Texas Today

This Week in Health Care Reform

After weeks of logjam on Capitol Hill, lawmakers in both the House and the Senate have reported progress in their respective negotiations this week, clearing way for a possible vote on sweeping health care reform legislation after the August recess.

<!– /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:”"; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:”Times New Roman”; mso-fareast-font-family:”Times New Roman”;} a:link, span.MsoHyperlink {color:blue; text-decoration:underline; text-underline:single;} a:visited, span.MsoHyperlinkFollowed {color:purple; text-decoration:underline; text-underline:single;} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} –> EasyToInsureME offers clients the easiest way to buy individual health insurance. Free services include instant online health insurance quotes, custom proposals for each client, free phone consultations, and 10-minute application by phone. Nobody does what we do for our clients!

Public Plan

House Democrats Reach Compromise: After weeks of infighting, House Democrats on the Energy and Commerce Committee came to an agreement on Wednesday that would shave $100 billion off the House bill’s original price tag of more than $1 trillion. The Energy and Commerce Committee resumed marking up the legislation Thursday, but the full House will not vote until after the August recess.

Congressional Budget Office (CBO) on House Plan:  The CBO helped the House Democrats’ case for a public option when it reported that under the proposed legislation , most people would still choose employer-based coverage rather than a government-run option. The CBO stated that, given the individual mandate, more employees would sign up for coverage through their employers. However, the latest analysis also stated that the proposal would still increase budget deficits.

Senate May Choose Co-Op Over Public Option: Senate Finance Committee negotiators indicated that they were close to reaching a bipartisan deal that would include a co-op modeled public plan. The proposal being discussed would include a tax on insurers and would use non-profit cooperatives to compete with private insurers. The proposal would also not include an employer mandate.

Alternative Plans

House Republicans Unveil $700B Plan: On Wednesday, House Republicans unveiled a $700 billion health care plan that would offer tax deductions and credits to assist individuals in purchasing insurance, as well as take on medical malpractice. According to House Republicans, the proposed plan would be fully paid for, but CBO has yet to officially assess the cost of the legislation.

Financing the Plan

New CBO Score on Senate Bill: The Senate Finance Committee got a boost when the CBO estimated the latest version of the Committee’s health reform bill would cost less than $900 billion. The bill would cover 95 percent of Americans by 2015 and would be fully paid for in the first 10 years, according to Finance Chairman Max Baucus (D-MT).

Tax on “Cadillac Plans” Gains Momentum:The Senate Finance Committee’s option to tax insurers on high-value “Cadillac plans” has attracted support in the Senate, and it seems senior House Democrats are warming to the financing proposal. A spokesperson for America’s Health Insurance Plans voiced opposition to the plan, and many assert that a tax on insurers will ultimately be passed down to consumers.

CBO Rates Independent Panel: CBO reported this week that the proposed independent panel to oversee payments by Medicare would result in just $2 billion in savings over 10 years.

Additional Activities

AARP Voices Concern: President Obama held a town hall-style meeting at the American Association for Retired Persons (AARP) Washington headquarters this past week to address growing concerns among seniors about health reform and subsequent cuts in benefits. Polls show that senior citizens are more skeptical about health care reform than any other age group. Consequentially, AARP has had to walk a careful line in endorsing the House bill. Earlier this week, AARP expressed disappointment in the lack of progress in the Senate, saying that Senators have “failed to act.”

Looking Ahead

House lawmakers plan to conclude work this week and break for a month-long recess, returning to their districts to further discuss health reform efforts. The Senate will recess on August 7th.

The House is scheduled to leave town for summer recess on July 31, and the Senate’s current schedule sends them home a week later on August 7. It will be next to impossible for the House to address individual health insurance care reform on the floor in that timeframe, and the Senate Leadership has already put off Senate floor action until September. The focal point in the Senate, the Finance Committee has three options: work out a deal and go to mark-up before the break; put out paper but no mark-up before the break; do nothing now and put it all off until fall. The last option seems to be gaining favor daily and may soon become the choice by default. In the House, the conservative Blue Dog Coalition has the numbers to keep a bill from emerging from the Energy & Commerce Committee, which while not fatal is certainly a wake-up call to Democrats that Congress may be moving too fast on health care reform with little or no real focus on health care costs. The on-again/off-again talks between Blue Dogs and E & C Chairman Waxman broke off at the end of last week with conflicting reports on whether they will resume this week. Technically, House Leadership can proceed to the House floor with approval from only two of the three Committees with jurisdiction. But this would send a very bad signal to the public and could portend even more fireworks on the House floor. The bottom line is that neither chamber of Congress is likely to do anything official before the break, but there could well be a years’ worth of policy and political activity in these last two weeks.

States
CALIFORNIA: The budget plan, which requires a two-thirds vote in the state Assembly and Senate, includes about $15 billion in cuts and some gimmicks to generate revenue in the 2009-10 fiscal year. Next to education, health and welfare programs will absorb some of the largest cuts with $1.3 billion coming out of Medicaid funding and $124 million from Healthy Families, a program that provides health insurance for 930,000 low-income children. The plan borrows about $2 billion from local governments’ property tax revenue, captures $1 billion in redevelopment money from local governments, and temporarily redirects to state coffers $1 billion in transportation funding. Local government groups have told legislators and the media that they will sue the state if these transfers occur. Meanwhile, hospitals are divided over a non-budget related tax proposal designed at drawing down additional federal Medicaid funds. If the proposed two-year fees help generate $2 billion in state funds, California could qualify for an additional $3.2 billion in federal funding. Facilities that either don’t treat Medi-Cal patients or do so on a very limited scale are opposing the measure. Gov. Arnold Schwarzenegger has said in the past that he supports using hospital fees to boost funding for health programs but is non-committal about this bill.

CONNECTICUT: In a special “veto session” held last week, the General Assembly failed to override Governor M. Jodi Rell’s veto of the controversial health care pooling bill but it did succeed in overriding her veto of the SustiNet plan. The pooling bill would have required the comptroller to offer employee and retiree coverage under the state benefit plan to: non-state public employers beginning January 1, 2010; municipal-related and nonprofit employers beginning July 1, 2010; and small employers beginning January 1, 2011. The SustiNet legislation establishes a nine-member Board of Directors to make recommendations to the Assembly by January 1, 2010 for the creation of a SustiNet universal coverage plan by January 1, 2012. The legislature and the governor will have to agree on the issue of self-insurance. SustiNet proposes to make the state liable for all insurance claims, though it is unclear how the revenue would be generated. Estimating the cost of SustiNet at $1.1 billion in 2012, the Governor and Republican legislators said the SustiNet program is simply too expensive, with a projected $8.85 billion deficit looming. Aetna will continue to work with all boards, councils and commissions for real health care reform that improves quality, reduces costs and expands access to insurance.

MARYLAND: The Insurance Administration circulated a draft regulation that would impact payments to non-participating providers under a PPO policy. The proposed regulation would require parity between a member’s in-network and out-of-network cost-sharing responsibility for services provided as 1) emergency care, 2) through a referral, and 3) by a hospital-based physician in a preferred facility. The Commissioner’s position is antithetical to the controlling statutory requirement and his own public statements that insureds are not protected from balance billing in a PPO environment. In addition, the Health Care Reimbursement Task Force, in which the Commissioner participated, considered this issue earlier and decided to make no recommendations regarding PPOs.

MISSOURI: A group of orthopedic surgeons in Springfield has initiated the state-required legal process to achieve an “any willing provider” statute through the 2010 general election ballot. These physicians and possibly other advocates are calling themselves Missourians United for Choice in Health and have reportedly amassed $1.5 million to start the initiative petition process. A coalition of opponents is forming. Aetna is evaluating whether it should be a member of the opposition effort.

NEW YORK: In just two days recently, the Senate passed hundreds of bills previously passed by the Assembly over several months before it adjourned. Health insurance legislation that has gone to Governor Paterson for his signature include bills expanding dependent coverage to age 29, extending COBRA eligibility to 36 months and opening the Family Health Plus program to voluntary employee benefits associations (VEBAs). The Managed Care Reform Act also passed. It would require that a provider be given notice of an adverse reimbursement change to a provider contract and an opportunity to cancel the contract; extend overpayment recovery limitations to all health care providers and permits them to challenge such recoveries; require that providers moving to New York be provisionally credentialed until the final credentialing determination is made; shorten utilization review timeframes for post-hospital home health care services; allow providers to appeal concurrent adverse determinations through the external appeal process; and establish a new external appeal standard for rare disease treatments. The bill also would authorize the Superintendent of Insurance to require that mandated submissions be filed electronically and lower the prompt-payment-of-claims threshold to 98 percent, rather than the current zero-tolerance policy. Bills that failed to pass include prior approval of claims and 85 percent medical loss ratio legislation.

NEW JERSEY: Neil Jasey has was named interim commissioner for the Department of Banking and Insurance. This was a surprising development given the indeterminate nature of the post, due to the upcoming gubernatorial election. Mr. Jasey spent more than 25 years with Prudential serving as general counsel prior to his retirement in 2004. His wife is a current assemblywoman running for reelection.

NORTH CAROLINA: The Governor has rejected a budget compromise that did not include an increased premium tax increase. So it is back to the drawing board and, in all likelihood, another extension of the legislative session. Last month, the Budget Committee of the legislature introduced a proposal to increase the premium tax across all lines of business from 1.9 percent to 2.25 percent effective January 1, 2011. Strong opposition to the tax increase helped take it off the table, but things could change as legislators search for a new budget solution.

OHIO Health Insurance : The state’s budget crisis concluded with Governor Strickland signing a compromise bill that includes a provision placing the contentious and heavily partisan video lottery terminal issue on the November ballot. Bill provisions affecting health care plans include: extending coverage to dependent children up to age 28; transferring oversight of health plans’ network adequacy from the Department of Health to the Department of Insurance; expanding the open enrollment program for individuals with a more gradual reduction in the rate cap; requiring a health insurer to cover a service if the Director determines it is a covered service; requiring a carrier to conduct an external review automatically upon notification by the Director that determination of coverage involves a medical issue; requiring electronic payment of electronically submitted provider claims; submission to the Director of an annual report detailing components of administrative expenses by line of business; requiring filing of small employer premium rates; and requiring employers of 10 or more to offer Section 125 plans. An autism mandate was removed.

Last week will go down as a truly significant week in health care reform. The House leadership unveiled its 1,000+ page bill and announced that the three committees of jurisdiction would immediately begin mark-up sessions designed to get a composite bill to the House floor by the end of July. Late last week the House Ways and Means Committee approved the House bill 23 to 18 — all of the Republicans and three Democrats on the committee voted against. The House Education and Labor Committee did likewise a short time later. Roughly $544 billion in funding is to come from tax increases on families making more than $350,000. On a straight party line vote (13-10), the Senate HELP Committee reported out its health care reform bill, which includes both individual and employer coverage mandates, gateways (aka exchanges) to provide a place to find and acquire health coverage, a public plan backed by the federal government and a number of quality, prevention and wellness provisions. The bill is estimated to cost $645 billion, though not all the pieces have been scored (e.g., the Medicaid expansion provision). The focus now turns to the Senate Finance Committee to see whether Chairman Baucus can forge the bipartisan compromise he has been seeking. All of this activity was thrown into high gear by President Obama who on several occasions last week promoted health care reform and publicly lit a fire under Congress to get it done by the August break.

States
CALIFORNIA Health Insurance : Governor Arnold Schwarzenegger and legislative leaders are expected to announce a budget deal aimed at closing the state’s $26 billion budget shortfall. The deal appears to include no new taxes beyond those that were passed in February but will rely on more cuts to health care services and general government expenditures. Reports indicate the state will limit enrollment for Healthy Families – the state’s Children’s Health Insurance Program — but not eliminate the program entirely. Additional cuts to Medi-Cal have been rejected, partially due to mandatory requirements under federal law. The budget plan also is expected to shift more Medi-Cal beneficiaries into systems of care or managed care programs. This proposal has been recommended by the Governor before but rejected by legislators and consumer advocates. The Governor is recommending creating a centralized Internet-based system to manage eligibility for state-funded health care and other public assistance programs. The push to include the consolidated system is likely to require significant start-up costs but ultimately would reduce state spending by $500 million annually.

CONNECTICUT Health Insurance : The House of Representatives has scheduled a veto session for this week to possibly take up some of the bills vetoed by Gov. M. Jodi Rell this year. The Governor has vetoed 19 bills to date and can be overridden by a two-thirds vote in both chambers of the General Assembly. The Senate also is expected to come in today. Aetna supports the Governor’s vetoes of four health care bills: the SustiNet bill, the pooling bill, the mega-mandate bill and the anti-rescission bill. The SustiNet and the Healthcare Partnership bills would have expanded the government bureaucracy but ultimately would do little to improve health care and costs. In the case of SustiNet, full implementation would cost the state about $1 billion a year. In addition, creating an expensive framework for a state government-run health plan without the benefit of the fast-moving federal health care reforms could require the state to dismantle and overhaul any actions taken prematurely. Connecticut members of the Aetna Citizen Action Network mobilized in support of the Governor’s vetoes, contacting 188 legislators with over 1,900 letters and numerous phone calls. The 7-mandate package would raise health care costs by significantly adding to Connecticut’s already long list of mandated health care benefits, and the anti-rescission bill would increase the likelihood of insurance fraud, raising costs for everyone.

KENTUCKY Health Insurance : Democratic Governor Beshear is making a couple of appointments that could be aimed at changing the balance of power in the Republican-controlled State Senate. He announced the appointment of Senator Charlie Borders to the Public Service Commission and is expected to appoint Senator Dan Kelly, the Republican Majority Leader, to an open judgeship. Coupled with the retirement of Senator Gary Tapp, these appointments could potentially shift the Senate from a Republican majority to a slight Democratic majority. The gains on the Democratic side are not necessarily a given, as the open seats would be filled by special election. The Governor is trying to remove roadblocks to the implementation of the administration’s plan to add slots at racetracks.

ILLINOIS Health Insurance : The General Assembly has adjourned after sending Governor Pat Quinn a budget very similar to an earlier version. The Governor was able to gain a higher percentage of funding for social services (from 50 percent to over 80 percent of the 2008 allotment), and he received authority to spend an additional $1 billion at his discretion. The legislature will take 12 unpaid furlough days, which is the equivalent of a 5 percent reduction in pay. Tax issues will be taken up in the fall or in January 2010.

MASSACHUSETTS Health Insurance : A coalition of small business associations, chambers of commerce and the Massachusetts Association of Health Plans (MAHP) have proposed the Affordable Health Plan – a product designed for small businesses and individuals that they project would decrease premiums by up to 22 percent. The proponents admit that this proposal does not address the over utilization of services that is responsible, in part, for ever-increasing medical costs. A Massachusetts state panel is in the process of developing a long-term reform of the health care payment system. However, their recommendations, when final, may take up to five years to implement. The Affordable Health Plan approach is supported by State Senator Richard T. Moore and State Representative Harriett L. Stanley, co-chairs of the Legislature’s Joint Committee on Health Care Financing. The Affordable Health Plan would create a new product with benefits actuarially equivalent to Commonwealth Choice Bronze Level coverage, be available to all small employers (50 or fewer) and individuals, be purchased through or outside the Connector, establish a statutory rate cap on reimbursements to all providers at no more than 110 percent of Medicare for all covered services for this product other than outpatient pharmacy benefits, and establish a minimum medical loss ratio of 85 percent.

MICHIGAN Health Insurance : Speaker of the House Andy Dillon has unveiled a plan to cut public employee health care costs and estimates it would save the state between $800 and $900 million dollars a year. Speaker Dillon is urging immediate action to help address the state’s projected $1.7 billion deficit for 2010. The plan calls for consolidation of more than 2,000 plans that are scattered across the state to one state plan for public school employees, all units of government, state police, and the legislature — affecting an estimated 400,000 people. Beyond consolidation of health plan delivery and administration, the plan calls for quality and cost reduction measures and for standardization of benefit plan designs. The proposal would impact current employees and retirees. The plan is drawing mixed reactions and a neutral reception from the Speaker’s own Democratic caucus and the Democratic governor. The state’s largest teacher’s union, the Michigan Education Association announced immediate opposition to the plan. Mike Cox, the Michigan Attorney General, issued a press release indicating the proposal deserves serious consideration. The collateral issue of how this would affect the work being done in both chambers on individual market reform and how this proposal may align with pending federal reform are just some of the questions being raised.

NEW JERSEY Health Insurance : The resignation of New Jersey Department of Banking & Insurance Commissioner, Steven Goldman, became effective last week. Governor Corzine is not expected to name an acting commissioner prior to the November election. In the absence of a designated commissioner, Division of Insurance Director Douglas Wheeler will act as commissioner on insurance matters, and Division of Banking Director Terry McEwen will have oversight of banking matters.

OHIO Health Insurance : The state’s budget crisis is nearing resolution as Governor Strickland received a new budget proposal on July 14. Movement in the negotiations was achieved through the Governor’s willingness to place the contentious video lottery terminal issue on the November ballot. The conference committee report includes the following recommendations: extend coverage to dependent children up to age 28; expand the open enrollment program for individuals with a more gradual reduction in the rate cap; require a health insurer to cover a service if the Director determines it is a covered service; require a carrier to conduct an external review automatically upon notification by the Director that determination of coverage involves a medical issue; require electronic payment of electronically submitted provider claims and prohibit providers from refusing to accept electronic payments; submission to the Director of an annual report detailing components of administrative expenses by line of business; require filing of small employer premium rates; and require employers of 10 or more to offer Section 125 plans. The autism mandate that was part of the House version of the budget was removed.

PENNSYLVANIA Health Insurance : Last week the House Appropriations Committee amended and passed, on straight party lines, a bill that sets forth the House Democrats’ spending portion of the budget. As expected, it incorporates revenues based on a 2 percent tax on all managed care products. As the budget impasse continues, Aetna continues to make the case that the administration’s tax is inequitable. In other news, an oral oncology coverage bill was introduced last week. The bill is backed by the American Cancer Society in conjunction with Glaxo SmithKline, which wants enhanced coverage of its oral chemotherapy drug.

WISCONSIN Health Insurance : Governor Jim Doyle has signed the 2009-11 state budget, and it includes various industry-related provisions: An autism mandate with minimum benefit limits of $50,000 per year for intensive services for a minimum of four years and $25,000 per year for non-intensive services; all commercial health insurance policies and all self-insured government health plans must offer coverage for an adult, unmarried child less than 27 years old or a full-time student, regardless of age; a mandate to cover outpatient health care services, preventive care and coverage for drugs or devices approved by the FDA that are prescribed by a health care provider to prevent pregnancy; outpatient consultations, examinations, procedures and medical services that are necessary to prescribe, administer, maintain or remove the contraceptives must also be covered. Small group and individual insurance market reforms include: a mandatory uniform application for individual health insurance; limit the “look back” period for pre-existing condition exclusions to 12 months before the effective date of coverage for individual health insurance policies; a reduction of the pre-existing condition exclusion period from a maximum of two years to a maximum of 12 months; and requirements for insurers to establish an independent review for rescissions and pre-existing condition denial determinations, in addition to adverse determinations or experimental treatment denial determinations.

Simply evaluating individual health insurance coverage.

Keep it simple

Simple is easy to put it if you know what to look for in your individual health insurance plan. To be a good plan the usual person likes to have copays for health care services such as doctors, emergency room visits, medicine, and annual routine checkups for preventative care. A small cost in the grand scheme of things when being admitted to the hospital is also a great feature this is called a deductible. The great thing about copays is that once you pay that set amount you do not pay a cent more and the services that have copays are the most utilized health care services. The less utilized services are ones such as x-ray, lab tests, and admittance to the hospital with an overnight stay. You pay for these services until your annual deductible is met for the year, which is a small price to pay in the grand scheme of things.

What should I choose?

Based upon comfortability and the amount of risk you are willing to take is the real question here. At age 40 you will need better individual health insurance coverage with a lower deductible. However, from age 18 to 30 a higher risk plan will fit perfectly.

Age 18-30

Being young is great and a lot less risky to your health. EasyToInsureME recommends that young adults in this age group select a higher deductible plan with copays for doctor visits, emergency room, and medicine. Everyone gets the common cold and has to go to the doctor once in a while and get medicine. These services are fully covered. To keep the individual health insurance affordable and since there is less risk with being young, this age group can afford to have a deductible around $2500 or less for hospital stays. For a male this insurance will cost less than $100 per month.

Ages 31-40

Family health insurance and individual coverage at this age can be affordable if you work with a knowledgeable broker that offers every plan in your area like EasyToInsureME. Most families in the U.S. pay 1200-1800 per month for their health care. At EasyToInsureME you will pay between $300 and $700 for your family health insurance plan. How is this possible? Well, people in this age group have finally secured a job and are receiving benefits from work. The benefits from work cost thirty percent more than if your family had their own plan. The reason why is because the amount of people the risk has been assessed to.

Ages 41-65

Getting older is a great gift but can be a burden on your health. This is why EasyToInsureME recommends the best of individual health insurance plans during these years. A great plan will cost about $300 per month and can provide you with the best of care at a very low cost. Along with low medicinal and doctor copays. These plans are built to lower risk and provide low costs for all healthcare services.

P.s.

EasyToInsureME offers clients the easiest way to buy individual health insurance. Free services include instant online health insurance quotes, custom proposals for each client, free phone consultations, and 10-minute application by phone. Nobody does what we do for our clients!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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