Texas Today

This Week in Health Care Reform

This week, Sen. Ted Kennedy, longtime champion of universal health coverage, died at age 77. It remains to be seen how his death will affect the debate over health care reform as Democrats continue efforts without his guidance. Sen. Kennedy was involved in nearly every piece of health care legislation that moved through Congress during his eight-term Senate tenure. In a statement, House Speaker Nancy Pelosi (D-CA) said, “Ted Kennedy’s dream of quality health care for all Americans will be made real this year because of his leadership and his inspiration.”

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Health Reform Activities

Obama Pledges Health Care Reform: This week, after much infighting over the fate of the public option, President Obama reaffirmed his commitment to health care reform legislation, suggesting that he would be willing to bypass the GOP. As Democrats consider a wide range of strategies for getting a health reform bill passed, other key senators called for the President to move more slowly as concerns over the growing deficit and the economic recession remain.

Republicans Launch Senior Health Care Bill of Rights: On Monday, the Republican National Committee introduced a “seniors’ health care bill of rights,” which outlines six principles for health care reform. Examples of the principles include protecting Medicare, prohibiting rationing of health care based on age, and making sure the government does not come between seniors and their physicians.

Democrats Launch National Grassroots Offensive: In an effort to show lawmakers that a majority of Americans still support an overhaul of the health care system amidst growing public concern, the Democratic National Committee’s grassroots arm launched a national campaign effort Wednesday. The Democratic Organizing for America, in partnership with the organization Health Care for America Now, expects to hold more than 500 events across the country by early September, when lawmakers return to Washington.

New Divides Emerge in the Senate: Aides have indicated that as Senate Finance Committee negotiators work to trim costs of their bill, new divisions are emerging between Republican and Democratic Senators over proposals to reduce the size of insurance tax credits to families and scale-back insurance coverage mandates. The committees, also known as the Gang of Six, rejected imposing deadlines on their efforts to reach bipartisanship legislation and agreed to talk again September 4th.

$1.2 Billion Allocated for Electronic Medical Records: Last week, Obama Administration officials announced that $1.2 billion in federal grants will be available for electronic health record systems. This is the first in a wave of funds allocated by the American Recovery and Reinvestment Act of 2009 to create record-sharing networks. The grant is part of the $36 billion originally included within the stimulus legislation to encourage adoption of electronic medical records by hospitals and doctors.

Looking Ahead

Lawmakers are slated to return to Washington on September 8th.

Week of August  24 , 2009 : EasyToInsureME

With opposition to a government-plan option evident at many health care reform town hall meetings this summer, an alternative option based on private regional cooperatives is now getting a lot more serious attention. In fact, Senate Finance Committee member Senator Mike Enzi (R-WY), part of a six-member team that continues to try to achieve a bipartisan agreement throughout the Congressional recess, said last week that he could support a co-op provision. However, the co-op idea has its detractors and is still not well defined. Aetna Chairman and CEO Ron Williams was asked last week about co-ops and other facets of health care reform during an interview televised on PBS’ Newshour with Jim Lehrer. To see the interview and hear his thoughts about the latest developments in health care reform, click here.

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

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!

States
CALIFORNIA: Legislation to initiate a health insurance tax to fund the state’s high-risk pool has been shelved for the year. The tax would have required all health insurers to be assessed up to $1 per member per month across each company’s entire book of business, including self-funded clients. Aetna led the opposition to this tax, which has been proposed in the past by California-domiciled health insurers and HMOs. Aetna argued that funding a high-risk pool should be broad-based and not single out one industry, nor should it tax employers that do not purchase insurance but instead choose to fund health benefit arrangements in-house. The concept of funding high-risk pools by tapping employer’s self-funded arrangements was proposed but ultimately withdrawn or defeated in Oregon, Maine and Colorado this year as well. It is anticipated that these states will revisit the legislation in 2010.

NEW YORK: Governor Paterson’s office is again outlining its priorities for federal health care reform for New York’s congressional delegation and is signaling its intent to maintain or strengthen the state’s role in regulating health care benefits. The Governor’s office is emphasizing a need for any insurance exchange program to ensure a level playing field between the exchange and non-exchange insurers; the view that the federal law should be a floor and not a ceiling; and that there should be concurrent jurisdiction of the federal and state governments to regulate the insurance industry. In addition, Governor Paterson appointed James Wrynn as the new superintendent of insurance. The Senate is expected to act on this and other appointments in a one-house special session on Sept. 10.

TEXAS Health Insurance : In a press conference held last week, Governor Rick Perry emphasized the importance of state-developed health care reform rather than the costly, expansive, one-size-fits-all mandates being considered by the federal government. The Governor expressed concern over the potential loss of a state’s ability to develop solutions tailored to the unique needs of its citizens. He further argued that current federal health care reform legislation would pose a serious threat to patients and providers, and would cost Texas taxpayers tens of billions of dollars over the next 10 years, without significantly improving care for Texans.

Week of August 17, 2009 : EasyToInsureME

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

Federal

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

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

States

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

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

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

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

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Health Reform Activities

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

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

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

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

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

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

Opinion Polls

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

Advertising Activities

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

Financing the Plans

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

Looking Ahead

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

Even as partisan rhetoric swirled even stronger around the subject of health care reform, the Senate Finance Committee continued its health reform negotiations last week in what is the last hope for a bipartisan bill from Congress. Senators left Washington late last week to start their August recess, but Finance Committee members have vowed to continue negotiations throughout the month. A bipartisan group of six Senators on the Committee, led by Chairman Max Baucus, briefed President Obama on their work Thursday, and they also conducted a conference call with a dozen governors. The emerging legislation would expand Medicaid coverage to millions of additional people, and the governors are concerned about the impact on state budgets. No details of the still-developing proposal have been officially released, but participants have indicated the package could shave $100 billion off the cost of the legislation over the next decade, providing coverage to 94 percent of the nation, expanding Medicaid, abandoning the government-insurance option and possibly replacing it with a state-based co-op plan, and taxing insurance companies that offer health care benefits under the richest plans. Baucus has set a Sept. 15 deadline for a bipartisan deal.

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!

States
ARIZONA: The State Senate last week postponed a vote on a plan to close the state’s estimated a $3.2 billion budget deficit using spending cuts, funding delays, borrowing, and federal stimulus funds. Approved by the House on July 31, the plan’s health-related provisions include: eliminating the KidsCare Parents Program; reducing AHCCCS (Medicaid) reimbursement rates to non-institutional providers by 5 percent but not reducing AHCCCS reimbursement rates to institutional providers; delaying one month’s capitation payment to AHCCCS contracted health plans; and requiring AHCCCS to comply with the federal False Claims Act.

NORTH CAROLINA: In a very positive development, a new budget was issued by the legislature last week that includes no premium tax increases. Previous budget proposals included increases from 1.9 to 2.25 percent, effective January 2011. Aetna, along with other carriers and trade associations, worked to educate legislators and oppose a premium tax increase. A final vote on the budget is expected soon.

OREGON: Governor Ted Kulongoski has signed legislation enacting a 1 percent premium tax that will be used to expand access to affordable health care for children. The premium tax will be assessed beginning October 1, 2009 through September 30, 2013. Rate filings submitted for approval may include the premium assessment as a valid administrative expense or retention element. The law also establishes the Health Care for Oregon Children program, which includes an expansion of SCHIP and a premium assistance program administered by the Office of Private Health Partnerships (OPHP). Under the premium assistance program: Children in families with incomes at or below 200 percent of the federal poverty level (FPL) and who have access to employer-sponsored coverage will receive a subsidy equal to the full cost of the premium; children in families with incomes above 200 percent but at or below 300 percent of FPL will receive assistance on a sliding-scale basis as determined by the OPHP; and children in families with incomes exceeding 300 percent of the FPL will not receive premium assistance but will have the opportunity to purchase coverage through the new OPHP private health option.

TEXAS Health Insurance : With Dallas saddled by the most expensive health care in the state, Mayor Tom Leppert and a local health insurer last week took a step toward changing the city’s direction. They are working on scheduling a North Texas health care summit on Sept. 30 at which company and government executives hope to agree on payment, practice and transparency fixes leading to greater competition based on quality and cost efficiency. In its national quality-to-cost ranking, Texas is rated third worst, behind Mississippi and Louisiana. Dartmouth Institute for Health Policy data indicates that on average Dallas health care providers submit $10,100 in Medicare claims for every enrollee, the highest among Texas cities with more than 50,000 residents. Dartmouth’s data shows that higher health care spending is not associated with better quality outcomes.

This Week in Health Care Reform

The debate over health care intensified this week as House members returned to their districts and the Senate prepared to adjourn for the remainder of August. Many House members held town hall meetings with constituents this week, adding fuel to the health care debate.

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

Public Plan

House Committee on Energy and Commerce Completes Markup: After weeks of negotiation, the House Energy and Commerce Committee was the last of three House committees to complete work on sweeping health care reform legislation. The committee approved the bill on a vote of 31-28, with all Republicans and five Democrats voting against the bill. The vote clears the way for the legislation to move to the House floor.

Alternative Plans

Senate Finance Committee Delays Until September: Senate Finance Committee members confirmed that they would not complete a draft bill before the August recess and that negotiations would continue into September. After a meeting with President Obama Tuesday, Senate Finance Committee Chairman Sen. Max Baucus (D-MT) has set a mid-September deadline for completion of a bipartisan bill. President Obama pressured Senate Democrats to move forward with health care reform if a bipartisan bill cannot be reached; he vowed Wednesday to get a reform bill through Congress this year even without Republican support. President Obama will meet with six negotiators from the Committee Thursday at the White House to discuss the bipartisan bill.

Financing the Plan

Obama Renews Pledge to Not Raise Middle Class Taxes but Remains Open to Taxing Health Insurance: White House officials scrambled to retract statements made by top economic advisors last Sunday, indicating that a tax increase on the middle class is an option to pay for health care reform. However, President Obama remains open to a proposal to tax health insurance.

Additional Activities

Democrats Criticize Insurance Industry: Democrats increased criticism aimed at the insurance industry, with House Speaker Nancy Pelosi accusing insurers of “immoral” profiteering. America’s Health Insurance Plans President Karen Ignagni quickly fired back , saying the health insurance industry “[does] not deserve to be demonized or vilified as part of a campaign to distract attention away from the sinking support for a government-run program.”

Debate Moves Outside the Capitol: The health care reform debate has moved outside the Beltway, with tactics ranging from town hall meetings and other grassroots efforts to advertising. Groups on both sides of the debate are mobilizing their constituencies to participate in local events and make direct contact with members of Congress in a battle over public opinion.

Administration officials and Democratic members of Congress are in the process of conducting town hall meetings across the country. In recent days, however, meetings in Pennsylvania, Wisconsin and Texas have spurred protests over details of the reform proposals. Democrats are accusing Republicans of organizing “angry mobs,” while Republicans indicate that the protests are signs of opposition.

According to the Campaign Media Analysis Group, more than $52 million has been spent nationwide this year on health care reform-related advertising. But as legislators return home for the August recess and the reform dialogue shifts to outside the Beltway, political groups are also shifting advertising emphasis from national cable news channels to local channels throughout the country.

Public Polls Show Rising Concern: As details of a potential health care overhaul take shape, public opinion polls show declining support. In a New York Times/CBS poll, 69 percent of Americans are concerned their care would suffer if they were on a government-run plan. A Wall Street Journal/NBC News poll reports that 42 percent of those surveyed in July thought Obama’s health care plan was a bad idea, up from 32 percent in June.

Looking Ahead

Senators will adjourn for August recess Friday, with many continuing the health care debate in their home states.

As Democrats work to gain support from the American public, and Republicans continue to voice concerns, the health care messaging battle will continue to heat up.

Federal
As mightily as it has tried over the last week, Congress has only marginally moved the needle on health care reform. The Finance Committee will go home for the recess without a deal but with a promise to continue negotiating during the break, and with a target date of September 15 for Committee action. In the House, the Blue Dog Coalition of 52 conservative Democrats put a halt to the Energy & Commerce Committee’s process for 10 days when seven coalition members refused to proceed without concessions and compromises on the House health reform bill: a public plan that is optional to providers and that negotiates rates; preservation of the role of agents/brokers; keeping the bill under $1 trillion; and allowing state-based exchanges. The compromise reached allowed the committee to continue its mark-up and ultimately approve the bill. There are 50 additional amendments that the Committee intends to address prior to floor debate in the Fall. The House will try to meld all three Committee versions into one bill in anticipation of a full House debate and vote in September, at the earliest. The Blue Dogs have made it clear that the larger coalition of 52 has not signed off on anything and that the compromise was chiefly designed to allow the Committee process to proceed. No sooner was the Energy & Commerce Committee/Blue Dog compromise struck when opposition came from both the House progressive caucus and the Congressional Black Caucus. The bottom-line is that neither the House nor the Senate will be voting as a Chamber on health care reform until the Fall, when there will be a major confrontation of all competing interests.

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!

States
ILLINOIS: The Illinois Department of Insurance (DOI) published second notice of proposed rulemaking regarding regulation of Preferred Provider Programs that will be considered for adoption by the Illinois Joint Committee on Administrative Rules (JCAR) on August 18. These rules affect both insurers and network administrators that offer incentives to insureds to utilize the services of contracted providers. For example, new network adequacy language would require that when a beneficiary has made a good faith effort to utilize network providers for a covered service but the appropriate preferred specialty providers are not under contract, then the administrator shall ensure that the beneficiary is provided the covered service at no greater cost than if the service had been provided by a preferred provider. Aetna is currently evaluating the proposed rules.

NEW YORK: The Departments of Health and Insurance released their report by the Urban Institute that examines several proposals to reform the state’s health insurance system. The study analyzes the cost and coverage implications of: 1) the Public-Private Partnership proposal that would simplify and expand existing public programs and reform private health insurance; 2) New York Health Plus, which would give all New Yorkers an option to enroll in Family Health Plus; 3) Public Health Insurance for All, a single-payer public health insurance option; and 4) the Freedom Plan, an option that relies on regulatory flexibility and tax credits. Due to the growing state deficit and interest in federal reform, no immediate action is expected on these proposals. However, legislation based on one or more of the models is likely to be introduced, or reintroduced in 2010.

The report’s key findings include: Three of the four proposals would cover all New Yorkers. The Freedom Plan would leave 13.3 percent of New Yorkers uninsured, down from the current 15.8 percent. There would be minimal change in employer-based coverage under the Public-Private Partnership and the Freedom Plan proposals. However, employer coverage would drop significantly under New York Health Plus and end altogether under Public Health Insurance for All. The individual insurance market would cease to exist under Public Health Insurance for All and New York Health Plus. Individual coverage would increase under the Public-Private Partnership and the Freedom Plan. Post-reform expenditures by employers and individuals would also vary widely. Under Public Health Insurance for All, employer and individual spending would be eliminated. New York Health Plus would reduce both individual and small employer spending. Individual spending would remain constant under the Public-Private Partnership proposal while small employer spending would drop slightly. The Freedom Plan would increase individual spending but somewhat reduce small employer spending.

OREGON: Oregon’s health care reform efforts this year included passage of a 1 percent premium tax on health insurers. Recently, the Division of Insurance offered a draft opinion that the tax should be collected on group policies issued in Oregon and polices issued in other states that cover Oregon residents. The Division opinion is contrary to longstanding NAIC guidance and would result in the imposition of a double-tax on all group policies, as well as administrative hurdles in tracking where individuals reside. Aetna is working with the Division in the hopes of modifying this opinion.