahoma State Auditor and Inspector suggested eliminating all health insurance options except for “HealthChoice” to cut $100 million in state employee benefits costs. Currently state employees can enroll in one of eight health insurance plans offered by four HMOs through the Employees Benefits Council or one of the HealthChoice plans offered by the Oklahoma State and Education Employees Group Insurance Board. Employees receive an allowance to offset the costs of the plans. According to state law, the allowance is calculated based on the average cost of the high-option health insurance plans, plus the average of the dental plan costs, plus the cost of life insurance, plus the cost of disability insurance, plus 75 percent of the dependent health costs, if applicable. Steve Burrage said the current arrangement creates a situation of "adverse selection" where healthy, younger employees purchase the less expensive health insurance policies offered by the HMOs, and less healthy, older employees buy the more expensive HealthChoice policies. However, both employees receive the same benefit allowance. In his FY2009 executive budget, Governor Brad Henry proposed adjusting the benefit allowance formula by giving the HealthChoice high-option plan a 40 percent weight. The proposed adjustment did not make it into the final budget.
WISCONSIN: Proposed legislation is circulating in the Senate that would create explicit statutory authority for the Wisconsin Office of the Commissioner of Insurance (OCI) to oversee operation of self-funded plans serving public-sector employees, resolve consumer complaints, and monitor reserve and reinsurance levels. Additionally, the bill would apply state minimum coverage requirements, such as mammograms, chiropractic care, diabetes education and care, and require a governmental body that provides a self-funded health plan to provide reports and replies to requests for information to the OCI as they relate to the plan. This bill is aimed at self-funded plans offered by cities, towns, villages, counties and school districts.
Health care reform provisions are changing fast as the Senate considers numerous amendments on the floor, and there is no better example of how fast than the much-reported government plan option. Senate leaders announced last week that a deal had been struck to remove the public plan from the bill in favor of a not-for-profit private insurance option and an expansion of Medicare to allow people 55 or older to buy in. The deal was quickly lauded by the White House and others, but concerns soon emerged about the new approach from various sectors of the health care system. A day or two later, the Associated Press reported that Senate Democrats were changing the "breakthrough" provisions in response to those concerns. The anticipated impact of the reform bill (especially its raft of proposed health care sector taxes and fees) on costs continues to be the focus of most critics, from labor unions to hospitals.
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Federal
The Senate last week barely moved forward on health care reform. Although the Senate focused on health care issues the entire week, there were no votes past Tuesday and the key amendment of the week (reimportation of cheaper drugs from Canada and overseas) is in limbo though the amendment clearly has majority support. Off the floor the action is more intense and meaningful. Earlier in the week Majority Leader Harry Reid announced a "deal" on the public plan. As it turned out the deal was among 10 Democrats only, and no details of any consequence were released. Reid himself was closed-mouthed claiming everyone had to wait until the CBO had a chance to "score" this newest iteration of health reform. The deal is in three parts: 1) use of the Federal Employee Health Benefit Plan model in which a federal agency would administer a national plan with private carriers in the mix; 2) triggering a true public plan if too few carriers participate in this national plan; and 3) allowing seniors 55 to 64 years old to buy in to Medicare. Even before the CBO score is back we already know that Senator Joseph Lieberman (D-CT) is opposed to the Medicare piece alone, if not the rest, and would filibuster the overall bill; Senator Ben Nelson (D-NE) is not far behind. And, if the score is bad and turns away additional moderate Democrats, Reid may have to go back to the drawing board for yet another twist to the never-ending saga of health care reform.
States
FLORIDA: A final draft of the voluntary compact regarding coverage for cancer clinical trials was circulated to interested parties late last week by legislative leadership. Aetna has been working with leadership, both directly and through the Florida Association of Health Plans, to assure the language follows current coverage guidelines. Aetna anticipates being a signatory to the compact.
MASSACHUSETTS: The Massachusetts Joint Health Care Financing Committee held a hearing on legislation requiring every full-and part-time college student in Massachusetts to have at least the basic level of health insurance required under the state's 2006 health reform law. If enacted, the new law would require students to carry the minimum credible coverage to be considered insured. Universities and colleges that fail to carry out their "responsibilities" to ensure student compliance would be fined a penalty of $1 per student for every day their "failure" continues. The bill also would require the Division of Insurance to issue regulations establishing procedures for implementation and monitoring of compliance. Massachusetts' existing individual mandate applies to students age 18 or older who pay in-state tuition rates for themselves at a Massachusetts community college, state college, or university.
MISSOURI: The pre-filing of bills for the second regular session of the Missouri 95th General Assembly began on December 1, and several new bills concern federal health care reform. Several pre-filed bills that failed to pass in the first regular session included an autism spectrum disorder mandate as well as a bill to amend the current prompt-pay statute. Both are expected to continue to be debated again in 2010. New to the Assembly are bills to pursue a constitutional amendment to prohibit compelling a patient, employer or health care provider to participate in any government- or privately run health system and to prohibit banning a person or employer from paying directly for legal health care services. Another new bill would pursue a constitutional amendment to penalize a political subdivision for participating in a health insurance option sponsored by the federal government. New also is a bill to provide premium refunds for consumers with cancelled long-term care and/or Medicare supplement policies and to make it an unfair trade practice to engage in certain practices when selling Medicare products. Aetna will continue to monitor the pre-filing of bills through the start of the next legislative session in January 2010.
NEW YORK: In a press release issued last week, Governor David Paterson is calling for the reinstatement of prior approval of insurance premium rates. The Governor introduced a bill during 2009 that would have given the Superintendent of Insurance sole authority to approve rates at his or her discretion, but that bill failed to pass. Given this latest press statement, it is expected that the Governor will ask the legislature to re-introduce his program bill for 2010. The Governor tied his support for the prior approval of rates to plans' dividend requests. The dividend requests were $800 million from Oxford (18.7 percent of 2008 New York premiums), $200 million from Empire (2.5 percent) and $134 million from Aetna (16 percent). The state's insurance lobby, the HPA, responded that the dividends reflect multiple years' earnings, and the plans' margins are in the 2 percent to 3 percent range.
OHIO: Resolutions continue to be introduced in Ohio with respect to implementation of anticipated federal health care reform. Specifically, a new resolution was recently introduced requesting all members of the General Assembly to support the public plan option as part of national health care reform. This resolution adds to other pending resolutions on health care reform, such as one supporting rights for people to enter into private contracts with health care providers for health care services and to purchase private health care coverage; and another to amend Ohio's Constitution to prohibit a law or rule from compelling a person, employer, or health care provider to participate in a health care system. They are not expected to pass, as the legislature continues to focus mainly on budgetary matters.
OKLAHOMA: While testifying at a hearing before the House Appropriations and Budget Subcommittee, the Oklahoma State Auditor and Inspector suggested eliminating all health insurance options except for “HealthChoice” to cut $100 million in state employee benefits costs. Currently state employees can enroll in one of eight health insurance plans offered by four HMOs through the Employees Benefits Council or one of the HealthChoice plans offered by the Oklahoma State and Education Employees Group Insurance Board. Employees receive an allowance to offset the costs of the plans. According to state law, the allowance is calculated based on the average cost of the high-option health insurance plans, plus the average of the dental plan costs, plus the cost of life insurance, plus the cost of disability insurance, plus 75 percent of the dependent health costs, if applicable. Steve Burrage said the current arrangement creates a situation of "adverse selection" where healthy, younger employees purchase the less expensive health insurance policies offered by the HMOs, and less healthy, older employees buy the more expensive HealthChoice policies. However, both employees receive the same benefit allowance. In his FY2009 executive budget, Governor Brad Henry proposed adjusting the benefit allowance formula by giving the HealthChoice high-option plan a 40 percent weight. The proposed adjustment did not make it into the final budget.
WISCONSIN: Proposed legislation is circulating in the Senate that would create explicit statutory authority for the Wisconsin Office of the Commissioner of Insurance (OCI) to oversee operation of self-funded plans serving public-sector employees, resolve consumer complaints, and monitor reserve and reinsurance levels. Additionally, the bill would apply state minimum coverage requirements, such as mammograms, chiropractic care, diabetes education and care, and require a governmental body that provides a self-funded health plan to provide reports and replies to requests for information to the OCI as they relate to the plan. This bill is aimed at self-funded plans offered by cities, towns, villages, counties and school districts.
Week in Health Insurance Reform EasyToInsureME
December 16, 2009
This Week in Health Reform—Legislative Overview
Senate
The Senate this week continued debate on its health care reform legislation, H.R. 3590, “The Patient Protection and Affordable Care Act”. The two most controversial issues continue to be the public option and abortion, with both issues being discussed at length last week. On December 9, Senate Democrats blocked an amendment, 54-45, by Ben Nelson (D-NE) and Orrin Hatch (R-UT) that would tighten restrictions for funding of abortions. The amendment’s language mirrored what was in the House legislation that passed last month to the opposition of many Progressive Democrats. Majority Leader Reid (D-NV), voted down the amendment stating that the language in the existing Senate bill already adequately states that insurance plans (public or private) in the new exchange would be restricted from using taxpayer money for abortions.
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Democrats Ben Nelson (NE), Bob Casey (PA), Kent Conrad (ND) and Byron Dorgan (ND), Ted Kaufman (DE) and Mark Pryor (AR) all supported the amendment. An outspoken opponent on abortion, it is unclear whether or not Nelson will support a final bill without the amendment. If he does not, then Reid has the additional task of ensuring that at least one Republican Senator votes in favor of his bill to secure the 60 votes needed to block a filibuster.
In order to break the bottleneck in the Senate over the public option last week, a group of ten moderate and liberal Democrats negotiated a compromise agreement that they said would appease both moderate and liberal Democrats – and perhaps interest some moderate Republicans. The re-formatted public option would create a national insurance plan, run by nonprofit private insurance companies, and supervised by the Office of Personnel Management. The program is said to be modeled after the Federal Employee Health Benefits Program (FEHBP), which currently covers more than eight million federal employees, including members of Congress. To appease the liberal base of the Democratic Party, the compromise also reportedly created an expansion of Medicare to individuals between the ages of 55 to 64.
Senator Joe Lieberman (I-CT), an Independent who often caucuses with the Democrats, has been an outspoken opponent of the Medicare expansion provision and publicly stated that he would not vote for any bill that includes it. While Senators still remain quiet on the details of the legislation, stating that they are waiting to receive a cost analysis from the Congressional Budget Office (CBO) before discussing it publicly, it looks like the Medicare expansion provision has been removed from the pending legislation.
Reid is still aiming to have a vote on the Senate’s portion of the health care reform bill ahead of the Christmas holiday.
House
Last week Speaker Nancy Pelosi (D-CA) publicly stated that she would not discard the option of keeping House members in Washington for part of Christmas week – if it means that they make progress in passing health care reform legislation. Pelosi reiterated both her support for President Obama’s top domestic priority – health care reform – and her enthusiasm for seeing the Senate’s version of the bill.
Overview: NFIB Opposes Senate Health Care Reform Bill
On December 8, the National Federation of Independent Businesses (NFIB), an association that represents small and independent businesses, publicly stated its opposition to the Senate’s “Patient Protection and Affordable Care Act” (H.R. 3590).
See below for excerpts from the letter:
* The letter states that “the most recent Congressional Budget Office (CBO) study detailing the effect that H.R. 3590 will have on insurance premiums reinforces that, despite claims by its supporters, the bill will not deliver the widely-promised help to the small business community. Instead, CBO findings report that the bill will increase non-group premiums by 10 to 13 percent and result in, at best, a two percent decrease for small group coverage by 2016. These findings tell small business all it needs to know – that the current bill does not do enough to reduce costs for small business owners and their employees.”
* “Despite the inclusion of insurance market reforms in the small-group and individual marketplaces, the savings that may materialize are too small for too few and the increases in premium costs are too great for too many. Those costs, along with greater government involvement, higher taxes and new mandates that are disproportionately targeted at small business and are being used to finance H.R. 3590, create a reality that is worse than the status quo for small business.”
* “...the excessively tight age rating (3:1) in H.R. 3590 will increase more costs than it will decrease, and make coverage unaffordable for the very populations that are most beneficial to the insurance pool – the young and the healthy. Independent actuaries have analyzed the negative impact of such tight bands and have indicated that there will be devastating effects to the long-term viability of a pool without action to correct this rating imbalance.”
This Week in Health Reform—Legislative Overview
Senate
The Senate this week continued debate on its health care reform legislation, H.R. 3590, “The Patient Protection and Affordable Care Act”. The two most controversial issues continue to be the public option and abortion, with both issues being discussed at length last week. On December 9, Senate Democrats blocked an amendment, 54-45, by Ben Nelson (D-NE) and Orrin Hatch (R-UT) that would tighten restrictions for funding of abortions. The amendment’s language mirrored what was in the House legislation that passed last month to the opposition of many Progressive Democrats. Majority Leader Reid (D-NV), voted down the amendment stating that the language in the existing Senate bill already adequately states that insurance plans (public or private) in the new exchange would be restricted from using taxpayer money for abortions.
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Democrats Ben Nelson (NE), Bob Casey (PA), Kent Conrad (ND) and Byron Dorgan (ND), Ted Kaufman (DE) and Mark Pryor (AR) all supported the amendment. An outspoken opponent on abortion, it is unclear whether or not Nelson will support a final bill without the amendment. If he does not, then Reid has the additional task of ensuring that at least one Republican Senator votes in favor of his bill to secure the 60 votes needed to block a filibuster.
In order to break the bottleneck in the Senate over the public option last week, a group of ten moderate and liberal Democrats negotiated a compromise agreement that they said would appease both moderate and liberal Democrats – and perhaps interest some moderate Republicans. The re-formatted public option would create a national insurance plan, run by nonprofit private insurance companies, and supervised by the Office of Personnel Management. The program is said to be modeled after the Federal Employee Health Benefits Program (FEHBP), which currently covers more than eight million federal employees, including members of Congress. To appease the liberal base of the Democratic Party, the compromise also reportedly created an expansion of Medicare to individuals between the ages of 55 to 64.
Senator Joe Lieberman (I-CT), an Independent who often caucuses with the Democrats, has been an outspoken opponent of the Medicare expansion provision and publicly stated that he would not vote for any bill that includes it. While Senators still remain quiet on the details of the legislation, stating that they are waiting to receive a cost analysis from the Congressional Budget Office (CBO) before discussing it publicly, it looks like the Medicare expansion provision has been removed from the pending legislation.
Reid is still aiming to have a vote on the Senate’s portion of the health care reform bill ahead of the Christmas holiday.
House
Last week Speaker Nancy Pelosi (D-CA) publicly stated that she would not discard the option of keeping House members in Washington for part of Christmas week – if it means that they make progress in passing health care reform legislation. Pelosi reiterated both her support for President Obama’s top domestic priority – health care reform – and her enthusiasm for seeing the Senate’s version of the bill.
Overview: NFIB Opposes Senate Health Care Reform Bill
On December 8, the National Federation of Independent Businesses (NFIB), an association that represents small and independent businesses, publicly stated its opposition to the Senate’s “Patient Protection and Affordable Care Act” (H.R. 3590).
See below for excerpts from the letter:
* The letter states that “the most recent Congressional Budget Office (CBO) study detailing the effect that H.R. 3590 will have on insurance premiums reinforces that, despite claims by its supporters, the bill will not deliver the widely-promised help to the small business community. Instead, CBO findings report that the bill will increase non-group premiums by 10 to 13 percent and result in, at best, a two percent decrease for small group coverage by 2016. These findings tell small business all it needs to know – that the current bill does not do enough to reduce costs for small business owners and their employees.”
* “Despite the inclusion of insurance market reforms in the small-group and individual marketplaces, the savings that may materialize are too small for too few and the increases in premium costs are too great for too many. Those costs, along with greater government involvement, higher taxes and new mandates that are disproportionately targeted at small business and are being used to finance H.R. 3590, create a reality that is worse than the status quo for small business.”
* “...the excessively tight age rating (3:1) in H.R. 3590 will increase more costs than it will decrease, and make coverage unaffordable for the very populations that are most beneficial to the insurance pool – the young and the healthy. Independent actuaries have analyzed the negative impact of such tight bands and have indicated that there will be devastating effects to the long-term viability of a pool without action to correct this rating imbalance.”
Thursday, December 10, 2009
Health Insurance Quotes Reform EasyToInsureME
Week of December 7, 2009
The Senate began to slog its way through amendments (see below) last week in a process that promises to get harder, not easier. In the meantime, the debate continues as to whether the Senate bill would do anything significant to slow rising health care costs, and a Bloomberg story points out that a number of economists and analysts are doubtful that it will. The White House defends the bill's ability to slow costs, but some analysts predict that Congress will need to make many more tough decisions to have a real impact. According to Bloomberg, a group of Senators that includes Joe Lieberman (I-CT) and Susan Collins (R-ME) is taking aim at rising costs with an amendment that would include new requirements on providers to try to wring more costs out of the system. Anyone concerned about the rising cost of health care should be engaged in the process by reaching out to their Senators to urge a greater focus on bending the cost curve.
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Federal
The Senate debate on health care reform actually consists of three simultaneous debates. The first is public on C-SPAN, and it's going slowly as Republicans are pressing for 60 votes as often as they can while Democrats try to speed things up. Nothing of any great moment has been passed or decided. The second debate is the one Majority Leader Harry Reid is conducting behind closed doors as he tries to garner 60 Democratic votes for some acceptable form of a public option. Once this is accomplished, most observers believe Reid will immediately file cloture to cut off debate on the bill itself. If successful at getting 60 votes, he will go straight to final passage, which would require 51 votes. This could happen before Christmas. The third debate is the one Reid is having with House Speaker Nancy Pelosi over whether to have a conference at all. If the Senate can pass a bill the House can accept "as is," then there will be no need for a time-consuming conference that could unravel the bill. Thus, Reid is checking in with Pelosi frequently to see what he needs to be able to pass a bill and avoid a conference.
Since returning from its Thanksgiving break last week, the Senate has slowly been making its way through a number of amendments. Key votes so far include: approved an amendment that would require first-dollar coverage (no cost sharing) for certain preventive services; approved an amendment stating that nothing in the bill reduce guaranteed benefits under Medicare; defeated a motion that would have sent the bill back to the Finance Committee for the purpose of removing proposed cuts to Medicare; defeated an amendment that would have removed the CLASS Act provisions from the bill; defeated a motion that would have sent the bill back to the Finance Committee to eliminate the proposed Medicare Advantage funding cuts; approved an amendment requiring that nothing in the bill shall eliminate benefits “guaranteed by law” to Medicare Advantage enrollees (protects only benefits also covered by traditional Medicare and does not protect extra benefits and services provided by MA plans); and defeated an amendment that would have placed limits on how much attorneys can earn from medical malpractice lawsuits.
States
ALL STATES: The National Governors Association (NGA) has announced an initiative outlining preparations for federal health care reform. Titled "Rx for Health Reform - Affordable, Accessible, Accountable," the 2009-2010 initiative is led by Vermont Governor and NGA Chair James Douglas. It will focus on: providing governors with the information needed to transition to a new health care system; developing state-based system improvements and cost containment measures, including tools necessary to develop delivery system enhancements, looking at what is required under federal legislation, and highlighting other reforms the states could undertake to create a more efficient and effective health care system; and preparing states for implementing insurance market reforms, state-based exchanges, new mechanisms to support delivery system reform, and other national health reforms. The NGA's Health Care Task Force includes Governor Douglas and West Virginia Governor Joe Manchin, both serving as co-chairs, as well as Indiana Governor Mitch Daniels, Mississippi Governor Haley Barbour, New Hampshire Governor John Lynch, and Oregon Governor Ted Kulongoski.
CALIFORNIA: The California Medical Association (CMA), the second largest medical association after Texas, has announced its opposition to the “Patient Protection and Affordable Care Act,” the health care reform bill being debated in the Senate. The CMA also opposed Governor Arnold Schwarzenegger’s comprehensive health care reform proposal in 2007. In other news, Republican Governor Schwarzenegger has appointed State Senator Abel Maldonado to serve as Lieutenant Governor, but Democrats in the legislature have vowed not to confirm the Republican Senator because they view him as a viable state-wide candidate who could be elected easily to the position. Maldonado still must be confirmed by the legislature, which has 90 days to act.
COLORADO: The Colorado Medical Society (CMS) continues to seek support for a bill that would define the practice of medicine as including medical necessity determinations and utilization reviews performed by health plan medical directors. As currently drafted, the proposal would potentially expose medical directors to disciplinary action by the state Board of Medicine when medical necessity or utilization review decisions are challenged. Several discussions have been held with the executive director of CMS to ascertain the nature of the problem the association is trying to address, particularly since the organization as a whole may not be supporting the bill.
ILLINOIS: Illinois' fiscal situation is "grim and getting worse." Illinois has a reported $12 billion structural budget deficit. Comptroller Hynes said Illinois had nearly $4.6 billion in unpaid bills at the end of September, a record development for the first quarter of any fiscal year. This, despite the state having borrowed $2.25 billion in short-term loans, which must be repaid before the end of FY2010. Hynes identified two factors that have had a major impact on the deteriorating fiscal position: the steep decline in economy-driven revenues, such as personal and corporate income taxes and sales taxes, and record lapse-period spending. Hynes predicted fiscal pressures would continue well into FY2011 and warned of record and prolonged payment delays for most categories of state programs and operations, including health care and social services. There will be increasing pressure on health care programs as the economic stimulus funds expire and the amount of money demanded by utilization increases continue to be realized. There are already significant payment cycle delays on portions of the State employee health plan. The budget situation will dominate discussions in the General Assembly, which reconvenes in January.
KANSAS: At the request of Kansas Congresswoman Lynn Jenkins, the Kansas Health Policy Authority recently announced that it estimates the health reform bill passed by the U.S. House would provide health insurance for 240,000 Kansans without coverage and possibly save the state treasury up to $25 million a year. It estimated the U.S. Senate Finance Committee bill would insure an estimated 190,000 Kansans and reduce state costs by $25 million to $50 million a year. The Authority also concluded that the House bill would provide more federal matching dollars for Medicaid and likely would allow a reduced package of benefits for Medicaid beneficiaries added to the state rolls as a result of health reform. Current Kansas Medicaid eligibility is among the strictest in the nation, with benefits generally available only to the oldest and youngest of the state’s poor. Childless adults of working age are not eligible and parents are enrolled only if they earn less than about 27 percent of poverty guidelines. Exceptions are made for pregnant women.
MICHIGAN: State House Democrats announced a plan last week to cut auto insurance rates through tighter restrictions on auto insurance companies and the medical portion of those claims, affecting subrogation and coordination of benefits for Aetna and Cofinity®. Generally, the proposal requires auto insurance companies to offer low-cost auto insurance to low-income drivers with good driving records. The bill also would: allow the state insurance commissioner to deny rate changes by auto insurance companies before they take effect; prohibit auto insurance rate increases for those with good driving records; prohibit auto insurers from using certain types of rating factors; and limit fees paid to doctors and hospitals for treating auto accident injuries. Michigan is the only state that requires all auto insurance policies to give unlimited medical coverage for injuries suffered in auto accidents. The proposal would change that requirement and allow motorists to buy maximum medical coverage as low as $50,000. This means that rate-regulated provider groups would likely have group policies pay auto claims rather than wait for adjudication of the claim in court, as they would not want their fees limited. In addition, the allowance of low medical coverage on auto claims would affect Aetna's subrogation and coordination of benefit activities with both auto carriers and Aetna enrollees.
MISSOURI: The Department of Insurance recently released its 2008 HMO Annual Report showing that the entire managed care market is declining. The report shows that the number of people enrolled in either an HMO or a major medical health insurance plan decreased 15 percent since 2006. PPO plans are gaining the most enrollment, and POS plans remain more popular in certain areas than HMO plans. Total premiums for managed care coverage continue to rise with the industry reporting a 7.5 percent increase from 2004 to 2008. The medical cost ratio for all HMOs operating in Missouri, covering only Missouri business, was 82 percent in 2008, compared to the nationwide industry number of 83.6 percent.
NEW JERSEY: The legislature returned from its extended recess and took action on legislation to establish a medical home demonstration project for the Medicaid population. Upon federal approval, the state Medicaid program would set out a three-year demonstration project with an annual evaluation and reporting requirement by the Division of Medicaid Assistance Services to the Governor and legislature. On the Senate side, Aetna offered support for legislation requiring chain restaurants to provide nutritional information for food and beverages on their menus. Similar legislation is currently making its way through the Assembly and will likely receive a full vote in both chambers prior to the end of the session.
NEW YORK: The legislature passed another deficit reduction plan, trimming spending and using unspent funds to plug a $2.7 billion dollar budget deficit. A large percentage of the revenue used to fill the gap came from federal stimulus money that was originally designated for the 2010 budget and cuts to the Medicaid trend factor. After intense lobbying and coalition efforts, the legislature did not pass the Governor's proposed 0.25 percent increase to the patient services assessment or "sick tax". In addition, the Senate did not pass the Marriage Equality Act, effectively defeating the bill for the year. The legislature will return to face a multi-billion dollar deficit again in January, and it is likely that increases to health insurance taxes will be back on the table.
UTAH: The Department of Insurance remains committed to pursuing legislation to expand the Utah Health Exchange Network Portal to include a master patient index that providers could access to obtain coverage eligibility information. The bill contains a number of troubling provisions, including a monthly batch reporting requirement on health plans. The proposal also includes a July 1, 2010 effective date allowing no time to update and test affected internal systems.
The Senate began to slog its way through amendments (see below) last week in a process that promises to get harder, not easier. In the meantime, the debate continues as to whether the Senate bill would do anything significant to slow rising health care costs, and a Bloomberg story points out that a number of economists and analysts are doubtful that it will. The White House defends the bill's ability to slow costs, but some analysts predict that Congress will need to make many more tough decisions to have a real impact. According to Bloomberg, a group of Senators that includes Joe Lieberman (I-CT) and Susan Collins (R-ME) is taking aim at rising costs with an amendment that would include new requirements on providers to try to wring more costs out of the system. Anyone concerned about the rising cost of health care should be engaged in the process by reaching out to their Senators to urge a greater focus on bending the cost curve.
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Federal
The Senate debate on health care reform actually consists of three simultaneous debates. The first is public on C-SPAN, and it's going slowly as Republicans are pressing for 60 votes as often as they can while Democrats try to speed things up. Nothing of any great moment has been passed or decided. The second debate is the one Majority Leader Harry Reid is conducting behind closed doors as he tries to garner 60 Democratic votes for some acceptable form of a public option. Once this is accomplished, most observers believe Reid will immediately file cloture to cut off debate on the bill itself. If successful at getting 60 votes, he will go straight to final passage, which would require 51 votes. This could happen before Christmas. The third debate is the one Reid is having with House Speaker Nancy Pelosi over whether to have a conference at all. If the Senate can pass a bill the House can accept "as is," then there will be no need for a time-consuming conference that could unravel the bill. Thus, Reid is checking in with Pelosi frequently to see what he needs to be able to pass a bill and avoid a conference.
Since returning from its Thanksgiving break last week, the Senate has slowly been making its way through a number of amendments. Key votes so far include: approved an amendment that would require first-dollar coverage (no cost sharing) for certain preventive services; approved an amendment stating that nothing in the bill reduce guaranteed benefits under Medicare; defeated a motion that would have sent the bill back to the Finance Committee for the purpose of removing proposed cuts to Medicare; defeated an amendment that would have removed the CLASS Act provisions from the bill; defeated a motion that would have sent the bill back to the Finance Committee to eliminate the proposed Medicare Advantage funding cuts; approved an amendment requiring that nothing in the bill shall eliminate benefits “guaranteed by law” to Medicare Advantage enrollees (protects only benefits also covered by traditional Medicare and does not protect extra benefits and services provided by MA plans); and defeated an amendment that would have placed limits on how much attorneys can earn from medical malpractice lawsuits.
States
ALL STATES: The National Governors Association (NGA) has announced an initiative outlining preparations for federal health care reform. Titled "Rx for Health Reform - Affordable, Accessible, Accountable," the 2009-2010 initiative is led by Vermont Governor and NGA Chair James Douglas. It will focus on: providing governors with the information needed to transition to a new health care system; developing state-based system improvements and cost containment measures, including tools necessary to develop delivery system enhancements, looking at what is required under federal legislation, and highlighting other reforms the states could undertake to create a more efficient and effective health care system; and preparing states for implementing insurance market reforms, state-based exchanges, new mechanisms to support delivery system reform, and other national health reforms. The NGA's Health Care Task Force includes Governor Douglas and West Virginia Governor Joe Manchin, both serving as co-chairs, as well as Indiana Governor Mitch Daniels, Mississippi Governor Haley Barbour, New Hampshire Governor John Lynch, and Oregon Governor Ted Kulongoski.
CALIFORNIA: The California Medical Association (CMA), the second largest medical association after Texas, has announced its opposition to the “Patient Protection and Affordable Care Act,” the health care reform bill being debated in the Senate. The CMA also opposed Governor Arnold Schwarzenegger’s comprehensive health care reform proposal in 2007. In other news, Republican Governor Schwarzenegger has appointed State Senator Abel Maldonado to serve as Lieutenant Governor, but Democrats in the legislature have vowed not to confirm the Republican Senator because they view him as a viable state-wide candidate who could be elected easily to the position. Maldonado still must be confirmed by the legislature, which has 90 days to act.
COLORADO: The Colorado Medical Society (CMS) continues to seek support for a bill that would define the practice of medicine as including medical necessity determinations and utilization reviews performed by health plan medical directors. As currently drafted, the proposal would potentially expose medical directors to disciplinary action by the state Board of Medicine when medical necessity or utilization review decisions are challenged. Several discussions have been held with the executive director of CMS to ascertain the nature of the problem the association is trying to address, particularly since the organization as a whole may not be supporting the bill.
ILLINOIS: Illinois' fiscal situation is "grim and getting worse." Illinois has a reported $12 billion structural budget deficit. Comptroller Hynes said Illinois had nearly $4.6 billion in unpaid bills at the end of September, a record development for the first quarter of any fiscal year. This, despite the state having borrowed $2.25 billion in short-term loans, which must be repaid before the end of FY2010. Hynes identified two factors that have had a major impact on the deteriorating fiscal position: the steep decline in economy-driven revenues, such as personal and corporate income taxes and sales taxes, and record lapse-period spending. Hynes predicted fiscal pressures would continue well into FY2011 and warned of record and prolonged payment delays for most categories of state programs and operations, including health care and social services. There will be increasing pressure on health care programs as the economic stimulus funds expire and the amount of money demanded by utilization increases continue to be realized. There are already significant payment cycle delays on portions of the State employee health plan. The budget situation will dominate discussions in the General Assembly, which reconvenes in January.
KANSAS: At the request of Kansas Congresswoman Lynn Jenkins, the Kansas Health Policy Authority recently announced that it estimates the health reform bill passed by the U.S. House would provide health insurance for 240,000 Kansans without coverage and possibly save the state treasury up to $25 million a year. It estimated the U.S. Senate Finance Committee bill would insure an estimated 190,000 Kansans and reduce state costs by $25 million to $50 million a year. The Authority also concluded that the House bill would provide more federal matching dollars for Medicaid and likely would allow a reduced package of benefits for Medicaid beneficiaries added to the state rolls as a result of health reform. Current Kansas Medicaid eligibility is among the strictest in the nation, with benefits generally available only to the oldest and youngest of the state’s poor. Childless adults of working age are not eligible and parents are enrolled only if they earn less than about 27 percent of poverty guidelines. Exceptions are made for pregnant women.
MICHIGAN: State House Democrats announced a plan last week to cut auto insurance rates through tighter restrictions on auto insurance companies and the medical portion of those claims, affecting subrogation and coordination of benefits for Aetna and Cofinity®. Generally, the proposal requires auto insurance companies to offer low-cost auto insurance to low-income drivers with good driving records. The bill also would: allow the state insurance commissioner to deny rate changes by auto insurance companies before they take effect; prohibit auto insurance rate increases for those with good driving records; prohibit auto insurers from using certain types of rating factors; and limit fees paid to doctors and hospitals for treating auto accident injuries. Michigan is the only state that requires all auto insurance policies to give unlimited medical coverage for injuries suffered in auto accidents. The proposal would change that requirement and allow motorists to buy maximum medical coverage as low as $50,000. This means that rate-regulated provider groups would likely have group policies pay auto claims rather than wait for adjudication of the claim in court, as they would not want their fees limited. In addition, the allowance of low medical coverage on auto claims would affect Aetna's subrogation and coordination of benefit activities with both auto carriers and Aetna enrollees.
MISSOURI: The Department of Insurance recently released its 2008 HMO Annual Report showing that the entire managed care market is declining. The report shows that the number of people enrolled in either an HMO or a major medical health insurance plan decreased 15 percent since 2006. PPO plans are gaining the most enrollment, and POS plans remain more popular in certain areas than HMO plans. Total premiums for managed care coverage continue to rise with the industry reporting a 7.5 percent increase from 2004 to 2008. The medical cost ratio for all HMOs operating in Missouri, covering only Missouri business, was 82 percent in 2008, compared to the nationwide industry number of 83.6 percent.
NEW JERSEY: The legislature returned from its extended recess and took action on legislation to establish a medical home demonstration project for the Medicaid population. Upon federal approval, the state Medicaid program would set out a three-year demonstration project with an annual evaluation and reporting requirement by the Division of Medicaid Assistance Services to the Governor and legislature. On the Senate side, Aetna offered support for legislation requiring chain restaurants to provide nutritional information for food and beverages on their menus. Similar legislation is currently making its way through the Assembly and will likely receive a full vote in both chambers prior to the end of the session.
NEW YORK: The legislature passed another deficit reduction plan, trimming spending and using unspent funds to plug a $2.7 billion dollar budget deficit. A large percentage of the revenue used to fill the gap came from federal stimulus money that was originally designated for the 2010 budget and cuts to the Medicaid trend factor. After intense lobbying and coalition efforts, the legislature did not pass the Governor's proposed 0.25 percent increase to the patient services assessment or "sick tax". In addition, the Senate did not pass the Marriage Equality Act, effectively defeating the bill for the year. The legislature will return to face a multi-billion dollar deficit again in January, and it is likely that increases to health insurance taxes will be back on the table.
UTAH: The Department of Insurance remains committed to pursuing legislation to expand the Utah Health Exchange Network Portal to include a master patient index that providers could access to obtain coverage eligibility information. The bill contains a number of troubling provisions, including a monthly batch reporting requirement on health plans. The proposal also includes a July 1, 2010 effective date allowing no time to update and test affected internal systems.
This Week in Health Reform EasyToInsureME
December 9, 2009
This Week in Health Reform —Legislative Overview
Senate
Less than two weeks after the debut of official legislative language, the Senate began official debate on its $848 billion health care reform bill “The Patient Protection and Affordable Care Act” (H.R. 3590) on November 30. The bill, which is estimated to cover 94 percent of Americans, passed its first hurdle before the Thanksgiving holiday when Senate Democrats received the needed 60 votes on the “motion to proceed” to debate.
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More than 60 amendments have been filed to the Senate health care reform legislation in its first week of debate. Some of the notable amendments include one by Senator Barbara Mikulski (D-MD), which was adopted by a vote of 61-39. The amendment would eliminate co-payments for many preventive services for women – and would require that insurers provide full coverage for breast and cervical cancer screenings. Senator David Vitter (R-LA) also included a stipulation to the amendment that would preclude the most recent controversial recommendations on breast cancer screenings by the U.S. Preventive Services Task Force from being used for insurance coverage determinations. Additionally, Senator Ben Nelson (D-NE) and Senator Orrin Hatch (R-UT) are crafting an abortion-related amendment that will mirror the one passed in the House version of the bill last month. The amendment would prohibit the use of federal funds for abortions.
Senator Thomas Carper (D-DE) is leading efforts in the Democratic caucus on the creation of a public health insurance option that is built around a state-by-state “trigger” option. Carper has spent weeks working with members of the Democratic caucus, as well as some moderate Republicans on the amendment that he is hoping will appease a broad range of individuals concerned about the government-run health insurance plan, also known as the “public option”.
Majority Leader Harry Reid (D-NV) still has significant work to do in uniting his divided Democratic caucus. Reid has stated that he will keep Senators in Washington on weekends throughout December to ensure that key legislative issues are worked out before a final bill can be brought to the Senate floor. As detailed above, Reid will have to balance trying to appease the progressive members of his party with a robust government-run health insurance plan with corralling the moderate and conservative Democrats who have been vocal on issues such as abortion and cost-containment measures.
House
The House of Representatives remains quiet on health care reform legislation after passing its portion of the bill in November. Its main focus during the next few weeks before the holiday recess will be on a financial regulation package to be brought up by the House Committee on Ways and Means.
This Week in Health Reform —Legislative Overview
Senate
Less than two weeks after the debut of official legislative language, the Senate began official debate on its $848 billion health care reform bill “The Patient Protection and Affordable Care Act” (H.R. 3590) on November 30. The bill, which is estimated to cover 94 percent of Americans, passed its first hurdle before the Thanksgiving holiday when Senate Democrats received the needed 60 votes on the “motion to proceed” to debate.
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More than 60 amendments have been filed to the Senate health care reform legislation in its first week of debate. Some of the notable amendments include one by Senator Barbara Mikulski (D-MD), which was adopted by a vote of 61-39. The amendment would eliminate co-payments for many preventive services for women – and would require that insurers provide full coverage for breast and cervical cancer screenings. Senator David Vitter (R-LA) also included a stipulation to the amendment that would preclude the most recent controversial recommendations on breast cancer screenings by the U.S. Preventive Services Task Force from being used for insurance coverage determinations. Additionally, Senator Ben Nelson (D-NE) and Senator Orrin Hatch (R-UT) are crafting an abortion-related amendment that will mirror the one passed in the House version of the bill last month. The amendment would prohibit the use of federal funds for abortions.
Senator Thomas Carper (D-DE) is leading efforts in the Democratic caucus on the creation of a public health insurance option that is built around a state-by-state “trigger” option. Carper has spent weeks working with members of the Democratic caucus, as well as some moderate Republicans on the amendment that he is hoping will appease a broad range of individuals concerned about the government-run health insurance plan, also known as the “public option”.
Majority Leader Harry Reid (D-NV) still has significant work to do in uniting his divided Democratic caucus. Reid has stated that he will keep Senators in Washington on weekends throughout December to ensure that key legislative issues are worked out before a final bill can be brought to the Senate floor. As detailed above, Reid will have to balance trying to appease the progressive members of his party with a robust government-run health insurance plan with corralling the moderate and conservative Democrats who have been vocal on issues such as abortion and cost-containment measures.
House
The House of Representatives remains quiet on health care reform legislation after passing its portion of the bill in November. Its main focus during the next few weeks before the holiday recess will be on a financial regulation package to be brought up by the House Committee on Ways and Means.
Friday, December 4, 2009
Health Insurance Quotes Reform EasyToInsureME
DECEMBER 4, 2009
This Week in Health Care Reform
On November 21st Senate lawmakers voted along party lines to move ahead with a floor debate over Senate Majority Leader Harry Reid's (D-NV) proposed health care reform legislation. Negotiations began in the Senate this week following the Thanksgiving recess.
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WellPoint believes the Senate legislation will have a significant, negative impact on the cost and nature of coverage for our customers. We believe it will cause more problems and have outlined several reasons why employers, employees, and consumers should be concerned about this legislation.
If these points concern you as well, we encourage you to engage your Senators thru visiting the Health Action Network.
House and Senate Negotiations
Senate Debates Health Care Reform Bill: As the debate began Monday, discussions highlighted many contentious issues including cost-containment, the public option, illegal immigrants, Medicare cuts and abortion funding. In the coming weeks each side will be offering dozens of amendments that will be debated and voted on. On Wednesday, lawmakers agreed to vote on amendments addressing two of this week's main issues , centering on women and seniors:
* One proposed amendment, co-sponsored by Sens. Barbara Mikulski (D-MD) and Olympia Snowe (R-ME), would increase insurance benefits for women, mandating that policies include an annual health screening. While the amendment does not specifically lay out what preventive services will be covered, the measure gives the Health and Human Services Secretary authority to make these determinations. Debate on the amendment in part focused on the controversial recommendations last month that women undergo fewer mammograms and Pap smears to test for cervical cancer. The Congressional Budget Office said the amendment would cost $940 million over a decade. This amendment passed by a vote of 61-39.
* Another proposed amendment was filed by Sen. John McCain (R-AZ) and would remove from the bill $400 million in Medicare cuts to home health providers, hospitals and private providers of Medicare Advantage plans. This motion failed by a vote of 58 to 42.
AARP Backs Medicare Cuts: As Senate lawmakers prepare to vote on controversial Medicare funding amendments to the reform legislation, AARP said in a letter on Wednesday that the organization supports Medicare cuts.
Medical Groups Oppose Senate Bill: A coalition of the American College of Surgeons and 18 other medical societies representing surgeon specialists indicated Wednesday that they could not support the proposed Senate bill given that it inadequately addresses Medicare's doctor payment system. In addition, the California Medical Association joined a number of other state medical associations , including Florida, Georgia and Texas, in opposition to the bill being discussed in the Senate. The California Medical Association cites increases in costs of services and restrictions in access to care for elderly and low-income people as reason for the opposition.
CBO: Premiums Could Rise for Individuals: According to a new analysis from the Congressional Budget Office (CBO) released Monday, the Senate's health care reform bill may increase premiums for individuals purchasing insurance, unless they qualify for government subsidies. The report also indicates that employees from large companies would see premiums decrease, while those from small firms would see premiums remain largely unchanged. On Tuesday, The Wall Street Journal editorial page made the case that, according to the CBO, employer-sponsored insurance costs would remain roughly in line with the status quo; a result tantamount to failure, considering the overall cost-cutting goals of reform.
Abortion Continues to Take Center Stage: Abortion-rights groups held a lobby day on Wednesday as part of a national "week of action" to fight language in the House health care bill, which would impose greater restrictions on access to the controversial procedure. The Senate's reform bill currently does not include the same level of restrictions. However, the language from the House bill is expected to come up during the debate.
Other Activities
Pfizer CEO Backs Reform: Pfizer, Inc . CEO, Jeffery Kindler, said Tuesday that he supports Congress' efforts to reform the health care system. However, he is specifically opposed to anything that could lead to price controls - such as giving the government the ability to directly negotiate with drug makers for products under the Medicare Part D drug benefit program. Mr. Kindler also stated that the $80 billion that the pharmaceutical industry has agreed to contribute to help pay for the health care system overhaul exceeds any benefit that the industry would receive from additional patients due to extended coverage.
Public Opinion
Americans Lean Against Health Care Reform: The latest USA Today/Gallup Poll released Monday shows that Americans currently skew against passing health care reform legislation. Forty-nine percent of Americans say they would advise their member of Congress to vote against the bill, while 44 percent say they would support it. A Robert Wood Johnson Foundation poll conducted just before Thanksgiving indicates that most Americans do not expect health care reform to affect their lives directly. However, for those who do expect a change, a larger number believe that there will be more negative affects than positive ones. Interestingly, however, another poll released Monday by the Robert Wood Johnson Foundation Center for Health Policy (UNM-RWJF Center), Latino Decisions and impreMedia shows widespread consensus among the Latino/Hispanic electorate about the importance of health care reform, indicating significant support for expansion of coverage.
Americans Support Malpractice Reform: An Associated Press poll released just before Thanksgiving shows that 54 percent of Americans favor making it harder to sue doctors and hospitals for medical errors, while 32 percent are opposed to the idea.
Looking Ahead
Negotiations on proposed amendments to Sen. Reid's reform bill will continue in the coming weeks. Sen. Reid hopes to have a health care reform bill passed by Christmas but has warned Senators to plan on working weekends to get this done.
This Week in Health Care Reform
On November 21st Senate lawmakers voted along party lines to move ahead with a floor debate over Senate Majority Leader Harry Reid's (D-NV) proposed health care reform legislation. Negotiations began in the Senate this week following the Thanksgiving recess.
Quoting & Saving just got easier...EasyToInsureME Health Insurance Quotes... Quote all carriers in seconds
Health insurance
Health insurance quotes
WellPoint believes the Senate legislation will have a significant, negative impact on the cost and nature of coverage for our customers. We believe it will cause more problems and have outlined several reasons why employers, employees, and consumers should be concerned about this legislation.
If these points concern you as well, we encourage you to engage your Senators thru visiting the Health Action Network.
House and Senate Negotiations
Senate Debates Health Care Reform Bill: As the debate began Monday, discussions highlighted many contentious issues including cost-containment, the public option, illegal immigrants, Medicare cuts and abortion funding. In the coming weeks each side will be offering dozens of amendments that will be debated and voted on. On Wednesday, lawmakers agreed to vote on amendments addressing two of this week's main issues , centering on women and seniors:
* One proposed amendment, co-sponsored by Sens. Barbara Mikulski (D-MD) and Olympia Snowe (R-ME), would increase insurance benefits for women, mandating that policies include an annual health screening. While the amendment does not specifically lay out what preventive services will be covered, the measure gives the Health and Human Services Secretary authority to make these determinations. Debate on the amendment in part focused on the controversial recommendations last month that women undergo fewer mammograms and Pap smears to test for cervical cancer. The Congressional Budget Office said the amendment would cost $940 million over a decade. This amendment passed by a vote of 61-39.
* Another proposed amendment was filed by Sen. John McCain (R-AZ) and would remove from the bill $400 million in Medicare cuts to home health providers, hospitals and private providers of Medicare Advantage plans. This motion failed by a vote of 58 to 42.
AARP Backs Medicare Cuts: As Senate lawmakers prepare to vote on controversial Medicare funding amendments to the reform legislation, AARP said in a letter on Wednesday that the organization supports Medicare cuts.
Medical Groups Oppose Senate Bill: A coalition of the American College of Surgeons and 18 other medical societies representing surgeon specialists indicated Wednesday that they could not support the proposed Senate bill given that it inadequately addresses Medicare's doctor payment system. In addition, the California Medical Association joined a number of other state medical associations , including Florida, Georgia and Texas, in opposition to the bill being discussed in the Senate. The California Medical Association cites increases in costs of services and restrictions in access to care for elderly and low-income people as reason for the opposition.
CBO: Premiums Could Rise for Individuals: According to a new analysis from the Congressional Budget Office (CBO) released Monday, the Senate's health care reform bill may increase premiums for individuals purchasing insurance, unless they qualify for government subsidies. The report also indicates that employees from large companies would see premiums decrease, while those from small firms would see premiums remain largely unchanged. On Tuesday, The Wall Street Journal editorial page made the case that, according to the CBO, employer-sponsored insurance costs would remain roughly in line with the status quo; a result tantamount to failure, considering the overall cost-cutting goals of reform.
Abortion Continues to Take Center Stage: Abortion-rights groups held a lobby day on Wednesday as part of a national "week of action" to fight language in the House health care bill, which would impose greater restrictions on access to the controversial procedure. The Senate's reform bill currently does not include the same level of restrictions. However, the language from the House bill is expected to come up during the debate.
Other Activities
Pfizer CEO Backs Reform: Pfizer, Inc . CEO, Jeffery Kindler, said Tuesday that he supports Congress' efforts to reform the health care system. However, he is specifically opposed to anything that could lead to price controls - such as giving the government the ability to directly negotiate with drug makers for products under the Medicare Part D drug benefit program. Mr. Kindler also stated that the $80 billion that the pharmaceutical industry has agreed to contribute to help pay for the health care system overhaul exceeds any benefit that the industry would receive from additional patients due to extended coverage.
Public Opinion
Americans Lean Against Health Care Reform: The latest USA Today/Gallup Poll released Monday shows that Americans currently skew against passing health care reform legislation. Forty-nine percent of Americans say they would advise their member of Congress to vote against the bill, while 44 percent say they would support it. A Robert Wood Johnson Foundation poll conducted just before Thanksgiving indicates that most Americans do not expect health care reform to affect their lives directly. However, for those who do expect a change, a larger number believe that there will be more negative affects than positive ones. Interestingly, however, another poll released Monday by the Robert Wood Johnson Foundation Center for Health Policy (UNM-RWJF Center), Latino Decisions and impreMedia shows widespread consensus among the Latino/Hispanic electorate about the importance of health care reform, indicating significant support for expansion of coverage.
Americans Support Malpractice Reform: An Associated Press poll released just before Thanksgiving shows that 54 percent of Americans favor making it harder to sue doctors and hospitals for medical errors, while 32 percent are opposed to the idea.
Looking Ahead
Negotiations on proposed amendments to Sen. Reid's reform bill will continue in the coming weeks. Sen. Reid hopes to have a health care reform bill passed by Christmas but has warned Senators to plan on working weekends to get this done.
Monday, November 23, 2009
This Week in Health Reform—Federal Legislative Overview
Senate
Former President Bill Clinton visited Senate Democrats on Capitol Hill this week, urging them to quickly pass health care reform by the end of the year. Senate Leadership continues to work pulling its final merged bill together and Majority Leader Harry Reid (D-NV) says that he will introduce the legislation on the Senate floor the week of November 16th.
Under Senate rules, a 60-vote majority is required to move the bill forward before official debate can begin. It is likely that Democrats will receive the 60-votes needed to move the bill to the Senate floor, but it remains to be seen whether Reid has the full 60 votes to overcome a filibuster for bill’s official passage. Reid is still aiming to pass the legislation by the Christmas holiday.
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House
After passing its health care reform legislation, the “Affordable Health Care for America Act” (H.R. 3962), the House of Representatives was quiet this week.
Overview: Medicare Payroll in Senate Health Care Reform Legislation
The Senate’s health care reform legislation has still not yet been unveiled, but there are reports that an analysis from the Congressional Budget Office has found the bill to be more costly than expected, so Senate Democrats are already considering new ways to pay for the bill.
One of the options is an increase to the Medicare portion of the payroll tax on individuals making $250,000 per year or more. Currently, workers and employers each pay a 1.45 percent payroll tax for Medicare and the new proposal would increase that to 2.5 percent payroll tax bracket for those making $250,000 per year or more.
By including this new approach, it would allow the Senate to either reduce or eliminate altogether the controversial excise tax on “Cadillac” or high-cost insurance plans, passed in the Senate Finance Committee’s bill last month. Under legislation (S 1796) approved by the Senate Finance Committee, individual insurance plans costing more than $8,000 and family plans costing more than $21,000 would face a 40 percent excise tax on any amount above that level.
Former President Bill Clinton visited Senate Democrats on Capitol Hill this week, urging them to quickly pass health care reform by the end of the year. Senate Leadership continues to work pulling its final merged bill together and Majority Leader Harry Reid (D-NV) says that he will introduce the legislation on the Senate floor the week of November 16th.
Under Senate rules, a 60-vote majority is required to move the bill forward before official debate can begin. It is likely that Democrats will receive the 60-votes needed to move the bill to the Senate floor, but it remains to be seen whether Reid has the full 60 votes to overcome a filibuster for bill’s official passage. Reid is still aiming to pass the legislation by the Christmas holiday.
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House
After passing its health care reform legislation, the “Affordable Health Care for America Act” (H.R. 3962), the House of Representatives was quiet this week.
Overview: Medicare Payroll in Senate Health Care Reform Legislation
The Senate’s health care reform legislation has still not yet been unveiled, but there are reports that an analysis from the Congressional Budget Office has found the bill to be more costly than expected, so Senate Democrats are already considering new ways to pay for the bill.
One of the options is an increase to the Medicare portion of the payroll tax on individuals making $250,000 per year or more. Currently, workers and employers each pay a 1.45 percent payroll tax for Medicare and the new proposal would increase that to 2.5 percent payroll tax bracket for those making $250,000 per year or more.
By including this new approach, it would allow the Senate to either reduce or eliminate altogether the controversial excise tax on “Cadillac” or high-cost insurance plans, passed in the Senate Finance Committee’s bill last month. Under legislation (S 1796) approved by the Senate Finance Committee, individual insurance plans costing more than $8,000 and family plans costing more than $21,000 would face a 40 percent excise tax on any amount above that level.
EasyToInsureME This Week in Health Reform: November 20, 2009
This week focused on the unveiling of Senate Majority Leader Harry Reid's (D-NV) proposed health care reform legislation.
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House and Senate Negotiations
Reid Unveils Senate Bill: Senate Majority Leader Harry Reid unveiled his version of health care reform legislation on Wednesday night after receiving cost estimates from the Congressional Budget Office (CBO). With a price tag of $849 billion over ten years, the bill will reduce the deficit by $127 billion over a decade and cut Medicare spending by $500 billion, while increasing taxes by $500 billion. In addition, the bill will:
* Provide coverage for 31 million Americans who currently lack health insurance - accounting for 94 percent of eligible Americans
* Offer a government-run option of which states can opt out
* Expand Medicaid
* Require most Americans to carry health insurance, providing subsidies for those who cannot afford it and imposing weak penalties for violations
* Bar insurance companies from denying coverage based on pre-existing conditions or dropping coverage for those who become sick
* Impose penalties on medium and large sized employers for not providing health insurance to employees
* Increase the Medicare payroll tax on higher-income workers
* Imposes fees totaling $101.9 billion on insurance companies, drug makers, and medical device manufacturers over ten years
* Impose a tax on high-cost health insurance plans provided by employers to their employees.
While Democrats remain committed to passing the legislation, it is not certain that Reid has the 60 votes needed to bring the measure to the floor for debate. Several moderate democrats, including Sens. Mary L. Landrieu of Louisiana, Blanche Lincoln of Arkansas and Ben Nelson of Nebraska have expressed concerns over the inclusion of a government-run plan. Sen. Sherrod Brown (D-OH), however, expressed in a meeting Monday night with Reid that liberal lawmakers had conceded enough ground on the government-run plan and that he should push forward with the bill.
Members of the Senate will convene on Saturday for a rare weekend session to hold a procedural vote, deciding whether or not to bring the legislation to the Senate floor for debate.
Immigration and Abortion Remain Central to the Debate: Access to care for illegal immigrants will continue to be contentious as lawmakers work to reconcile the health care legislation passed by the House and pending in the Senate. Under the bill approved by the House, illegal immigrants would not be barred from using their own money in the newly-created insurance exchanges. White House officials and members of the Senate Finance Committee, however, pledged that undocumented workers be barred not only from receiving subsidies but also from buying insurance through federally sponsored exchanges - even with their own money.
As Senate Majority Leader Harry Reid works to finalize the legislation, he will also need to address the question of federal funding for abortions, an issue that has proved starkly divisive. Because of pressure from the Catholic Church and anti-abortion groups, the House-approved bill restricts the use of taxpayer funds for abortions, a decision that has sparked a heated debate among pro-choice and pro-life advocacy organizations. In contrast, the Senate's proposed bill would allow the use of federal funds for abortion in cases of rape and incest, requiring insurers that cover elective abortions to segregate money from Americans who get government subsidies.
Public Opinion
Polls Continue to Show Deep Divisions: A new Washington Post-ABC News poll shows that Americans are deeply divided over the current health care proposals and that the majority believes costs will rise. Forty-eight percent say they support the proposed changes to overhaul the health care system, whereas 49 percent are opposed. In addition, 52 percent say an altered system would probably make their own care more expensive, and 56 percent see the overall cost of health care in the country going up as a result of the reform.
Furthermore, a recent Associated Press (AP) poll shows that Americans are split (43 percent opposed; 41 percent support) over the health care plans being discussed in Congress. The AP poll also suggests that the public is becoming more attuned to the details of the proposals, including the cost implications and the public option. And, according to a Quinnipiac University poll released Thursday, 53 percent of voters disapprove of President Barack Obama's handling of health care reform.
However, a new CBS News poll shows that only one in four Americans prefer to have no health care legislation at all, while 51 percent support a bill with a public option.
Other Activities
CMS Report Indicates Costs Would Rise Under House Bill: According to a report issued by Richard Foster, the chief actuary at the Centers for Medicare and Medicaid (CMS), overall spending on health care would rise as a result of the legislation approved by the House. Specifically, the measure to reduce more than $500 billion from future Medicare spending would sharply reduce benefits for some seniors and may jeopardize access to care for millions of others.
Drug Makers Increase Price, Anticipating Health Reform: The media has reported that the drug industry has been raising prices at its fastest rate in years, in anticipation of the costs associated with health care reform. These costs include the $80 billion in fees over the next decade that the industry agreed to in order to help pay for coverage of the uninsured.On Wednesday, Democrats in Congress asked for two separate investigations of drug industry pricing.
Economists Endorse Health Care Reform Bill: Twenty-three high profile economists from universities and think tanks sent a letter to President Obama on Tuesday to support four important elements of health reform legislation critical to its success: deficit neutrality, an excise tax on high-cost insurance plans, an independent Medicare commission, and delivery system reforms.
Looking Ahead
The Senate will convene on Saturday for a procedural vote, deciding whether or not to bring the legislation to the Senate floor for debate. Debate could continue throughout the weekend.
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House and Senate Negotiations
Reid Unveils Senate Bill: Senate Majority Leader Harry Reid unveiled his version of health care reform legislation on Wednesday night after receiving cost estimates from the Congressional Budget Office (CBO). With a price tag of $849 billion over ten years, the bill will reduce the deficit by $127 billion over a decade and cut Medicare spending by $500 billion, while increasing taxes by $500 billion. In addition, the bill will:
* Provide coverage for 31 million Americans who currently lack health insurance - accounting for 94 percent of eligible Americans
* Offer a government-run option of which states can opt out
* Expand Medicaid
* Require most Americans to carry health insurance, providing subsidies for those who cannot afford it and imposing weak penalties for violations
* Bar insurance companies from denying coverage based on pre-existing conditions or dropping coverage for those who become sick
* Impose penalties on medium and large sized employers for not providing health insurance to employees
* Increase the Medicare payroll tax on higher-income workers
* Imposes fees totaling $101.9 billion on insurance companies, drug makers, and medical device manufacturers over ten years
* Impose a tax on high-cost health insurance plans provided by employers to their employees.
While Democrats remain committed to passing the legislation, it is not certain that Reid has the 60 votes needed to bring the measure to the floor for debate. Several moderate democrats, including Sens. Mary L. Landrieu of Louisiana, Blanche Lincoln of Arkansas and Ben Nelson of Nebraska have expressed concerns over the inclusion of a government-run plan. Sen. Sherrod Brown (D-OH), however, expressed in a meeting Monday night with Reid that liberal lawmakers had conceded enough ground on the government-run plan and that he should push forward with the bill.
Members of the Senate will convene on Saturday for a rare weekend session to hold a procedural vote, deciding whether or not to bring the legislation to the Senate floor for debate.
Immigration and Abortion Remain Central to the Debate: Access to care for illegal immigrants will continue to be contentious as lawmakers work to reconcile the health care legislation passed by the House and pending in the Senate. Under the bill approved by the House, illegal immigrants would not be barred from using their own money in the newly-created insurance exchanges. White House officials and members of the Senate Finance Committee, however, pledged that undocumented workers be barred not only from receiving subsidies but also from buying insurance through federally sponsored exchanges - even with their own money.
As Senate Majority Leader Harry Reid works to finalize the legislation, he will also need to address the question of federal funding for abortions, an issue that has proved starkly divisive. Because of pressure from the Catholic Church and anti-abortion groups, the House-approved bill restricts the use of taxpayer funds for abortions, a decision that has sparked a heated debate among pro-choice and pro-life advocacy organizations. In contrast, the Senate's proposed bill would allow the use of federal funds for abortion in cases of rape and incest, requiring insurers that cover elective abortions to segregate money from Americans who get government subsidies.
Public Opinion
Polls Continue to Show Deep Divisions: A new Washington Post-ABC News poll shows that Americans are deeply divided over the current health care proposals and that the majority believes costs will rise. Forty-eight percent say they support the proposed changes to overhaul the health care system, whereas 49 percent are opposed. In addition, 52 percent say an altered system would probably make their own care more expensive, and 56 percent see the overall cost of health care in the country going up as a result of the reform.
Furthermore, a recent Associated Press (AP) poll shows that Americans are split (43 percent opposed; 41 percent support) over the health care plans being discussed in Congress. The AP poll also suggests that the public is becoming more attuned to the details of the proposals, including the cost implications and the public option. And, according to a Quinnipiac University poll released Thursday, 53 percent of voters disapprove of President Barack Obama's handling of health care reform.
However, a new CBS News poll shows that only one in four Americans prefer to have no health care legislation at all, while 51 percent support a bill with a public option.
Other Activities
CMS Report Indicates Costs Would Rise Under House Bill: According to a report issued by Richard Foster, the chief actuary at the Centers for Medicare and Medicaid (CMS), overall spending on health care would rise as a result of the legislation approved by the House. Specifically, the measure to reduce more than $500 billion from future Medicare spending would sharply reduce benefits for some seniors and may jeopardize access to care for millions of others.
Drug Makers Increase Price, Anticipating Health Reform: The media has reported that the drug industry has been raising prices at its fastest rate in years, in anticipation of the costs associated with health care reform. These costs include the $80 billion in fees over the next decade that the industry agreed to in order to help pay for coverage of the uninsured.On Wednesday, Democrats in Congress asked for two separate investigations of drug industry pricing.
Economists Endorse Health Care Reform Bill: Twenty-three high profile economists from universities and think tanks sent a letter to President Obama on Tuesday to support four important elements of health reform legislation critical to its success: deficit neutrality, an excise tax on high-cost insurance plans, an independent Medicare commission, and delivery system reforms.
Looking Ahead
The Senate will convene on Saturday for a procedural vote, deciding whether or not to bring the legislation to the Senate floor for debate. Debate could continue throughout the weekend.
Thursday, November 19, 2009
Individual Health Insurance Reform EasyToInsureME
Week of November 16, 2009
The Business Roundtable released a report late last week that found key components of existing health care reform legislation could slow the growth of health care costs and offer real savings for companies and their employees. The results were immediately welcomed by the White House. Yet, the report goes on to warn that certain provisions within the legislation could actually accelerate costs. "The report also shows that reform done wrong won't work and could make a bad situation much worse," said Antonio M. Perez, Chair of Business Roundtable's Consumer Health and Retirement Initiative. Aetna, a supporter of bipartisan health care reform, has expressed similar concerns. Specifically, the report notes changes that threaten to increase health care spending include failure to implement a strong individual mandate, increases in the cost of health care to individuals from changes to consumer spending accounts, and increased cost shifting to the private sector from reduced reimbursements to providers and the public plan option.
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Federal
The Democratic leadership continues to play an "inch-by-inch" game on health care reform. In the House, Speaker Pelosi is fully aware of the fact that the very bill she managed through the House would very likely not pass a second time because of the abortion issue. But she succeeded in inching the bill forward, which was the plan all along. In the Senate, Majority Leader Harry Reid continues weaving policy substance with political reality in order to create a mosaic that can inch forward to the next milestone, which is getting the 60 votes needed to allow the Senate to proceed to debate. He has yet to release the final "merged" bill; Senator Reid is going one-on-one with the Senate to sort out the combination of provisions that will allow him to get past the next hurdle. The abortion issue is the latest stumbling block, as at least one Senator is saying "no" to proceeding without this very provision. To jump start the process, Senator Reid is using the first of myriad procedural tactics to get the bill to the Senate floor. But if Republicans stand their ground, Senator Reid probably can't get to that next step (the "motion to proceed") until Friday. That would leave only enough time to make a few introductory speeches and go home for Thanksgiving.
On Thursday, the House is expected to proceed to debate and possibly pass a permanent "fix" to the perennial problem of what to do about scheduled cuts to physician reimbursement in Medicare. The House leadership wants to spend $210 billion (with no good funding source) to eliminate the upcoming 21 percent cut in 2010, along with all future cuts. The Speaker needs to make the gesture, given the AMA's support for her health care reform bill. It is unclear whether this measure will pass in the House; however, it is clear that such a measure will have a more difficult time in the Senate. For one, the Finance Committee reform bill already contains a one-year "fix" costing $10.9 billion, which is the best Chairman Max Baucus thinks is currently possible. The Senate already tried two weeks ago to pass a permanent fix, and Senator Reid was soundly rebuffed in the effort.
States
ILLINOIS: A leader in the Senate has prefiled a bill to amend Illinois' HIPAA law with a proposal that group and individual health insurance carriers be prohibited from imposing any pre-existing condition exclusions. Current limitations imposed by state law would be deleted. While the issue is being discussed on the federal level, this issue has had a lot of traction with both House and Senate Insurance Committee members for the past six months. As amended, the current proposal may not meet current federal HIPAA requirements. The bill will not be considered until January 2010.
MICHIGAN: The Office of Financial and Insurance Regulation (OFIR) has scheduled a hearing on November 23 to review Blue Care Network's proposal to buy Physicians Health Plan. In late September, Blue Care Network, a Michigan nonprofit HMO, filed a statement with OFIR regarding its intention to acquire control or merge with Physicians Health Plan of Mid-Michigan-Family Care and PHPMM Insurance Company. OFIR has 90 days to review the statement. Various parties have requested that OFIR conduct public hearings before making a decision on the sale, due to concerns raised regarding the size of the Blue Cross Blue Shield of Michigan.
NEW JERSEY: The governor has directed state departments and agencies to collectively cut $400 million from the state budget due to state revenue collection falling well short of budget projections. Furthermore, the Governor requested that the legislature not pass any spending bills during the upcoming "lame duck" session. This nearly half-a-billion dollar shortfall, coupled with a projected $8 billion budget deficit for next fiscal year, puts the state in dire fiscal straits. With options limited for making up the lost revenue, businesses operating in the state will be closely monitoring this developing situation.
NEW YORK: The legislature has passed a bill that prohibits all subrogation (collateral source or third party) recoveries by an insurer for medical expenses. The former collateral source rule eliminated the potential windfall of double recoveries by plaintiffs who receive medical benefits and win recoveries from defendant payments. The old rule of law allowed insurance companies to offset potential premium increases to consumers by authorizing them to recover medical costs from payments made to an injured plaintiff from a jury award or settlement. With that option no longer available, insurance premiums in New York will be further stressed. In addition, Governor Paterson and the hospital sector are proposing that the current Patient Services Assessment (PSA) of 9.63 percent be increased by 0.25 percent to generate an additional $54 million as part of the Governor's second Deficit Reduction plan (DRP) for 2009. The hospitals are advocating for this insurance tax increase to offset some of the governor’s proposed Medicaid cuts on hospitals. The $800 in insurance taxes adopted this year already includes an increase in the PSA, and the new proposal would make the latest increase retroactive to November 1, clearly not included in premium increases for 2010. The legislature is set to return to the Capitol for two more special session days to address the DRP.
OKLAHOMA: Two Republican State Senators are sounding the alarm bell regarding both U.S. House and Senate versions of health care reform, charging that either would devastate at least one new health care facility in Oklahoma City and cost Oklahoma County and surrounding environs more than 500 jobs. State Sen. Jim Reynolds and Sen. Harry Coates say both bills would financially devastate many top-quality health care facilities, including Oklahoma Heart Hospital’s $98 million South Campus, which is set to open soon. The bills would financially undermine the facility by denying the facility federal reimbursement for services such as Medicare and Medicaid. A joint venture of Mercy Hospital, Midwest City Regional and a group of local physicians, the facility will serve much of southeast Oklahoma County along with hundreds of active-duty military and veterans. Both Sen. Coates and Sen. Reynolds say they will ask Gov. Brad Henry to intercede quickly to remove the onerous provisions.
UTAH: The Department of Insurance is circulating a draft bill to amend the state's uniform electronic standards law to require insurers to provide coverage eligibility and detailed coordination of benefits information to physicians. Aetna will be submitting comments, including the fact that an insurer is not the repository of each member's applicable insurance coverage information and that a July 1, 2010, effective date does not allow sufficient time for implementation.
The Business Roundtable released a report late last week that found key components of existing health care reform legislation could slow the growth of health care costs and offer real savings for companies and their employees. The results were immediately welcomed by the White House. Yet, the report goes on to warn that certain provisions within the legislation could actually accelerate costs. "The report also shows that reform done wrong won't work and could make a bad situation much worse," said Antonio M. Perez, Chair of Business Roundtable's Consumer Health and Retirement Initiative. Aetna, a supporter of bipartisan health care reform, has expressed similar concerns. Specifically, the report notes changes that threaten to increase health care spending include failure to implement a strong individual mandate, increases in the cost of health care to individuals from changes to consumer spending accounts, and increased cost shifting to the private sector from reduced reimbursements to providers and the public plan option.
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Federal
The Democratic leadership continues to play an "inch-by-inch" game on health care reform. In the House, Speaker Pelosi is fully aware of the fact that the very bill she managed through the House would very likely not pass a second time because of the abortion issue. But she succeeded in inching the bill forward, which was the plan all along. In the Senate, Majority Leader Harry Reid continues weaving policy substance with political reality in order to create a mosaic that can inch forward to the next milestone, which is getting the 60 votes needed to allow the Senate to proceed to debate. He has yet to release the final "merged" bill; Senator Reid is going one-on-one with the Senate to sort out the combination of provisions that will allow him to get past the next hurdle. The abortion issue is the latest stumbling block, as at least one Senator is saying "no" to proceeding without this very provision. To jump start the process, Senator Reid is using the first of myriad procedural tactics to get the bill to the Senate floor. But if Republicans stand their ground, Senator Reid probably can't get to that next step (the "motion to proceed") until Friday. That would leave only enough time to make a few introductory speeches and go home for Thanksgiving.
On Thursday, the House is expected to proceed to debate and possibly pass a permanent "fix" to the perennial problem of what to do about scheduled cuts to physician reimbursement in Medicare. The House leadership wants to spend $210 billion (with no good funding source) to eliminate the upcoming 21 percent cut in 2010, along with all future cuts. The Speaker needs to make the gesture, given the AMA's support for her health care reform bill. It is unclear whether this measure will pass in the House; however, it is clear that such a measure will have a more difficult time in the Senate. For one, the Finance Committee reform bill already contains a one-year "fix" costing $10.9 billion, which is the best Chairman Max Baucus thinks is currently possible. The Senate already tried two weeks ago to pass a permanent fix, and Senator Reid was soundly rebuffed in the effort.
States
ILLINOIS: A leader in the Senate has prefiled a bill to amend Illinois' HIPAA law with a proposal that group and individual health insurance carriers be prohibited from imposing any pre-existing condition exclusions. Current limitations imposed by state law would be deleted. While the issue is being discussed on the federal level, this issue has had a lot of traction with both House and Senate Insurance Committee members for the past six months. As amended, the current proposal may not meet current federal HIPAA requirements. The bill will not be considered until January 2010.
MICHIGAN: The Office of Financial and Insurance Regulation (OFIR) has scheduled a hearing on November 23 to review Blue Care Network's proposal to buy Physicians Health Plan. In late September, Blue Care Network, a Michigan nonprofit HMO, filed a statement with OFIR regarding its intention to acquire control or merge with Physicians Health Plan of Mid-Michigan-Family Care and PHPMM Insurance Company. OFIR has 90 days to review the statement. Various parties have requested that OFIR conduct public hearings before making a decision on the sale, due to concerns raised regarding the size of the Blue Cross Blue Shield of Michigan.
NEW JERSEY: The governor has directed state departments and agencies to collectively cut $400 million from the state budget due to state revenue collection falling well short of budget projections. Furthermore, the Governor requested that the legislature not pass any spending bills during the upcoming "lame duck" session. This nearly half-a-billion dollar shortfall, coupled with a projected $8 billion budget deficit for next fiscal year, puts the state in dire fiscal straits. With options limited for making up the lost revenue, businesses operating in the state will be closely monitoring this developing situation.
NEW YORK: The legislature has passed a bill that prohibits all subrogation (collateral source or third party) recoveries by an insurer for medical expenses. The former collateral source rule eliminated the potential windfall of double recoveries by plaintiffs who receive medical benefits and win recoveries from defendant payments. The old rule of law allowed insurance companies to offset potential premium increases to consumers by authorizing them to recover medical costs from payments made to an injured plaintiff from a jury award or settlement. With that option no longer available, insurance premiums in New York will be further stressed. In addition, Governor Paterson and the hospital sector are proposing that the current Patient Services Assessment (PSA) of 9.63 percent be increased by 0.25 percent to generate an additional $54 million as part of the Governor's second Deficit Reduction plan (DRP) for 2009. The hospitals are advocating for this insurance tax increase to offset some of the governor’s proposed Medicaid cuts on hospitals. The $800 in insurance taxes adopted this year already includes an increase in the PSA, and the new proposal would make the latest increase retroactive to November 1, clearly not included in premium increases for 2010. The legislature is set to return to the Capitol for two more special session days to address the DRP.
OKLAHOMA: Two Republican State Senators are sounding the alarm bell regarding both U.S. House and Senate versions of health care reform, charging that either would devastate at least one new health care facility in Oklahoma City and cost Oklahoma County and surrounding environs more than 500 jobs. State Sen. Jim Reynolds and Sen. Harry Coates say both bills would financially devastate many top-quality health care facilities, including Oklahoma Heart Hospital’s $98 million South Campus, which is set to open soon. The bills would financially undermine the facility by denying the facility federal reimbursement for services such as Medicare and Medicaid. A joint venture of Mercy Hospital, Midwest City Regional and a group of local physicians, the facility will serve much of southeast Oklahoma County along with hundreds of active-duty military and veterans. Both Sen. Coates and Sen. Reynolds say they will ask Gov. Brad Henry to intercede quickly to remove the onerous provisions.
UTAH: The Department of Insurance is circulating a draft bill to amend the state's uniform electronic standards law to require insurers to provide coverage eligibility and detailed coordination of benefits information to physicians. Aetna will be submitting comments, including the fact that an insurer is not the repository of each member's applicable insurance coverage information and that a July 1, 2010, effective date does not allow sufficient time for implementation.
Monday, November 16, 2009
EasyToInsureME Health Insurance Quotes Reform Weekly
This Week in Health Reform: November 13, 2009
This week's debate focused on last Saturday's approval of health care reform legislation by the House of Representatives. Some members of the media have raised concerns over the costs associated with the Democrat version of health care reform, highlighting the challenges Democrats might face politically as health care reform legislation evolves in Congress.
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House and Senate Negotiations
House Passes Health Care Reform Legislation: Late last Saturday, the House narrowly passed its health care reform package with a 220-215 vote, which included opposition from 39 Democrats. One Republican, Rep. Joseph Cao (R-LA), voted in favor of the bill. President Barack Obama visited Capitol Hill on Saturday morning to encourage House Democrats to pass the legislation.
The $1.1 trillion legislation passed by the House would extend coverage to an estimated 36 million Americans, vastly expand Medicaid, establish a government-run option, and create individual and employer mandates. It would also bar insurers from denying coverage based on pre-existing conditions or from dropping coverage for those who become sick. To pay for the expansion, the House passed measures including a $400 billion cut in Medicare spending over the next 10 years and new taxes on the wealthy. While the Congressional Budget Office (CBO) estimates that the bill will reduce the federal deficit by about $104 billion over a decade, the bill's longer term impact remains unclear, and some Democrats are still raising concerns over its costs.
In order to secure enough votes for passage, House Speaker Nancy Pelosi (D-CA) agreed to hold a vote on an amendment that would specifically bar the public plan from covering abortion and prohibit those who receive insurance subsidies from using the subsidy to purchase private plan options that cover abortion. The amendment was approved 240 to 194, with 64 Democrats in favor. Abortion rights supporters, however, vowed to oppose the final legislation if it remains in the amendment, highlighting the difficult road ahead.
AARP and AMA Back House Bill: The House reform legislation received a boost last Thursday, winning the support of two highly influential lobbies - AARP and the American Medical Association (AMA). The announcements came at a critical time as the House Speaker was working to shore up the last votes needed to pass the reform legislation.
Small Businesses Voice Concern: Groups and coalitions representing small businesses showed their opposition to the health care reform late last week, sending letters to lawmakers urging them to vote against the House health care reform bill. In a statement Saturday, Susan Eckerly, Senior Vice President of the National Federation of Independent Business, said, "With unemployment at a 26-year high, the punitive employer mandates and atrocious new taxes will force small business owners to eliminate jobs and freeze expansion plans at a time when our nation's economy needs small business to thrive."
Obstacles Remain for Senate: While Senate Majority Leader Harry Reid (D-NV) waits for the CBO to review the Senate's health care proposal, many hurdles remain before securing the 60 votes needed for it to pass. These obstacles include the incorporation of a public option, issues associated with federal funding for abortion, and how to pay for the health care overhaul. Recent reports indicate that Sen. Reid is favoring an increase in payroll tax on the wealthy to help pay for reform. In addition, U.S. drug makers, medical-device manufacturers and insurers are gearing up for another opportunity to reduce proposed industry fees in the Senate version of reform legislation.
With continuing pressure from White House officials to pass health care reform legislation by the end of the year, Sen. Reid has indicated that he will bring the reform package to the Senate floor for debate as early as Monday. However, Senators have indicated that, more realistically, voting will take place before Christmas, with the final passage in mid-January. In an effort to spur on Senate Democrats, Former President Bill Clinton - whose health care reform efforts failed 15 years ago - told the senators over lunch last Tuesday that "passing health care reform is not only a moral issue but also an economic imperative."
Public Opinion
American Support Slips for Passing a Health Care Reform Bill: A new Gallup Poll released last Monday shows that Americans have moved in a more negative direction on whether or not a new bill should be passed into law. Thirty-eight percent of Americans now say they would advise their member of Congress to vote against a new health care bill this year, while 29 percent would advise their member to vote for it. In addition, 41 percent say a new health care bill would make the U.S. health care system better in the long run, while 40 percent say it would make things worse.
Other Activities
Republicans Mobilize to Increase Opposition: In an effort to drum up opposition to the Democratic health care reform bills, Senate Republican Conference Chairman Lamar Alexander (R-TN) indicated that Republicans are "quietly" planning approximately 50 in-person and telephone town hall gatherings over the next three weeks.
Looking Ahead
CBO estimates of the cost of the Senate health care reform package are expected late this week or early next week, which will clear the way for Senate Majority Leader Harry Reid to bring the legislation to the Senate floor for debate as early as Monday.
This week's debate focused on last Saturday's approval of health care reform legislation by the House of Representatives. Some members of the media have raised concerns over the costs associated with the Democrat version of health care reform, highlighting the challenges Democrats might face politically as health care reform legislation evolves in Congress.
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House and Senate Negotiations
House Passes Health Care Reform Legislation: Late last Saturday, the House narrowly passed its health care reform package with a 220-215 vote, which included opposition from 39 Democrats. One Republican, Rep. Joseph Cao (R-LA), voted in favor of the bill. President Barack Obama visited Capitol Hill on Saturday morning to encourage House Democrats to pass the legislation.
The $1.1 trillion legislation passed by the House would extend coverage to an estimated 36 million Americans, vastly expand Medicaid, establish a government-run option, and create individual and employer mandates. It would also bar insurers from denying coverage based on pre-existing conditions or from dropping coverage for those who become sick. To pay for the expansion, the House passed measures including a $400 billion cut in Medicare spending over the next 10 years and new taxes on the wealthy. While the Congressional Budget Office (CBO) estimates that the bill will reduce the federal deficit by about $104 billion over a decade, the bill's longer term impact remains unclear, and some Democrats are still raising concerns over its costs.
In order to secure enough votes for passage, House Speaker Nancy Pelosi (D-CA) agreed to hold a vote on an amendment that would specifically bar the public plan from covering abortion and prohibit those who receive insurance subsidies from using the subsidy to purchase private plan options that cover abortion. The amendment was approved 240 to 194, with 64 Democrats in favor. Abortion rights supporters, however, vowed to oppose the final legislation if it remains in the amendment, highlighting the difficult road ahead.
AARP and AMA Back House Bill: The House reform legislation received a boost last Thursday, winning the support of two highly influential lobbies - AARP and the American Medical Association (AMA). The announcements came at a critical time as the House Speaker was working to shore up the last votes needed to pass the reform legislation.
Small Businesses Voice Concern: Groups and coalitions representing small businesses showed their opposition to the health care reform late last week, sending letters to lawmakers urging them to vote against the House health care reform bill. In a statement Saturday, Susan Eckerly, Senior Vice President of the National Federation of Independent Business, said, "With unemployment at a 26-year high, the punitive employer mandates and atrocious new taxes will force small business owners to eliminate jobs and freeze expansion plans at a time when our nation's economy needs small business to thrive."
Obstacles Remain for Senate: While Senate Majority Leader Harry Reid (D-NV) waits for the CBO to review the Senate's health care proposal, many hurdles remain before securing the 60 votes needed for it to pass. These obstacles include the incorporation of a public option, issues associated with federal funding for abortion, and how to pay for the health care overhaul. Recent reports indicate that Sen. Reid is favoring an increase in payroll tax on the wealthy to help pay for reform. In addition, U.S. drug makers, medical-device manufacturers and insurers are gearing up for another opportunity to reduce proposed industry fees in the Senate version of reform legislation.
With continuing pressure from White House officials to pass health care reform legislation by the end of the year, Sen. Reid has indicated that he will bring the reform package to the Senate floor for debate as early as Monday. However, Senators have indicated that, more realistically, voting will take place before Christmas, with the final passage in mid-January. In an effort to spur on Senate Democrats, Former President Bill Clinton - whose health care reform efforts failed 15 years ago - told the senators over lunch last Tuesday that "passing health care reform is not only a moral issue but also an economic imperative."
Public Opinion
American Support Slips for Passing a Health Care Reform Bill: A new Gallup Poll released last Monday shows that Americans have moved in a more negative direction on whether or not a new bill should be passed into law. Thirty-eight percent of Americans now say they would advise their member of Congress to vote against a new health care bill this year, while 29 percent would advise their member to vote for it. In addition, 41 percent say a new health care bill would make the U.S. health care system better in the long run, while 40 percent say it would make things worse.
Other Activities
Republicans Mobilize to Increase Opposition: In an effort to drum up opposition to the Democratic health care reform bills, Senate Republican Conference Chairman Lamar Alexander (R-TN) indicated that Republicans are "quietly" planning approximately 50 in-person and telephone town hall gatherings over the next three weeks.
Looking Ahead
CBO estimates of the cost of the Senate health care reform package are expected late this week or early next week, which will clear the way for Senate Majority Leader Harry Reid to bring the legislation to the Senate floor for debate as early as Monday.
Thursday, November 12, 2009
EasyToInsureME Individual Health Insurance Reform Weekly
Week of November 9, 2009
Given that the Senate is expected to require much more time than the House to vote on a health care bill (see below), it is likely there is not enough legislative time left in 2009 to wrap up a bill for Christmas delivery to the White House. Senate Majority Leader Harry Reid fueled concerns about the schedule last week when he refused to commit publicly to passing an overhaul bill this year. This makes a "conference" between the House and Senate MORE likely in January 2010 THAN IN 2009, and that could require some time since the current House and Senate versions are vastly different on several key provisions. If the Conference pathway proves too contentious, House Speaker Nancy Pelosi and Reid could play legislative "ping-pong," whereby each Chamber makes a modest change and ships if off to the other, back and forth, until they both approve the same language.
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Late Saturday night the House of Representatives approved its version of health care reform by the slim margin of 220 to 215 (218 was the minimum needed). The core of the approved House bill remained unchanged from the version the Speaker introduced a few weeks ago and includes: an employer mandate to provide and pay for coverage; a fairly strong individual coverage requirement; a public plan option set up by government that would pay "negotiated" rates to providers; and insurance reforms, including guaranteed issue and modified community rating. It does not include the "Cadillac" plan tax or the insurer tax provisions currently in the Senate bill. The House bill would be paid for in part with cuts to Medicare Advantage and a surcharge on the "wealthy."
On the Senate side, Majority Leader Reid is waiting for the revenue score from CBO on several different Senate Bill scenarios, given that several Senators have publicly stated opposition to going forward without a hard and fast number on both cost and impact on bending the spending curve. He also needs this time to win over the 60 votes needed to even proceed with consideration of the bill, let alone the 60 needed to cut off debate once the debate begins; he may not have either right now. The earliest the Senate could start debate would be the week of November 16, but a date in December seems more likely. Approval of the House bill will surely put increased pressure on the Senate to move forward but to do so cautiously, given the slim voting margin in the House, as the issue moves closer to the finish line.
Bills to extend and expand COBRA have been introduced in both the House and Senate and could well be part of the final push on health care reform. Both versions extend the Special COBRA subsidy program from end of 2009 to June 30, 2010 and maintain the government's 65 percent subsidy. The Senate version increases this subsidy to 75 percent, and the House extends basic COBRA eligibility from 18 to 24 months. Given the unemployment numbers, it seems likely that, whether as part of health reform or on its own, a COBRA extension (including the subsidy) will be enacted in 2009.
States
ARIZONA: Governor Jan Brewer and legislative leaders have reached a tentative agreement to reconvene to address the projected 2010 budget shortfall, which ballooned from $1 billion in early September to $2 billion by the end of October. Although the governor favors a temporary tax increase to boost revenue, she is unlikely to float that idea this time around to help limit the length of the session. Governor Brewer is expected to announce her candidacy for re-election. Although the former lieutenant governor is now the incumbent and has never lost an election, she is viewed as vulnerable by some Republicans because of budget concerns and her continued focus on obtaining additional revenue through taxation.
CALIFORNIA: California’s state budget deficit could reach $7 billion for the current fiscal year in part because of recent court decisions blocking state funding cuts. For example, a federal judge recently blocked the state's plans to cut $80 million from its budget for In-Home Supportive Services, and Insurance Commissioner Steve Poizner has filed a suit to block the sale of part of the State Compensation Insurance Fund, which was projected to generate $1 billion. Some analysts project that the state’s budget deficit will range from $10 billion to $20 billion in the upcoming fiscal year. In other developments, Lt. Governor John Garamendi won a special election to fill the Congressional seat vacated by U.S. Representative Ellen Tauscher (D). Garamendi was elected lieutenant governor in 2006 after 16 years in the legislature and two terms as insurance commissioner.
COLORADO: Senator Betty Boyd, President Pro Tem and Chair of the Health and Human Services Committee, met with insurer representatives to highlight the issues likely to get attention in the upcoming session. A proposal to prohibit the use of gender in rating individual policies has a high likelihood of passing, she said. Senator Boyd also advised that efforts will be made to ensure that the Cover Colorado program remains solvent, as it has potential to be used as the state’s public plan option. Speculation has it that Colorado could become one of the first states to act on federal health care reform if it is enacted. Finally, she expressed a strong interest in authorizing the DOI to establish standardized policy forms.
DELAWARE: Department of Health and Social Services Secretary Rita M. Landgraf has issued an update to existing statutes adding virtual colonoscopy as an approved colorectal screening modality. Delaware law requires coverage for colorectal screening modalities and empowers the Secretary to add modalities as recommended by the Delaware Cancer Consortium. Accordingly, all contracts for health insurance issued, delivered or renewed after December 1, 2009 must include coverage for virtual colonoscopy for colorectal cancer screening.
DISTRICT OF COLUMBIA: Newly passed legislation requires individual and group health plans to provide coverage for orally administered chemotherapy medication in a manner no more restrictive than intravenously administered treatment or injected cancer medications. In other business, the Council of the District of Columbia confirmed Acting Commissioner Gennet Purcell as Commissioner for the District of Columbia Department of Insurance, Securities and Banking (DISB). Commissioner Purcell, who served as DISB’s Deputy Commissioner since 2008, is an attorney and member of both the State of Maryland Bar and the Commonwealth of Virginia Bar. As deputy, her primary responsibilities included oversight of the agency’s core functional areas, including the divisions of Insurance, Securities, Banking, Fraud Enforcement and Investigation, and Risk Finance.
GEORGIA: A meeting was held last week between health insurance representatives and the Chairman of the Senate Insurance Committee to discuss legislation for 2010 that would restrict rental networks. The Medical Association of Georgia also was represented. Aetna has committed to work with all interested parties on the legislation.
ILLINOIS: A fall veto session concluded at the end of October, and three health insurance bills of import passed both chambers. The first bill creates external review requirements for all commercial insurance products, rather than just HMOs, effective July 1, 2010. The bill also establishes committees to create a uniform small-employer group health status questionnaire and an individual health statement for use on January 1, 2011. The legislation also requires insurers to semi-annually prepare and provide the Department of Insurance a statement on aggregate administrative expenses and other information. It is a good compromise versus what was originally proposed. In addition, both chambers passed an orthotics and prosthetics mandate on health carriers and HMOs for policies amended, delivered, issued, or renewed six months after the effective date of the amendatory act. The third bill changed the requirements to obtain a producer license. The Illinois General Assembly is not expected to reconvene until January 2010.
MISSOURI: The Secretary of the State recently approved a ballot initiative proposal for the November 2010 ballot that would essentially eliminate network-based health care delivery in Missouri. The move follows unsuccessful efforts to enact an any-willing-provider bill in past legislative sessions.The petition effort behind the ballot initiative appears to have been spearheaded by a local surgical practice that has been excluded from the medical staffs of local hospitals. Any willing provider is only one portion of the proposal. It would apply to health carriers and health benefit plans, including Medicare and Medicaid, and facilities. It would, for example, prohibit carriers from: Imposing on a beneficiary any co-payment, fee, or condition that is not equally imposed on all other beneficiaries in the same benefit category, co-payment level, or class; prohibiting or limiting a provider from the opportunity to participate in the network if that provider is willing to accept the carrier’s operating terms and conditions, fee schedule, covered expenses, utilization and quality standards. The State Auditor is preparing an assessment of the fiscal impact of the proposed measure as well as a brief summary of the fiscal impact for the petition. Legal challenges to the ballot initiative are permitted. A group of stakeholders, including Aetna, are discussing strategy.
NEW JERSEY: Health insurance issues were front and center in a bitter battle for the governor's office, which ended last week when Republican candidate Chris Christie defeated Democratic Governor Jon Corzine. The governor-elect has publicly supported greater flexibility for carriers to make health coverage more affordable via mandate-free plan designs and interstate sales of health policies. The Democrats remain in firm control of the legislature, which will make the governor-elect's agenda an uphill battle. Also, the Department of Banking and Insurance (DOBI) adopted a regulation standardizing the information and format on health identification cards. Additionally, DOBI initiated a meeting with the state's major health plans seeking guidance as to how the state might proceed in limiting plans,’ and members,’ exposure to exorbitant out-of-network provider charges. This is one in a series of meetings aimed at developing consensus on an appropriate fee schedule or other mechanism for non-par provider charges. Lastly, the NJ Department of Health & Senior Services (DHSS) has launched a six-month Hospital Newborn Pilot Program. Nine hospitals throughout the state are participating in a pilot to ensure no newborn leaves the hospital without health insurance. The participating hospitals are expected to submit data to the DHSS.
NEW YORK: Governor David Paterson is calling for a special session to address the current state budget deficit. The Governor’s two-year, $5.2 billion Deficit Reduction Package would have a current-year impact of $3.2 billion in 2009-10 and a recurring impact of $2 billion in 2010-11. The components include across-the-board spending reductions and a tax penalty forgiveness program. The Governor indicated that his agenda will include a bill that would completely prohibit all subrogation (collateral source) recoveries on any insured or self-insured plans. The existing collateral source rule eliminates the potential windfall of double recoveries to plaintiffs who receive benefits and make recoveries from both their insurance coverage and defendant payments, while still ensuring that uncompensated losses are fully compensated. This subrogation legislation passed the Senate earlier this year, but it has not passed the Assembly. In other business, State Sen. Eric Schneiderman, chairman of the Codes Committee, and Sen. Neil Breslin, chairman of the Insurance Committee, introduced a bill known as "Ian's Law," which is named after a patient with muscular dystrophy. The proposed legislation would prohibit non-renewal of group policies and would require heath plans to get state Department of Insurance approval before discontinuing a class of insurance. The bill also would require plans to continue covering a totally disabled policyholder for 18 months, even if the plan gets state permission to cancel an entire class of policies.
Given that the Senate is expected to require much more time than the House to vote on a health care bill (see below), it is likely there is not enough legislative time left in 2009 to wrap up a bill for Christmas delivery to the White House. Senate Majority Leader Harry Reid fueled concerns about the schedule last week when he refused to commit publicly to passing an overhaul bill this year. This makes a "conference" between the House and Senate MORE likely in January 2010 THAN IN 2009, and that could require some time since the current House and Senate versions are vastly different on several key provisions. If the Conference pathway proves too contentious, House Speaker Nancy Pelosi and Reid could play legislative "ping-pong," whereby each Chamber makes a modest change and ships if off to the other, back and forth, until they both approve the same language.
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Federal
Late Saturday night the House of Representatives approved its version of health care reform by the slim margin of 220 to 215 (218 was the minimum needed). The core of the approved House bill remained unchanged from the version the Speaker introduced a few weeks ago and includes: an employer mandate to provide and pay for coverage; a fairly strong individual coverage requirement; a public plan option set up by government that would pay "negotiated" rates to providers; and insurance reforms, including guaranteed issue and modified community rating. It does not include the "Cadillac" plan tax or the insurer tax provisions currently in the Senate bill. The House bill would be paid for in part with cuts to Medicare Advantage and a surcharge on the "wealthy."
On the Senate side, Majority Leader Reid is waiting for the revenue score from CBO on several different Senate Bill scenarios, given that several Senators have publicly stated opposition to going forward without a hard and fast number on both cost and impact on bending the spending curve. He also needs this time to win over the 60 votes needed to even proceed with consideration of the bill, let alone the 60 needed to cut off debate once the debate begins; he may not have either right now. The earliest the Senate could start debate would be the week of November 16, but a date in December seems more likely. Approval of the House bill will surely put increased pressure on the Senate to move forward but to do so cautiously, given the slim voting margin in the House, as the issue moves closer to the finish line.
Bills to extend and expand COBRA have been introduced in both the House and Senate and could well be part of the final push on health care reform. Both versions extend the Special COBRA subsidy program from end of 2009 to June 30, 2010 and maintain the government's 65 percent subsidy. The Senate version increases this subsidy to 75 percent, and the House extends basic COBRA eligibility from 18 to 24 months. Given the unemployment numbers, it seems likely that, whether as part of health reform or on its own, a COBRA extension (including the subsidy) will be enacted in 2009.
States
ARIZONA: Governor Jan Brewer and legislative leaders have reached a tentative agreement to reconvene to address the projected 2010 budget shortfall, which ballooned from $1 billion in early September to $2 billion by the end of October. Although the governor favors a temporary tax increase to boost revenue, she is unlikely to float that idea this time around to help limit the length of the session. Governor Brewer is expected to announce her candidacy for re-election. Although the former lieutenant governor is now the incumbent and has never lost an election, she is viewed as vulnerable by some Republicans because of budget concerns and her continued focus on obtaining additional revenue through taxation.
CALIFORNIA: California’s state budget deficit could reach $7 billion for the current fiscal year in part because of recent court decisions blocking state funding cuts. For example, a federal judge recently blocked the state's plans to cut $80 million from its budget for In-Home Supportive Services, and Insurance Commissioner Steve Poizner has filed a suit to block the sale of part of the State Compensation Insurance Fund, which was projected to generate $1 billion. Some analysts project that the state’s budget deficit will range from $10 billion to $20 billion in the upcoming fiscal year. In other developments, Lt. Governor John Garamendi won a special election to fill the Congressional seat vacated by U.S. Representative Ellen Tauscher (D). Garamendi was elected lieutenant governor in 2006 after 16 years in the legislature and two terms as insurance commissioner.
COLORADO: Senator Betty Boyd, President Pro Tem and Chair of the Health and Human Services Committee, met with insurer representatives to highlight the issues likely to get attention in the upcoming session. A proposal to prohibit the use of gender in rating individual policies has a high likelihood of passing, she said. Senator Boyd also advised that efforts will be made to ensure that the Cover Colorado program remains solvent, as it has potential to be used as the state’s public plan option. Speculation has it that Colorado could become one of the first states to act on federal health care reform if it is enacted. Finally, she expressed a strong interest in authorizing the DOI to establish standardized policy forms.
DELAWARE: Department of Health and Social Services Secretary Rita M. Landgraf has issued an update to existing statutes adding virtual colonoscopy as an approved colorectal screening modality. Delaware law requires coverage for colorectal screening modalities and empowers the Secretary to add modalities as recommended by the Delaware Cancer Consortium. Accordingly, all contracts for health insurance issued, delivered or renewed after December 1, 2009 must include coverage for virtual colonoscopy for colorectal cancer screening.
DISTRICT OF COLUMBIA: Newly passed legislation requires individual and group health plans to provide coverage for orally administered chemotherapy medication in a manner no more restrictive than intravenously administered treatment or injected cancer medications. In other business, the Council of the District of Columbia confirmed Acting Commissioner Gennet Purcell as Commissioner for the District of Columbia Department of Insurance, Securities and Banking (DISB). Commissioner Purcell, who served as DISB’s Deputy Commissioner since 2008, is an attorney and member of both the State of Maryland Bar and the Commonwealth of Virginia Bar. As deputy, her primary responsibilities included oversight of the agency’s core functional areas, including the divisions of Insurance, Securities, Banking, Fraud Enforcement and Investigation, and Risk Finance.
GEORGIA: A meeting was held last week between health insurance representatives and the Chairman of the Senate Insurance Committee to discuss legislation for 2010 that would restrict rental networks. The Medical Association of Georgia also was represented. Aetna has committed to work with all interested parties on the legislation.
ILLINOIS: A fall veto session concluded at the end of October, and three health insurance bills of import passed both chambers. The first bill creates external review requirements for all commercial insurance products, rather than just HMOs, effective July 1, 2010. The bill also establishes committees to create a uniform small-employer group health status questionnaire and an individual health statement for use on January 1, 2011. The legislation also requires insurers to semi-annually prepare and provide the Department of Insurance a statement on aggregate administrative expenses and other information. It is a good compromise versus what was originally proposed. In addition, both chambers passed an orthotics and prosthetics mandate on health carriers and HMOs for policies amended, delivered, issued, or renewed six months after the effective date of the amendatory act. The third bill changed the requirements to obtain a producer license. The Illinois General Assembly is not expected to reconvene until January 2010.
MISSOURI: The Secretary of the State recently approved a ballot initiative proposal for the November 2010 ballot that would essentially eliminate network-based health care delivery in Missouri. The move follows unsuccessful efforts to enact an any-willing-provider bill in past legislative sessions.The petition effort behind the ballot initiative appears to have been spearheaded by a local surgical practice that has been excluded from the medical staffs of local hospitals. Any willing provider is only one portion of the proposal. It would apply to health carriers and health benefit plans, including Medicare and Medicaid, and facilities. It would, for example, prohibit carriers from: Imposing on a beneficiary any co-payment, fee, or condition that is not equally imposed on all other beneficiaries in the same benefit category, co-payment level, or class; prohibiting or limiting a provider from the opportunity to participate in the network if that provider is willing to accept the carrier’s operating terms and conditions, fee schedule, covered expenses, utilization and quality standards. The State Auditor is preparing an assessment of the fiscal impact of the proposed measure as well as a brief summary of the fiscal impact for the petition. Legal challenges to the ballot initiative are permitted. A group of stakeholders, including Aetna, are discussing strategy.
NEW JERSEY: Health insurance issues were front and center in a bitter battle for the governor's office, which ended last week when Republican candidate Chris Christie defeated Democratic Governor Jon Corzine. The governor-elect has publicly supported greater flexibility for carriers to make health coverage more affordable via mandate-free plan designs and interstate sales of health policies. The Democrats remain in firm control of the legislature, which will make the governor-elect's agenda an uphill battle. Also, the Department of Banking and Insurance (DOBI) adopted a regulation standardizing the information and format on health identification cards. Additionally, DOBI initiated a meeting with the state's major health plans seeking guidance as to how the state might proceed in limiting plans,’ and members,’ exposure to exorbitant out-of-network provider charges. This is one in a series of meetings aimed at developing consensus on an appropriate fee schedule or other mechanism for non-par provider charges. Lastly, the NJ Department of Health & Senior Services (DHSS) has launched a six-month Hospital Newborn Pilot Program. Nine hospitals throughout the state are participating in a pilot to ensure no newborn leaves the hospital without health insurance. The participating hospitals are expected to submit data to the DHSS.
NEW YORK: Governor David Paterson is calling for a special session to address the current state budget deficit. The Governor’s two-year, $5.2 billion Deficit Reduction Package would have a current-year impact of $3.2 billion in 2009-10 and a recurring impact of $2 billion in 2010-11. The components include across-the-board spending reductions and a tax penalty forgiveness program. The Governor indicated that his agenda will include a bill that would completely prohibit all subrogation (collateral source) recoveries on any insured or self-insured plans. The existing collateral source rule eliminates the potential windfall of double recoveries to plaintiffs who receive benefits and make recoveries from both their insurance coverage and defendant payments, while still ensuring that uncompensated losses are fully compensated. This subrogation legislation passed the Senate earlier this year, but it has not passed the Assembly. In other business, State Sen. Eric Schneiderman, chairman of the Codes Committee, and Sen. Neil Breslin, chairman of the Insurance Committee, introduced a bill known as "Ian's Law," which is named after a patient with muscular dystrophy. The proposed legislation would prohibit non-renewal of group policies and would require heath plans to get state Department of Insurance approval before discontinuing a class of insurance. The bill also would require plans to continue covering a totally disabled policyholder for 18 months, even if the plan gets state permission to cancel an entire class of policies.
Friday, November 6, 2009
EasyToInsureME Health Insurance Quotes Reform Weekly
This Week in Health Reform: November 6, 2009
As we near the end of a busy week in Congress, WellPoint sent a letter to Congressional Members highlighting the detrimental impact of current legislation on our health care system. The letter focuses on the potential impact of the Affordable Health Care for America Act (HR 3962) currently being debated in the House of Representatives.
WellPoint also provided Congress with a point-by-point response to the White House Blog's criticism of its actuarial analyses released late last week.
And, earlier this week, The Wall Street Journal published alead editorial highly critical of House Speaker Nancy Pelosi (D-CA) and the House bill. In addition, House Republicans proposed their own health care reform legislation.
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URGENT ACTION IS NEEDED
On Saturday, November 7, the House of Representatives is scheduled to vote on health care reform legislation that would force individuals to purchase coverage through the government health care exchange. Section 202(c) of HR 3962 prohibits individual coverage from being sold outside of the government health care exchange.
Forcing individuals to purchase coverage through the exchange reflects a sharp departure from the current system, and we believe Americans should have the choice of not buying coverage through the government exchange if they choose not to do so.
We encourage you to take action and contact your Congressional Member today.
House and Senate Negotiations
House Republicans Offer Health Care Reform Plan: On Tuesday, House Republican Leader John Boehner (R-OH) described key aspects of the newly proposed health care reform bill that focus more on controlling health care costs than on expanding coverage. The proposed bill will:
* cap medical malpractice damages;
* increase incentives for people to open health savings accounts;
* allow insurance companies to sell insurance across state lines;
* allow trade associations and guild members to band together to purchase group insurance , and
* create state-based, high-risk insurance pools for individuals who have difficulty obtaining health care coverage.
The bill does not bar insurance providers from denying coverage based on pre-existing conditions, nor does it create individual or employer mandates. It also does not raise taxes. The media suggest that Republicans may galvanize around their newly introduced bill. However, the media also speculate that the proposed legislation may make Republicans more vulnerable to criticism. Late Wednesday, the Congressional Budget Office (CBO) indicated that the bill would only cover 3 million additional people at a cost of $60 billion through 2019.
Biofuel Tax Credit Restrictions Added to House Health Care Reform Legislation: A measure introduced by Rep. Chris Van Hollen (D-MD), a member of the House Democrat leadership, would save the federal government $24 billion in biofuel tax credits over 10 years.
The measure would restrict the paper industry from claiming tax incentives for use of a fuel known as "black liquor." The tax credit savings could be used to offset costs of the health care bill, Van Hollen said.
Abortion and Immigration Issues May Imperil House Legislation: As House Speaker Nancy Pelosi works to shore up 218 votes for the House health care reform legislation introduced last week, two key contentious issues remain at the center of debate - funding for abortions and coverage for illegal immigrants . This week, anti-abortion Democrats circulated legislation to strengthen prohibitions in the bill against federal funding of abortion. It is also still up for debate as to whether or not illegal immigrants would be allowed to shop for insurance within the new exchange.
Senate Leader Signals Delay: Senate Majority Leader Harry Reid (D-NV) signaled Tuesday that Congress may fail to meet the end-of-year deadline for health care reform imposed by President Barack Obama. Senators are currently waiting for CBO cost estimates on their health care reform proposal, which may not come until late next week. Given this timeline and the upcoming Thanksgiving holiday, a bill may not reach the Senate floor until December.
Public Option Developments
CBO Indicates House Bill Would Attract Less Healthy: According to the CBO, the House health care reform legislation would attract less healthy enrollees in its version of the public option and would subsequently result in higher health care costs. In addition, the CBO predicted that of the 30 million Americans likely to purchase insurance through the insurance exchanges, one fifth would purchase insurance from the public option.
Looking Ahead
President Obama indicated that he will visit Capitol Hill late this week to address House Democrats and encourage a final push towards health care reform legislation. While House leaders plan to hold a rare Saturday vote on their proposed measure, Senate leaders still await a CBO cost estimate.
As we near the end of a busy week in Congress, WellPoint sent a letter to Congressional Members highlighting the detrimental impact of current legislation on our health care system. The letter focuses on the potential impact of the Affordable Health Care for America Act (HR 3962) currently being debated in the House of Representatives.
WellPoint also provided Congress with a point-by-point response to the White House Blog's criticism of its actuarial analyses released late last week.
And, earlier this week, The Wall Street Journal published alead editorial highly critical of House Speaker Nancy Pelosi (D-CA) and the House bill. In addition, House Republicans proposed their own health care reform legislation.
Quoting & Saving just got easier...EasyToInsureME Health Insurance Quotes... Quote all carriers in seconds
Health insurance
Health insurance quote
URGENT ACTION IS NEEDED
On Saturday, November 7, the House of Representatives is scheduled to vote on health care reform legislation that would force individuals to purchase coverage through the government health care exchange. Section 202(c) of HR 3962 prohibits individual coverage from being sold outside of the government health care exchange.
Forcing individuals to purchase coverage through the exchange reflects a sharp departure from the current system, and we believe Americans should have the choice of not buying coverage through the government exchange if they choose not to do so.
We encourage you to take action and contact your Congressional Member today.
House and Senate Negotiations
House Republicans Offer Health Care Reform Plan: On Tuesday, House Republican Leader John Boehner (R-OH) described key aspects of the newly proposed health care reform bill that focus more on controlling health care costs than on expanding coverage. The proposed bill will:
* cap medical malpractice damages;
* increase incentives for people to open health savings accounts;
* allow insurance companies to sell insurance across state lines;
* allow trade associations and guild members to band together to purchase group insurance , and
* create state-based, high-risk insurance pools for individuals who have difficulty obtaining health care coverage.
The bill does not bar insurance providers from denying coverage based on pre-existing conditions, nor does it create individual or employer mandates. It also does not raise taxes. The media suggest that Republicans may galvanize around their newly introduced bill. However, the media also speculate that the proposed legislation may make Republicans more vulnerable to criticism. Late Wednesday, the Congressional Budget Office (CBO) indicated that the bill would only cover 3 million additional people at a cost of $60 billion through 2019.
Biofuel Tax Credit Restrictions Added to House Health Care Reform Legislation: A measure introduced by Rep. Chris Van Hollen (D-MD), a member of the House Democrat leadership, would save the federal government $24 billion in biofuel tax credits over 10 years.
The measure would restrict the paper industry from claiming tax incentives for use of a fuel known as "black liquor." The tax credit savings could be used to offset costs of the health care bill, Van Hollen said.
Abortion and Immigration Issues May Imperil House Legislation: As House Speaker Nancy Pelosi works to shore up 218 votes for the House health care reform legislation introduced last week, two key contentious issues remain at the center of debate - funding for abortions and coverage for illegal immigrants . This week, anti-abortion Democrats circulated legislation to strengthen prohibitions in the bill against federal funding of abortion. It is also still up for debate as to whether or not illegal immigrants would be allowed to shop for insurance within the new exchange.
Senate Leader Signals Delay: Senate Majority Leader Harry Reid (D-NV) signaled Tuesday that Congress may fail to meet the end-of-year deadline for health care reform imposed by President Barack Obama. Senators are currently waiting for CBO cost estimates on their health care reform proposal, which may not come until late next week. Given this timeline and the upcoming Thanksgiving holiday, a bill may not reach the Senate floor until December.
Public Option Developments
CBO Indicates House Bill Would Attract Less Healthy: According to the CBO, the House health care reform legislation would attract less healthy enrollees in its version of the public option and would subsequently result in higher health care costs. In addition, the CBO predicted that of the 30 million Americans likely to purchase insurance through the insurance exchanges, one fifth would purchase insurance from the public option.
Looking Ahead
President Obama indicated that he will visit Capitol Hill late this week to address House Democrats and encourage a final push towards health care reform legislation. While House leaders plan to hold a rare Saturday vote on their proposed measure, Senate leaders still await a CBO cost estimate.
Thursday, November 5, 2009
EasyToInsureME Individual Health Insurance Reform Weekly
Week of November 2, 2009
That the bill going to the floor of the House contains a government plan option is no surprise. But Senate leadership's decision to pursue a government plan option in defiance of the Senate Finance Committee's preference is something of a surprise (see below), given it was perhaps the most bitterly argued reform issue of the summer's town hall meetings. The path ahead in the Senate will not be an easy one, as Connecticut Senator Joseph Lieberman's opposition makes clear. Lieberman is a former Democrat who still caucuses with Senate Democrats and had been counted among a potential 60 filibuster-proof majority. As the issue heats up, expect more debate and media attention on the real ramifications of this controversial provision.
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Health insurance
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Federal
Several discrete events occurred this past week that have bearing on the health care reform (HCR) debate. First, Majority Leader Harry Reid boldly moved where he was not expected to go: He announced that a relatively strong form of the public plan, the "opt-out" version, would be in the bill he brings to the Senate floor. Most observers thought Reid would pick a "lighter" form of public plan. However, he clearly wants to keep the Democratic left on board while he works to secure votes on the right, rather than the other way around. Second, within 24 hours, Senator Joseph Lieberman (I-CT) broke ranks publicly and stated flat-out that he would filibuster against Reid's bill because of the government plan option. The Senate is expected to take a week longer to merge its two Committee bills and secure a score from the Congressional Budget Office, which is likely fine with Reid who probably does not have the 60 votes needed to bring the bill to the floor or end a filibuster. The Senate Floor debate is likely to begin around Veteran's Day. On the House side, Speaker Nancy Pelosi has unveiled the merged House bill (1990 pages, $894 billion in costs and rising), setting the stage for an expected vote -- with no real debate and no amendments allowed -- on the House floor late this week. The Speaker likely would not let the bill come to the floor unless she knows she has the votes or she believes can get them.
On related fronts, in order to get the HCR bill below the $1 trillion mark, the Speaker purged it of a $200+ billion item by deleting the Medicare physician reimbursement fix provision and introducing this as a freestanding bill, which has no "pay fors," i.e., it would add to the federal deficit. The Senate has already rejected this freestanding bill approach, which means Congress still has no solution for the impending slashing of 21 percent in doctor Medicare fees in 2010. Separately, Congressman McDermott (D-WA) has introduced a bill to neutralize ERISA's preemption protection by allowing state law causes of action for claims disputes to be processed under state liability law. Aetna would oppose either measure should it gain traction.
States
COLORADO: Governor Bill Ritter has unveiled another plan to shore up the state’s ever-widening budget shortfall by using federal stimulus dollars as a short-term stop gap. Although $1 billion has been trimmed from the budget since last year, a deficit of $271 million remains. Additional revenue through tax increases is being discussed, but health insurers have not been a part of the discussion.
FLORIDA: The Senate Health Committee and Senator Gaetz have asked the health insurance industry to sign a voluntary compact regarding coverage for cancer clinical trials. The compact would be similar to those signed in Georgia and New Jersey, to which Aetna was a signatory. A preliminary meeting was held last week at which concerns were raised. Aetna will continue to be engaged in these discussions.
KANSAS: Four state lawmakers announced last week that they are co-sponsoring a "Health Care Freedom Amendment" in the form of a Senate concurrent resolution that would add a new article to the Kansas Constitution to "preserve the right and freedom of Kansans to provide for their health care." Essentially the resolution is the first step toward trying to opt out of any potential federal health care legislation. The co-sponsors expressed opposition to a federal health care plan, stating that Washington is ill suited to manage health care. If passed, the resolution will be on the ballot in the fall of 2010. The legislators expressed confidence that they have the votes to pass the measure, but they conceded that many members had yet to be contacted.
MICHIGAN: As the state's budget crisis continues, legislators and engaged groups at the capitol are actively looking for ways to find revenue. Legislators and the Michigan Hospital Association have raised the issue of a 1.8 percent tax on all insurance claims paid, including disability and workers' compensation. There have also been discussions about taking the life, health, and property & casualty guarantee fund(s) reserves, but no concrete proposal has been floated to date. In addition, Public Employee Health Care Reform Committee hearings continue regarding the consolidation of purchasing benefits for public employees in Michigan. To date, over 30 organizations have asked to make public comments. The Speaker said that the proposal is still evolving but that he expects it to expand to include vision, dental and disability/workers' compensation benefits. Approximately $900 million in savings have been projected from administrative savings, economies of scale, "better benefits" and lower costs.
MISSOURI: The Missouri Speaker of the House, Ron Richards, has appointed an Interim Committee on autism spectrum disorders. The Committee will evaluate the impact autism spectrum disorders are having on families in the state. The committee's goal is to identify a solution that considers medical, educational and insurance changes to improve the lives of families dealing with autism. Aetna was very involved with last session's debate over an autism mandate and will continue to have a voice in this interim committee's work. The next Missouri legislative session begins in January 2010.
OHIO: Two bills concerning physician/insurer relationships are moving in the Ohio legislature. A bill that passed out of the House on October 21 specifies that a material amendment to a health care contract does not become part of the contract unless agreed upon by both parties. A different bill passed the House Health Committee on October 14, and its companion bill had sponsor testimony on October 27 in the Senate Insurance, Commerce & Labor Committee. The bill would place various requirements on health insurers that operate a system for physician designations to assign a grade or rating for certain physicians. This bill includes what must be considered in the evaluations, disclosure requirements, appeal rights and legal remedies against an insurer if a provider is adversely affected by a violation of the requirements. It is sponsored by the Ohio State Medical Association. Aetna opposes both measures and continues to discuss what may be agreeable language for physician designation programs.
WISCONSIN: The Office of the Insurance Commissioner (OCI) is working on several regulations and bulletins regarding recently passed laws. The OCI has issued a revised bulletin summarizing the provisions of the 2009-2011 state budget that impact insurance, including: establishing a uniform application for individual major medical policies; expanding independent review rights to adverse findings regarding coverage denial determinations, including preexisting condition exclusion denials and rescissions; requiring an insurer to provide coverage for an unmarried child dependent who is not eligible for other group coverage and is under age 27 or a full-time student regardless of age; and requiring coverage for autism spectrum disorders and contraceptives. Related to implementation of the budget bill, OCI published an emergency rule on September 30, 2009 related to the coverage of treatment for autism spectrum disorders that is effective on Nov. 1, 2009.On issues unrelated to the budget bill, OCI has issued two regulations. First, OCI issued emergency rules providing for eligibility for continuation of coverage under the American Recovery and Reinvestment Act of 2009 (ARRA) for individuals whose group coverage is terminated. Second, the OCI recently issued a proposed rule intended to expand the eligibility requirements for guarantee issue of Medicare supplemental policies and bring Wisconsin rules more closely in line with the NAIC Medicare Supplement Model Regulation. The proposed regulations establish two new categories of eligible individuals for Medigap guaranteed issue; modify current regulations pertaining to Wisconsin's "Plan M and N" look-alike plans to more closely follow corresponding NAIC model regulations; and reintroduce a high-deductible Medigap option.
That the bill going to the floor of the House contains a government plan option is no surprise. But Senate leadership's decision to pursue a government plan option in defiance of the Senate Finance Committee's preference is something of a surprise (see below), given it was perhaps the most bitterly argued reform issue of the summer's town hall meetings. The path ahead in the Senate will not be an easy one, as Connecticut Senator Joseph Lieberman's opposition makes clear. Lieberman is a former Democrat who still caucuses with Senate Democrats and had been counted among a potential 60 filibuster-proof majority. As the issue heats up, expect more debate and media attention on the real ramifications of this controversial provision.
Quoting & Saving just got easier...EasyToInsureME Health Insurance Quotes... Quote all carriers in seconds
Health insurance
Health insurance quote
Federal
Several discrete events occurred this past week that have bearing on the health care reform (HCR) debate. First, Majority Leader Harry Reid boldly moved where he was not expected to go: He announced that a relatively strong form of the public plan, the "opt-out" version, would be in the bill he brings to the Senate floor. Most observers thought Reid would pick a "lighter" form of public plan. However, he clearly wants to keep the Democratic left on board while he works to secure votes on the right, rather than the other way around. Second, within 24 hours, Senator Joseph Lieberman (I-CT) broke ranks publicly and stated flat-out that he would filibuster against Reid's bill because of the government plan option. The Senate is expected to take a week longer to merge its two Committee bills and secure a score from the Congressional Budget Office, which is likely fine with Reid who probably does not have the 60 votes needed to bring the bill to the floor or end a filibuster. The Senate Floor debate is likely to begin around Veteran's Day. On the House side, Speaker Nancy Pelosi has unveiled the merged House bill (1990 pages, $894 billion in costs and rising), setting the stage for an expected vote -- with no real debate and no amendments allowed -- on the House floor late this week. The Speaker likely would not let the bill come to the floor unless she knows she has the votes or she believes can get them.
On related fronts, in order to get the HCR bill below the $1 trillion mark, the Speaker purged it of a $200+ billion item by deleting the Medicare physician reimbursement fix provision and introducing this as a freestanding bill, which has no "pay fors," i.e., it would add to the federal deficit. The Senate has already rejected this freestanding bill approach, which means Congress still has no solution for the impending slashing of 21 percent in doctor Medicare fees in 2010. Separately, Congressman McDermott (D-WA) has introduced a bill to neutralize ERISA's preemption protection by allowing state law causes of action for claims disputes to be processed under state liability law. Aetna would oppose either measure should it gain traction.
States
COLORADO: Governor Bill Ritter has unveiled another plan to shore up the state’s ever-widening budget shortfall by using federal stimulus dollars as a short-term stop gap. Although $1 billion has been trimmed from the budget since last year, a deficit of $271 million remains. Additional revenue through tax increases is being discussed, but health insurers have not been a part of the discussion.
FLORIDA: The Senate Health Committee and Senator Gaetz have asked the health insurance industry to sign a voluntary compact regarding coverage for cancer clinical trials. The compact would be similar to those signed in Georgia and New Jersey, to which Aetna was a signatory. A preliminary meeting was held last week at which concerns were raised. Aetna will continue to be engaged in these discussions.
KANSAS: Four state lawmakers announced last week that they are co-sponsoring a "Health Care Freedom Amendment" in the form of a Senate concurrent resolution that would add a new article to the Kansas Constitution to "preserve the right and freedom of Kansans to provide for their health care." Essentially the resolution is the first step toward trying to opt out of any potential federal health care legislation. The co-sponsors expressed opposition to a federal health care plan, stating that Washington is ill suited to manage health care. If passed, the resolution will be on the ballot in the fall of 2010. The legislators expressed confidence that they have the votes to pass the measure, but they conceded that many members had yet to be contacted.
MICHIGAN: As the state's budget crisis continues, legislators and engaged groups at the capitol are actively looking for ways to find revenue. Legislators and the Michigan Hospital Association have raised the issue of a 1.8 percent tax on all insurance claims paid, including disability and workers' compensation. There have also been discussions about taking the life, health, and property & casualty guarantee fund(s) reserves, but no concrete proposal has been floated to date. In addition, Public Employee Health Care Reform Committee hearings continue regarding the consolidation of purchasing benefits for public employees in Michigan. To date, over 30 organizations have asked to make public comments. The Speaker said that the proposal is still evolving but that he expects it to expand to include vision, dental and disability/workers' compensation benefits. Approximately $900 million in savings have been projected from administrative savings, economies of scale, "better benefits" and lower costs.
MISSOURI: The Missouri Speaker of the House, Ron Richards, has appointed an Interim Committee on autism spectrum disorders. The Committee will evaluate the impact autism spectrum disorders are having on families in the state. The committee's goal is to identify a solution that considers medical, educational and insurance changes to improve the lives of families dealing with autism. Aetna was very involved with last session's debate over an autism mandate and will continue to have a voice in this interim committee's work. The next Missouri legislative session begins in January 2010.
OHIO: Two bills concerning physician/insurer relationships are moving in the Ohio legislature. A bill that passed out of the House on October 21 specifies that a material amendment to a health care contract does not become part of the contract unless agreed upon by both parties. A different bill passed the House Health Committee on October 14, and its companion bill had sponsor testimony on October 27 in the Senate Insurance, Commerce & Labor Committee. The bill would place various requirements on health insurers that operate a system for physician designations to assign a grade or rating for certain physicians. This bill includes what must be considered in the evaluations, disclosure requirements, appeal rights and legal remedies against an insurer if a provider is adversely affected by a violation of the requirements. It is sponsored by the Ohio State Medical Association. Aetna opposes both measures and continues to discuss what may be agreeable language for physician designation programs.
WISCONSIN: The Office of the Insurance Commissioner (OCI) is working on several regulations and bulletins regarding recently passed laws. The OCI has issued a revised bulletin summarizing the provisions of the 2009-2011 state budget that impact insurance, including: establishing a uniform application for individual major medical policies; expanding independent review rights to adverse findings regarding coverage denial determinations, including preexisting condition exclusion denials and rescissions; requiring an insurer to provide coverage for an unmarried child dependent who is not eligible for other group coverage and is under age 27 or a full-time student regardless of age; and requiring coverage for autism spectrum disorders and contraceptives. Related to implementation of the budget bill, OCI published an emergency rule on September 30, 2009 related to the coverage of treatment for autism spectrum disorders that is effective on Nov. 1, 2009.On issues unrelated to the budget bill, OCI has issued two regulations. First, OCI issued emergency rules providing for eligibility for continuation of coverage under the American Recovery and Reinvestment Act of 2009 (ARRA) for individuals whose group coverage is terminated. Second, the OCI recently issued a proposed rule intended to expand the eligibility requirements for guarantee issue of Medicare supplemental policies and bring Wisconsin rules more closely in line with the NAIC Medicare Supplement Model Regulation. The proposed regulations establish two new categories of eligible individuals for Medigap guaranteed issue; modify current regulations pertaining to Wisconsin's "Plan M and N" look-alike plans to more closely follow corresponding NAIC model regulations; and reintroduce a high-deductible Medigap option.
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