Texas Today

Making Health Insurance Shopping Easier

Buying individual health insurance on the EasyToInsureME site is very simple. When individuals and families get quotes on the site they will be provided with every carrier available in the U.S. and all the plans that come with them. This includes full brochures and documentation of each and every plan along with a search tool for participating doctors. To apply, an apply button is next to each plan and this will forward the shopper directly to the carrier’s website to submit an application. EasyToInsureME cannot view your private information it is secured with the carrier. (Read the rest of Buying individual health insurance here)

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.

DECEMBER 23, 2009

This Week in Health Reform

Senate Majority Leader Harry Reid (D-NV), may just reach his goal of getting a health care reform package approved by the Senate by Christmas. This past week, Sen. Reid clinched the 60th vote needed to pass the legislation. As of this communication, he has scheduled the final Senate vote for 7 a.m. on Christmas Eve day. In an effort to shore up votes, Sen. Reid and his colleagues struck deals to overcome hot-button issues such as abortion funding.

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Senate Negotiations

Senate Eyes Finish Line: After weeks of rancorous debate and more than 20 straight days and nights spent negotiating on Capitol Hill, Senate lawmakers cleared all three major procedural hurdles prior to a final vote on the legislation.

* The first procedural motion passed on a 60-40 vote early Monday morning , ending debate on Sen. Reid’s proposed amendments, called the “manager’s package,” and cutting off a Republican filibuster. The “manager’s package” represented a series of last-minute deals and compromises to shore up support for the legislation.
* The second procedural motion to approve the “manager’s package” passed 60-39 on Tuesday morning.
* The third motion came Wednesday and ended debate on the final legislation in a 60-39 vote, setting up the reform bill for a final vote just in time for Sen. Reid’s Christmas deadline.

Sen. Reid Carves Out State-Specific Deals to Secure the 60 Votes: On Saturday, Sen. Reid secured the 60 votes needed to pass the historic legislation, winning over Sen. Ben Nelson, (D-NE), with an amendment to prevent federal subsidies from being used for abortions. Under the new abortion provisions, states can opt out of allowing coverage for abortion. If states do offer coverage, enrollees must pay for abortion coverage separately – a compromise that has sparked criticism from both sides of the abortion divide. Sen. Nelson also secured other benefits for the state of Nebraska, including:

* Millions of dollars from the federal government to pay for the proposed cost of the Medicaid expansion in his state; and
* An exemption for Blue Cross Blue Shield of Nebraska from an annual fee on insurers.

Throughout his amendment package, Sen. Reid included several other state-specific deals to secure the 60 votes. Such last-minute deals have been criticized by Republicans, including:

* For Sen. Max Baucus, (D-MT), the package included a provision to help 2,900 residents of Libby, Mont., sign up for Medicare benefits. Many residents have asbestos-related illnesses;
* For Sen. Christopher Dodd, (D-CT), it included a measure to provide $100 million for the construction of a hospital at a public university;
* Sen. Patrick Leahy, (D-VT), negotiated for $600 million in additional Medicaid benefits for his state over 10 years;
* Sen. Bernie Sanders, (I-VT), got a $10 billion increase for community health centers over a number of years;
* Sen. Mary Landrieu, (D-LA), procured at least $100 million in 2011 from the federal government for help with Medicaid; and
* For Sen. Bill Nelson, (D-FL), the package included a measure allowing some 800,000 Florida senior citizens currently enrolled in private Medicare Advantage plans to keep their extra benefits.

Sen. Reid’s negotiations also included:

* The removal of a 5 percent tax on elective cosmetic surgeries, and the inclusion of a 10 percent tax on indoor tanning services;
* 12 years of patent protection for the makers of brand-name biotech drugs;
* An increase in the Medicare payroll tax percent of an additional 0.9 percent of income for those making $200,000 as an individual and $250,000 for couples;
* An exemption from taxes on high-value insurance plans for those with certain professions, such as firefighters, policemen, construction workers, emergency first responders and longshoremen;
* A provision allowing for doctors and hospitals in Montana, North Dakota, South Dakota, Utah and Wyoming to get paid more than providers elsewhere; and
* About $1 billion extra in Medicaid payments for visiting nurses and other in-home or community services.

CBO Updates Estimates on Health Care Bill’s Impact: In a letter sent to Sen. Reid, the Congressional Budget Office (CBO) said that it had over-estimated the latest Senate health care bill’s impact on deficit reduction during the second decade of enactment. The original estimate indicated the overhaul would yield deficit reductions by one-half percent of GDP; the revised estimates indicate a reduction of between one-quarter and one-half percent of GDP. The CBO confirmed that its estimate over the first 10 years remains accurate, reducing the deficit by up to $132 billion by 2019.

However, in a Wednesday letter to Sen. Jeffery Sessions, (R-AL), the CBO indicated that the current Senate bill may potentially double count the savings from Medicare as a means to pay for the Senate health care bill. In the letter, CBO Director Doug Elmendorf writes: “The key point is that the savings to the (Hospital Insurance) trust fund under the (Patient Protection and Affordable Care Act) would be received by the government only once, so they cannot be set aside to pay for future Medicare spending and, at the same time, pay for current spending on other parts of the legislation or on other programs.” Republicans quickly jumped on the letter as proof that the Senate’s bill will not decrease the federal deficit over time, but rather add to it.

Late last week, the CBO estimated that the revised Senate bill will cost $871 billion over the next decade to extend coverage to the uninsured. It would dramatically expand Medicaid and offer federal subsidies to those who lack affordable coverage through employers. The nation will pay for the overhaul with about $400 billion in new taxes and about $500 billion in cuts to programs such as Medicare.

Sen. Snowe Indicates “No” Vote: Despite many weeks of negotiations with Republican Sen. Olympia Snowe of Maine and several one-on-one meetings with President Barack Obama, Sen. Snowe indicated that she will vote against the Senate’s legislation without significant changes. Sen. Snowe has been a pivotal figure in the health care reform debate as the only Republican to have voted for the Senate Finance Committee’s bill, which passed in October. The loss of Sen. Snowe’s support comes as a blow to Democratic leaders who were hoping to achieve some level of bipartisan support.

Other Activities

AMA, AHA, AARP and FAH Show Support; AHIP Opposes: On Monday, both the American Medical Association (AMA) and the American Hospital Association ( AHA) sent letters to Sen. Reid indicating support for the latest version of the Senate health care bill, while highlighting requests for changes. The AMA, for example, hopes to see changes to the independent board that would be created to slow the growth of Medicare costs. Among other adjustments, the AHA requested a change that would lower Medicare payments to hospitals with high readmission rates. Endorsements also came from AARP and from the Federation of American Hospitals (FAH). In contrast, a statement Friday from America’s Health Insurance Plans (AHIP) voiced opposition to the bill, citing cuts to Medicare Advantage programs and caps on insurers’ administrative costs as problematic.

Public Opinion

December Polls Show Americans Disapprove: As a final vote on the Senate’s health care reform package nears, Americans are increasingly wary of its impact. The December Kaiser Health Tracking Poll found that:

* Only 35 percent of Americans said they would personally be better off if health care reform passes – down from 42 percent last month;
* Only forty-five percent of voters said the country would be better off with health reform – down from 54 percent last month.

The latest poll results released Tuesday from Quinnipiac University show that:

* Americans “mostly disapprove” (53 percent to 36 percent) of the Senate’s plan;
* A majority (56 percent to 38 percent) disapprove of President Obama’s handling of health care reform;
* Voters oppose (72 percent to 23 percent) using any public money in the health care overhaul to pay for abortions;
* Americans support (56 percent to 38 percent) giving people the option of coverage by a government health insurance plan; and
* A majority (64 percent to 30 percent) support allowing younger people to buy into Medicare.

As a volatile year in health care reform comes to a close, an average of monthly polls since April shows that 82 percent of Americans say an overhaul of the nation’s health care system is important for recharging the economy. However, in the most recent Robert Wood Johnson Foundation poll taken in November, 60 percent said an overhaul will not affect their personal access to health care or their family finances, and only about 40 percent said a revamping will improve access to care in the nation overall. Further, only about 30 percent believe health care reform will help the county’s financial status.

Looking Ahead

Senate lawmakers are expected to vote on their final health care reform legislation early Thursday morning, setting the stage for reconciliation with the House bill passed in November. When lawmakers return from holiday break in January, the conference committee between the two chambers is expected to begin discussions about merging the two bills. Leaders of the House and Senate had hoped to have a final bill approved by Congress and sent to President Obama before the State of the Union address, scheduled for late January or early February. However, White House officials now indicate that given January’s tight legislative calendar, this timeframe is unlikely.

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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December 17, 2009

It appears that the U.S. Senate will vote to close debate on its version of federal health care reform as early as this weekend. Whether or not you have contacted your senators previously, now is the time for you to consider contacting both of your senators and encourage them to continue debate and to improve the legislation.

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It is difficult to overstate the negative implications of Senate Majority Leader Harry Reid’s (D-NV) proposal. According to the Congressional Budget Office, this legislation – if enacted – will have a significant, negative impact on the cost and nature of coverage for our customers. The administration’s chief actuary for Medicare and Medicaid Services has determined that if the Senate health care bill became law, it would increase national health care spending more than if we did nothing. Our own analysis concurs with these assessments and further indicates that Sen. Reid’s proposal will likely lead to higher premiums for many of our customers without reducing the growth in underlying health care costs.

A new Washington Post-ABC News poll indicates that 53% of Americans understand that their personal costs will increase under this proposal and only 37% believe that their personal health care will improve under this legislation. The Senate needs to set aside this version of health care reform and construct a proposal that has broad and deep public support.

Throughout the health care reform debate, our company has sought to partner with our elected leaders in both parties to pursue responsible, sustainable reform that lowers costs and increases access. The current legislation does not meet these goals and Congress needs to hear from individuals who are concerned about the consequences of well-intended but flawed reforms.

While we continue to support health care reform, we cannot support reform that fails to address the cost and quality issues in our health care delivery system and undermines the bipartisan consensus for responsible and sustainable reform.

The holiday season is a busy time for all. Now is the time to get involved today.

The Senate needs to hear from you and time is short.

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.

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.”

DECEMBER 11, 2009

This Week in Health Reform

This week Senate lawmakers continued to debate numerous proposed amendments to Senate Majority Leader Harry Reid’s (D-NV) health care reform bill.

An updated analysis by our parent company shows that, with the proposed health care reform legislation, across- the-board premiums will increase significantly for younger and healthier people who purchase insurance on the individual market or through small employer groups.

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Senate Negotiations

Senate Continues Debate on Health Care Reform Bill: As Senate lawmakers continued to debate through the weekend and voted on proposed amendments, President Barack Obama encouraged this effort by visiting Capital Hill on Sunday and urging lawmakers to put aside their differences and pass the historic legislation. While the President did not mention abortion or the government-run option specifically, those issues remain particularly divisive and at the center of debate on the Senate floor:

* Abortion – On Tuesday the Senate rejected (54-45) an amendment proposed by Sen. Ben Nelson (D-NE) that would have imposed restrictions on coverage of abortion services for people who received subsidies to buy insurance. Sen. Nelson has indicated that he will not support a health care reform bill that does not include language restricting abortion coverage. Tuesday’s vote puts into question whether Sen. Reid has the 60 votes necessary to pass the reform package.
* Government-Run Option – On Tuesday night a group of 10 appointed Democratic Senate lawmakers announced a tentative agreement in regards to the public option. In an effort to remove a major hurdle to passing legislation this year, the group of negotiators offered an alternative program to the government-run option that would create several national insurance plans administered by private companies but negotiated by the Office of Personnel Management, which oversees health policies for federal workers. The negotiators said that a government plan would only be created if private firms were unable to deliver acceptable national policies.

The agreement would allow individuals to buy into Medicare starting at age 55, and insurance companies would face new regulations, including a requirement that they spend at least 90 cents of every dollar collected in premiums on medical services for customers.

In response to the agreement, the American Hospital Association, the American Medical Association, the American Federation of Hospitals – along with other health care companies, including insurers and drug makers – expressed concerns over the proposed Medicare expansion. Some also voiced concerns that the agreement simply represents another form of a public option. Those in opposition cite potential cost increases, low Medicare reimbursements and greater government control over parts of the health care industry. Hospital representatives said an expansion of Medicare would violate a deal they reached with the White House this year to give up $155 billion in Medicare payments over the next decade. Furthermore, The National Federation of Independent Business, a small-business association, released a statement opposing the legislation as an inadequate response to rising costs.

Currently Sen. Reid has only released a few specific details about the agreement, and lawmakers are hesitant to endorse the plan until it is better understood. Sen. Joe Lieberman (I-CT) has indicated that the inclusion of a public option trigger may be a possible deal breaker. Sen. Reid presented this new agreement to the Congressional Budget Office (CBO) to be analyzed and is currently waiting for the CBO costs estimates.

In addition, on Wednesday Senate lawmakers debated an amendment offered by Byron L. Dorgan (D-ND) that would allow for the importation of prescription drugs from other countries. Should it pass, the measure could threaten the pharmaceutical industry’s support for President Obama’s health care reform. The pharmaceutical industry strongly opposes allowing prescription drug imports, indicating that the risk for counterfeit drugs would increase. While the amendment was supposed to come to a vote on Wednesday, an agreement was not reached and debate continued on Thursday.

Other Activities

Federal Insurers Warn of Higher Premiums: The Association of Federal Health Organizations , which includes federal employee-sponsored health insurance companies and Associate Member Blue Cross and Blue Shield Association, is starting to make waves on Capitol Hill with information released in a November 25 report to the Office of Management and Budget. The report indicates that health insurance premiums could go up and benefits could be hurt due to impending fees on the insurance industry and the excise tax on premiums above a certain amount.

Drug Makers May See Increased Fees: Media reports indicate that the bill emerging from the Senate may include fees on the pharmaceutical industry that are greater than the $80 billion originally discussed in June. Given that the House bill would cost drug makers about $140 billion, the eventual House-Senate bill is likely to include fees exceeding $80 billion.

Public Opinion

Americans Oppose Reform Plan: As special interest groups express concern over the latest Senate proposal, polls continue to show that Americans are increasingly worried about the impact of reform. The most recent Quinnipiac University Poll indicates that Americans disapprove (52-38 percent) of the health care reform proposal under consideration in Congress. Furthermore, a Bloomberg National Poll indicates that 62 percent of Americans say they are mostly pessimistic that they would benefit from the bill.

Looking Ahead

Senate lawmakers will continue working around the clock and weekends to debate and vote on the proposed amendments. Sen. Reid is still pushing to have a final Senate reform package put together by Christmas.

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.

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.