Texas Today

President Obama’s Health Insurance Bill

President Obama Releases New Health Care Proposal in Time for Health Summit: On Monday February 22, 2010, White House officials unveiled a new health insurance reform overhaul that builds on the Senate version passed last Christmas Eve, with some changes aimed at pleasing House Democrats who had concerns with the Senate bill. The President’s proposal does not include the public option, despite the hopes of Senate Democrats, due to White House concerns that the provision will hinder passage in the Senate. President Obama ignored requests by Republicans to scratch the Democratic plan and start over. As such, Republican leaders questioned Democratic motives and labeled the bill as a massive government takeover of America’s health care system.

Republicans Insist House Democrats Don’t Have the Votes to Pass Legislation: Minority Whip Eric Cantor (R-VA) announced on Wednesday that Democrats don’t have the necessary votes to pass the President’s proposal in the House because of three new House vacancies and lagging support among some moderate Democrats. At issue for some Democrats are weaker abortion provisions in the President’s proposal as well as the ongoing controversy over passing a bill by a simple majority, a process known as reconciliation.

Health Care Summit Preview

On Thursday, the President’s Health Care Summit began at 10:00 a.m. with opening comments from the President, followed by remarks from both Republicans and Democrats. The discussion centered on four themes: controlling health care costs, overhauling the insurance market, reducing the deficit and expanding insurance coverage. Prior to Thursday, several top Republicans and some Democrats stated that expectations were extremely low for the Summit’s success.

House Republicans arrived armed with their own version of a health care bill that encourages small businesses to join together to buy insurance, gives federal money to states to run high-risk pools for those unable to obtain private insurance and limits damages in medical malpractice lawsuits. The Republican plan would cost $61 billion and cover three million people over ten years. In contrast, President Obama contends his plan would cost $950 billion and cover 30 million people over the same time period. However, officials at the Congressional Budget Office (CBO) indicated they would not be able to officially score the President’s proposal with just a summary – that legislative language is needed.

Note: A full summary of the results from the Health Care Summit will be included in next week’s newsletter

Additional Activities

WellPoint Executives Defend Premium Increases: On Wednesday, the House Energy and Commerce Subcommittee on Oversight and Investigations held a hearing to examine the proposed health insurance premium increases by Anthem Blue Cross in California. Anthem, a WellPoint subsidiary, recently informed subscribers in California that premiums for individual insurance policies would be raised an average of 25 percent, with some rates going up as much as 39 percent. Angela Braly, president of WellPoint , said the premium increases were justified by soaring medical costs, and that pending legislation could make the problem worse, driving up costs further for young, healthy people.

“Raising our premiums was not something we wanted to do,” Ms. Braly said . “But we believe this was the most prudent choice, given the rising cost of care and the problems caused by many younger and healthier policyholders dropping or reducing their coverage during tough economic times. By law, premiums must be reasonable in relationship to benefits provided, which means they need to reflect the known and anticipated costs they will cover.”

In Sacramento , Leslie Margolin, president of Anthem Blue Cross in California, also testified before lawmakers, joined by vice president and general manager James Oatman. The focus of that hearing was also the proposed premium increase for California members in the individual market, with company executives pointing to the current economic climate and rising health care costs as reasons for the rate hikes.

U.S. House of Representatives Repeals Antitrust Exemption from Health Insurance Companies: On Wednesday, the House of Representatives voted 406-19 in favor of repealing a 65-year-old antitrust exemption from health insurance companies. Democrats said the repeal would lead to increased scrutiny of the industry. Yet, the non-partisan Congressional Budget Office said last year that repealing the exemption would not significantly reduce premiums because states already investigate health insurance companies.

In addition, industry executives pointed out that legislation could further hinder competition and the ability to share information to improve health care quality. “Health insurance is one of the most regulated industries in America at both the federal and the state levels,” said Karen Ignani, president and chief executive of America’s Health Insurance Plans (AHIP). “The real focus should be on addressing the rising cost of medical care, which is putting an unsustainable burden on families, employers and the federal budget,” she said.

Public Opinion

Polling Suggest Health Care Reform is Still Key to Economic Recovery: Recent polling on health care reform shows mixed reaction among the public over the proposed legislation. According to a recent CNN poll, 48 percent of those questioned said lawmakers should work on an entirely new bill and 25 percent felt that Congress should stop work on health care reform altogether.

According to the monthly poll from the nonpartisan Robert Wood Johnson Foundation, 75 percent of Americans still think it’s important that Obama include health care reform in addressing the nation’s economic crisis, while many still harbor doubts about the legislation.

When asked how health care legislation relates to their economic situation:

* Nearly 31 percent said they thought the Democratic bills would make their personal financial situation worse, compared with 10 percent who said it would improve their family budgets.
* Forty-two percent said the nation’s fiscal condition would suffer because of the legislation, compared with 26 percent who said it would get better.
* Americans were divided on whether the Democrats’ approach would improve overall access to health care around the country, with 35 percent saying it would and nearly that many disagreeing.

Health Insurance Coverage Varies Widely Based on Age: Coming just before the President’s Summit on Health Care Reform, a newly released Gallup Poll reinforces the wide degree of variability in health insurance coverage across U.S. population segments, especially when it comes to age. Eighty-four percent of 18-year-olds have health insurance, most likely because they are still covered under their parents’ policies. By age 22, health insurance coverage reaches its lowest point, with just 66 percent maintaining coverage. From age 22 on, the percentage of Americans with health insurance begins to climb, albeit slowly, reaching the 95 percent level at age 65 when Medicare becomes an option.

Looking Ahead

Legislators need to determine next steps for health care legislation coming out of the President’s Health Care Reform Summit. On Wednesday, Department of Health and Human Services Secretary Kathleen Sebelius invited executives from the top five insurance companies to meet at HHS to discuss their companies’ insurance premiums.

February 17, 2010

The Week in Individual Health Insurance Reform–Federal Legislative Overview

House and Senate
Things were quiet last week in Washington due to the 30 plus inches of snow the area received. On Feb. 9 House leaders announced that due to the heavy snow in the area they would suspend votes in the House for the remainder of the week. Congress will not be in session this week due to the President’s Day recess and will reconvene the week of Feb. 22.

As a result of the congressional schedule, the timeframe for a floor vote on the McCarran-Ferguson antitrust legislation will be pushed back until the week of Feb. 22 at the earliest. Reports have stated that the antitrust bill is part of House Speaker Nancy Pelosi’s (D-CA) strategy of moving smaller pieces of health insurance legislation quickly to help build momentum for a comprehensive health care reform bill. The Speaker also continues to urge House Democrats to pass the Senate bill as long as it is accompanied by a separate “reconciliation” bill that would “fix” key provisions in the Senate bill (e.g., raising the threshold for the Cadillac tax and dropping the Nebraska Medicaid provisions) to satisfy some members of her caucus.

The Senate remained in session last week, despite the weather, although Majority Leader Harry Reid (D-NV) stated that the Senate would not conduct any votes. On Feb. 11, Finance Committee Chairman Max Baucus (D-MT) and Ranking Member Charles Grassley (R-IA) released the highly anticipated “jobs bill” – The Hiring Incentives to Restore Employment (HIRE) Act.

Senators Baucus and Grassley issued a joint statement, emphasizing that this bill was drafted with bipartisan input. They further stated: “We also agree that, once properly reviewed, the package should be considered in a deliberate, but expeditious manner. Any efforts to needlessly delay Senate completion of consideration of this package through partisan means will undermine our goal of timely action in the current economic climate. Action on the expired provisions is long overdue. Timely action on incentives for economic activity and job creation also is needed.”
Hours after details of the “HIRE” legislation were released, Majority Leader Reid publicly stated that he was scrapping the bill. Reid told reporters that when the Senate returns from its recess on Feb. 22, “we will move to a smaller package than has been talked about in the press.” Reid went on to state that some of the tax provisions included in the legislation – key to garnering Republican support for the deal – “confuse” the bill. Reid went on to say that, “we don’t have a jobs bill. We have a jobs agenda.”

The draft “HIRE” legislation addresses a number of key health care issues:

* The bill extends, by three months, the eligibility period for premium subsidies for state continuation coverage and COBRA continuation coverage to include persons who are unemployed on or before May 31, 2010. The bill also clarifies that these subsidies are available to persons who are involuntarily terminated from their jobs after previously losing their employer-sponsored coverage due to a reduction in hours. The premium subsidies originally were enacted as part of the American Recovery and Reinvestment Act of 2009, also known as the “stimulus bill.”

* The bill provides for a seven-month Medicare physician payment fix (sometimes known as the “doc-fix”), maintaining physician payment rates at their current levels through Sept. 30, 2010. Under current law, in the absence of congressional action, physicians are scheduled to face a steep rate reduction on March 1.

* The bill provides for a one-year extension of both Medicare Advantage Special Needs Plans (section 626) and Medicare Cost Plans (section 627).

* The bill includes numerous provisions addressing Medicare fee-for-service reimbursement issues.
White House Health Care Reform Summit
In a pre-Super Bowl interview on CBS, President Obama said that he would like to host a televised health care summit with Republican and Democratic congressional leaders on Feb. 25. While specific details are not yet available, the summit represents the Obama Administration’s latest strategy to jumpstart the health care reform debate and seeks bipartisan cooperation following the loss of the Democrats’ supermajority in the Senate. Republican leaders expressed interest in the summit, and House Republican Leader John Boehner (OH) issued a statement saying that, “The best way to start on real, bipartisan reform would be to scrap those bills and focus on the kind of step-by-step improvements that will lower health care costs and expand access.” In response, White House officials insisted that the President is not interested in starting from scratch on health reform.

This week Democratic and Republican congressional leaders also met with President Obama at the White House to discuss the jobs bill, health reform, energy, trade and other legislative priorities.

Following the meeting, the President spoke with reporters and he made the following comments about health reform: “I’m going to be starting from scratch in the sense that I will be open to any ideas that help promote these goals. What I will not do, what I don’t think makes sense and I don’t think the American people want to see, would be another year of partisan wrangling around these issues; another six months or eight months or nine months worth of hearings in every single committee in the House and the Senate in which there’s a lot of posturing. Let’s get the relevant parties together; let’s put the best ideas on the table. My hope is that we can find enough overlap that we can say this is the right way to move forward, even if I don’t get every single thing that I want.

FEBRUARY 19, 2010

This Week in Health Insurance Reform

Although lawmakers left Washington this week for the President’s Day recess, debate continued to amplify around the upcoming Health Care Summit. The Summit, scheduled for February 25th in Washington, D.C., is considered by members of the news media to be President Barack Obama’s best attempt to salvage his health care reform agenda. Some Republicans view the Summit as political theater and a political trap for the GOP. White House officials insist, however, that the Summit is meant to find solutions to issues like soaring insurance premiums.

Health Insurance Reform Negotiations

President Obama Extends Invites to Health Summit, Lays Out Agenda: Last Friday, White House officials extended invitations to 21 lawmakers – Republicans and Democrats alike – to participate in the Health Care Summit. The list included the top leaders in the House and Senate, as well as the committees with jurisdiction over health legislation. In addition, the top four leaders of the House and Senate were each given the opportunity to invite four other lawmakers to the Summit. The meeting will ultimately be comprised of 20 Democrats and 17 Republicans.

Officials from the White House Office of Management and Budget, the Congressional Budget Office and the Joint Committee on Taxation have also been invited. President Obama did not invite House or Senate Budget Committee leaders, though, including Senate Budget Committee Chairman Kent Conrad (D-ND) and Ranking Member Judd Gregg (R-NH).

The invitation outlines the format of the event as follows:

* President Obama will offer opening remarks.
* A leading Republican lawmaker and a leading Democratic lawmaker will each comment.
* The President will then moderate a dialogue on: insurance reforms; cost containment; expanding coverage; and the impact of health legislation on the deficit.

Prior to the Summit, President Obama has asked House and Senate Democrats to resolve the differences between their bills and produce a final proposal. However, House Democrats said Thursday that a single plan might not be ready in time. President Obama also challenged Republicans to present a comprehensive reform package at the Summit. The President pledged to post the Democratic plan online before the 25th of this month. Members of the news media suggested that President Obama may also make his own health care reform proposal available.

Republicans Demand Halt on Compromise Bill: Last Friday, House Republican leaders sent a letter to Senate Majority Leader Harry Reid (D-NV) and House Speaker Nancy Pelosi (D-CA) in reaction to the Administration’s request that Congressional Democrats merge the House and Senate bills as a starting point for negotiations. In the letter, House Republican leaders asserted that merging the bills would amount to a “backroom deal among the White House and Democratic leaders” and would undermine negotiations at the bipartisan Summit. The Republicans continue to demand that Democrats scrap the current proposals and start over.

Senate Democrats Ask for Public Option: Sixteen Democratic Senators, including Michael Bennet (D-CO), Sherrod Brown (D-OH), Jeff Merkley (D-OR) and Kirsten Gillibrand (D-NY) sent a letter on Tuesday to Senate Majority Leader Harry Reid asking him to bring the public option back up for a vote, while also making the case for using a process called reconciliation as a way to move the legislation forward. The Senators support this approach, citing the following reasons:

*
Cost savings achieved by including the public option
* Continued public support for the public option (citing a December 2009 New York Times/CBS poll which showed that 59 percent of Americans supported the public option)
*
Need for increased competition in the insurance market, and
*
Senate history of using the reconciliation process for health care reform

Democratic leaders have thus far resisted using reconciliation to bypass a Republican filibuster because it would appear too partisan (given that it only requires a simple majority of 51 votes in the Senate).

Additional Activities

Anthem Blue Cross Delays Rate Increase: On Saturday, Anthem Blue Cross in California agreed to postpone its rate increase from March 1 until May 1, 2010. This decision was made at the request of the California Insurance Commissioner in order to engage a third-party actuary to review the filing. This extra time will allow outside experts to review the complex and detailed data around the medical costs the company expects to incur. In response to criticisms, Anthem Blue Cross’ parent company, WellPoint, Inc., held a press conference Thursday morning to address concerns and answer questions.

As the focus on insurance costs intensifies, Health and Human Services Secretary Kathleen Sebelius also held a news conference Thursday to discuss a new government report on rising insurance premiums across the country. She cited examples from Washington State to Maine in which insurers have sought premium increases for those buying coverage individually. Speaking on behalf of the industry, Robert Zirkelbach, a spokesperson for America’s Health Insurance Plans, said that “the focus needs to be on the underlying increase in health care costs.”

New Study – Excise Tax Will Fall Equally on Union and Nonunion Members: A new analysis regarding the controversial proposed tax on high-cost health insurance plans shows that the impact of the tax will fall equally on union and nonunion plans. The tax is a central component to the bill passed by the Senate in late December. The analysis was completed by Ken Jacobs, of the University of California at Berkeley Labor Center, and William H. Dow, professor of health economics at Berkeley and a member of President George W. Bush’s Council of Economic Advisers.

State-By-State Approach Builds Steam: With the national-level debate on health care reform stalled until the Summit, the argument to leave health care reform to the states has built momentum over the past week. Proponents of a state-by-state approach, including Missouri State Senator Charlie Shields (R), believe that a national health care reform effort would ignore local variations in health care markets and politics. To this end, lawmakers in states including Colorado , California and Virginia have recently taken steps to develop their own reform legislation. In contrast, supporters of the national approach counter that states would not be able to implement substantial reform (given that they are currently cash-strapped and not in a position to launch new initiatives).

Tauzin Steps Down from PhRMA Head: Late last week, former Republican Louisiana Congressman Billy Tauzin announced plans to step down as head of the pharmaceutical industry’s trade association, PhRMA, at the end of June. Mr. Tauzin helped to negotiate the $80 billion deal between drug makers and President Obama as part of the Administration’s plan for health care reform. Members of the news media report that some of PhRMA’s board members were concerned that more liberal House members will try to force the industry to commit to more deals. Some also felt that Mr. Tauzin conceded too much in the negotiating process, including spending up to $100 million on pro-reform advertising.

Public Opinion

Polling Suggests Americans Want to Start Over: The most recent polling suggests that while Americans want Congress to keep moving on health care reform, a majority think lawmakers should not rush through legislation.

A new Zogby International/University of Texas Health Science Center poll finds that 57 percent of respondents agree with the statement that lawmakers should start from scratch. When presented with a choice of approach:

*
Nearly 44 percent say Congress should start over.
*
Just over 25 percent say Congress should pass some sort of legislation and fix it later.
*
Only about 18 percent believe the House should pass the Senate bill alongside other legislation.

Another poll released by Franklin & Marshall College finds that while approximately 75 percent of Americans want health care reform, a majority of respondents (four out of five) are happy with their current health care. Only one in five says that the current system does not meet their personal needs. Further, the latest Quinnipiac University poll released last week shows that American voters still disapprove (54 – 35 percent) of President Obama’s health care reform plan, but say (52 – 44 percent) they want Congress and the President to continue their efforts to reform the system.

In addition, a New York Times/CBS poll released this month shows that only 13 percent of Americans believe health care reform is the most important issue facing the nation. Rather, jobs and the economy topped their priority list. The study also finds that 56 percent prefer “smaller government, providing fewer services.”

Looking Ahead

Both House and Senate lawmakers will return to Washington next Monday as Republicans and Democrats hash out their strategy for Thursday’s upcoming Health Care Summit.

http://www.easytoinsureme.com/

February 17, 2010

The Week in Health Reform–Federal Legislative Overview

House and Senate
Things were quiet last week in Washington due to the 30 plus inches of snow the area received. On Feb. 9 House leaders announced that due to the heavy snow in the area they would suspend votes in the House for the remainder of the week. Congress will not be in session this week due to the President’s Day recess and will reconvene the week of Feb. 22.

As a result of the congressional schedule, the timeframe for a floor vote on the McCarran-Ferguson antitrust legislation will be pushed back until the week of Feb. 22 at the earliest. Reports have stated that the antitrust bill is part of House Speaker Nancy Pelosi’s (D-CA) strategy of moving smaller pieces of health insurance legislation quickly to help build momentum for a comprehensive individual health insurance reform bill. The Speaker also continues to urge House Democrats to pass the Senate bill as long as it is accompanied by a separate “reconciliation” bill that would “fix” key provisions in the Senate bill (e.g., raising the threshold for the Cadillac tax and dropping the Nebraska Medicaid provisions) to satisfy some members of her caucus.

The Senate remained in session last week, despite the weather, although Majority Leader Harry Reid (D-NV) stated that the Senate would not conduct any votes. On Feb. 11, Finance Committee Chairman Max Baucus (D-MT) and Ranking Member Charles Grassley (R-IA) released the highly anticipated “jobs bill” – The Hiring Incentives to Restore Employment (HIRE) Act.

Senators Baucus and Grassley issued a joint statement, emphasizing that this bill was drafted with bipartisan input. They further stated: “We also agree that, once properly reviewed, the package should be considered in a deliberate, but expeditious manner. Any efforts to needlessly delay Senate completion of consideration of this package through partisan means will undermine our goal of timely action in the current economic climate. Action on the expired provisions is long overdue. Timely action on incentives for economic activity and job creation also is needed.”
Hours after details of the “HIRE” legislation were released, Majority Leader Reid publicly stated that he was scrapping the bill. Reid told reporters that when the Senate returns from its recess on Feb. 22, “we will move to a smaller package than has been talked about in the press.” Reid went on to state that some of the tax provisions included in the legislation – key to garnering Republican support for the deal – “confuse” the bill. Reid went on to say that, “we don’t have a jobs bill. We have a jobs agenda.”

The draft “HIRE” legislation addresses a number of key health care issues:

* The bill extends, by three months, the eligibility period for premium subsidies for state continuation coverage and COBRA continuation coverage to include persons who are unemployed on or before May 31, 2010. The bill also clarifies that these subsidies are available to persons who are involuntarily terminated from their jobs after previously losing their employer-sponsored coverage due to a reduction in hours. The premium subsidies originally were enacted as part of the American Recovery and Reinvestment Act of 2009, also known as the “stimulus bill.”

* The bill provides for a seven-month Medicare physician payment fix (sometimes known as the “doc-fix”), maintaining physician payment rates at their current levels through Sept. 30, 2010. Under current law, in the absence of congressional action, physicians are scheduled to face a steep rate reduction on March 1.

* The bill provides for a one-year extension of both Medicare Advantage Special Needs Plans (section 626) and Medicare Cost Plans (section 627).

* The bill includes numerous provisions addressing Medicare fee-for-service reimbursement issues.

White House Health Care Reform Summit
In a pre-Super Bowl interview on CBS, President Obama said that he would like to host a televised health care summit with Republican and Democratic congressional leaders on Feb. 25. While specific details are not yet available, the summit represents the Obama Administration’s latest strategy to jumpstart the health care reform debate and seeks bipartisan cooperation following the loss of the Democrats’ supermajority in the Senate. Republican leaders expressed interest in the summit, and House Republican Leader John Boehner (OH) issued a statement saying that, “The best way to start on real, bipartisan reform would be to scrap those bills and focus on the kind of step-by-step improvements that will lower health care costs and expand access.” In response, White House officials insisted that the President is not interested in starting from scratch on health reform.

This week Democratic and Republican congressional leaders also met with President Obama at the White House to discuss the jobs bill, health reform, energy, trade and other legislative priorities.

Following the meeting, the President spoke with reporters and he made the following comments about health reform: “I’m going to be starting from scratch in the sense that I will be open to any ideas that help promote these goals. What I will not do, what I don’t think makes sense and I don’t think the American people want to see, would be another year of partisan wrangling around these issues; another six months or eight months or nine months worth of hearings in every single committee in the House and the Senate in which there’s a lot of posturing. Let’s get the relevant parties together; let’s put the best ideas on the table. My hope is that we can find enough overlap that we can say this is the right way to move forward, even if I don’t get every single thing that I want.”

Federal

Owing to multiple blizzards in Washington, Congress started its President’s Day recess a full week early and conducted no official business last week. However, there was some legislative drama as Senate Majority Leader Harry Reid pulled the rug out from under Finance Committee Chairman Max Baucus by scrapping the Baucus jobs bill (without warning), which contained many health insurance items, and replacing it with a stripped down, narrow jobs bill. Whether the health items Baucus originally inserted with Republican help will make it back to the table remains fuzzy. Among the health items that have been dropped are: the COBRA eligibility extension (to May 31); the “doc fix” (to October, 2010) of Medicare reimbursement rates; and the favorable statutory direction to CMS to calculate the 2011 Medicare Advantage rates “as if” the doc fix were in place.

States

California health insurance The Office of Patient Advocacy released a report card on the state’s HMOs last week. Aetna received 3 out of 4 stars. The goal of the report card is to allow consumers to compare how well health plans use personal medical records and help address conditions such as asthma, arthritis and diabetes.

COLORADO: Governor Bill Ritter held a press conference to announce what he calls “the next round of reforms that represent common sense.” His legislative package includes bills to preclude insurance companies from charging different rates due to a person’s gender, ensure that women have access to breast cancer screening, assure plain language is used in insurance forms, standardize insurance applications and explanations of benefits, and encourage greater use of online tools to enroll people in public programs. Apart from the Governor’s proposals, a bill that would establish a public option was also introduced.

CONNECTICUT: In a short legislative session of only three months, the Insurance & Real Estate Committee wasted no time in putting forth an agenda that includes many concept drafts for repeat legislation from previous sessions. These include prohibiting health insurance copayments for preventive care, limiting prescription drug copayments, prohibiting Social Security disability payment offsets, and exempting the Municipal Employees Health Insurance Plans from the premium tax on small group premiums. In addition, the committee reintroduced legislation that includes nearly a dozen new health benefit mandates. The Council for Affordable Health Insurance, an independent think-tank, says that health insurance mandates could increase premiums in Connecticut by more than 50 percent overall.

GEORGIA: A bill was proposed last week that would impose significant restrictions on insurers’ ability to rescind health insurance policies. Aetna, through the Georgia Association of Health Plans and AHIP, met with the legislator sponsoring the bill to express concerns with the bill.

INDIANA: The legislative session is at halftime, and the insurance agenda is now limited. Most insurance issue bills are officially dead, including a bill that would have prohibited health plan provisions requiring a contracted provider to accept more than a certain number of patients; coverage for dialysis treatment regardless of whether the facility is contracted or not and without certain benefit restrictions; and a bill that would have allowed out-of-network assignment of benefits. However, Aetna is expecting that a bill requiring insurer and HMO annual reporting of premium cost composition, including administrative costs, may be resurrected. A bill that restricts dental insurers and HMOs from establishing fee schedules for non-covered services passed the Senate, with our amendment to accommodate most of the key concerns expressed by opponents of the bill. As the bill stands, dental insurance plans may impose fee schedules for covered services, regardless of whether the plan actually pays for the services rendered.

KANSAS: An amended version of S.B. 389 related to dental services passed the Senate Financial Institutions and Insurance Committee on February 11. The amended bill prohibits any contract between a health insurer that offers a health benefit plan and a dentist from containing a provision that requires the dentist to accept a fee schedule for services unless the service is a covered service. Committee amendments added to the definition of a “health benefit plan” the following: any subscription agreement issued by a non-profit dental service corporation; any policy of health insurance purchased by an individual; the state children’s health insurance plan; and the state medical assistance program under Medicaid. We will continue to update you as this bill progresses and hope to make favorable changes as the bill moves through the House.

MASSACHUSETTS: Governor Deval Patrick filed a 40-page bill that proposes giving the insurance commissioner the power to hold public hearings on rate adjustments and essentially cap health care price increases. Rate increases for individuals would be held to the rate of medical inflation; those sold to employers with 50 or fewer workers could not exceed one and a half times the level of medical inflation. The legislation would also impose a two-year moratorium on any new health benefit mandates. Legislative leaders praised the intent of the governor’s plan but declined to promise support. Strong opposition is expected from medical provider groups. The Governor simultaneously announced emergency regulations to take immediate effect that will require health insurers to submit proposed small business rate increases for review by the state 30 days before they take effect. Several other proposed provisions include a requirement that insurers offer at least one coverage plan with a limited network of health care providers costing at least 10 percent less than health plans with access to more physicians. The Massachusetts Association of Health plans is lobbying in support of a bill introduced by Senate Insurance Chair Richard Moore that would create a cheaper health insurance product for small employers by capping payments to providers at just 10 percent above Medicare rates. The Massachusetts Medical Society is against that proposal.

MISSOURI: An autism coverage mandate bill was amended and “perfected” by the Senate and then sent to the Government Accountability and Fiscal Oversight Committee from which it must emerge before returning to the floor of the Senate. In addition to two mandate-related amendments, a third amendment to the bill allowing for limited cross border sales of health insurance also passed. In its current form, the bill contains a mandated offering of the coverage in the individual market. Coverage is limited to treatment ordered by a licensed physician or psychologist whose treatment plan the carrier is entitled to review every six months. Coverage for applied behavior analysis (ABA) is limited to $52,000 annually (down from the $72,000 as introduced) for persons under age 21. Meanwhile in the House, a bill containing significant language relating to the credentialing of autism service providers also passed. The bill also contains a mandate to offer coverage in the individual market and to groups of fewer than 25. Groups of 25 to 50 would be entitled to an exemption from the mandate if they could demonstrate an increase in premiums tied to the mandate. The bill limits annual coverage of ABA ($36,000 for children ages 3-9; $20,000 for children ages 9-21). Aetna will continue to monitor the status of these mandates, but it appears fairly clear at this point that something will pass on the issue of autism.

NEW JERSEY: Last week Governor Chris Christie declared a fiscal state of emergency calling a special session of the legislature to lay out his plan for dealing with state’s current $2.2 billion budget shortfall. His plan calls for significant cuts or eliminations across 375 state programs and withholding $500 million of state education aid. Of note on the program side is a $12.6 million reduction in Charity Care funding to hospitals, which pays for care to uninsured residents. In legislative action, the Assembly Financial Institutions and Insurance Committee held a three-hour public hearing on out-of-network reimbursement. Much of the hearing focused on the markedly higher billing practices of ambulatory surgery centers and one non-par hospital. Aetna presented testimony regarding its experience with the non-par hospital, citing their disparate year-over-year increase in charges compared to other similarly situated hospitals. Chairman Schaer indicated the committee will work over the next several months to craft a solution.

NEW YORK: With Democratic Senator Hiram Monserrate officially expelled from the Senate, the Democratic majority (31-30) now faces an uphill battle getting the 32 votes needed to pass legislation. However, both the Senate and the Assembly moved forward with a public hearing on the Executive Budget proposal for health, including the section mandating the prior approval of rate adjustments. The Health Plan Association testified on behalf of the industry. If enacted, Governor Paterson’s proposal for an 85 percent medical loss ratio and a prior approval hearing process for all rate adjustments would essentially amount to government control of health insurance, undermining the private health insurance market in New York. Price controls would weaken health plan solvency, hurt providers and virtually eliminate innovation and efficiency. At the same time, the proposal ignores the underlying cause of the increasing cost of health insurance — the increase in the actual costs of health care services.

OKLAHOMA: The second session of the 52nd Oklahoma Legislature convened in Oklahoma City on February 1. Legislators quickly turned to the state’s $1.3 billion budget deficit described by Governor Brad Henry (D) in his eighth and final state of the state address and FY 2011 executive budget. During his address, the Governor focused on his plans for resolving the $1.3 billion budget deficit through precise budget cuts. His only reference to health insurance was to encourage the expansion of Insure Oklahoma, a program developed by the state in partnership with small employers to provide affordable health coverage. The legislature is scheduled to adjourn on May 28 but only after addressing a range of legislation including several bills of interest to Aetna.

SOUTH DAKOTA: A dental fee schedule bill (S.B. 108) unanimously passed the Senate Commerce Committee and is expected to be taken up by the full Senate early this week. The bill prohibits any contract between a health insurer that offers a health benefit plan and a dentist from containing a provision that requires the dentist to accept a fee schedule for services unless the service is a covered service. Aetna will continue to follow the bill’s progress as it progresses.

TENNESSEE: Several bills have been proposed that would make changes to the state’s external review law. Aetna and other industry representatives will be meeting with the Tennessee Department of Commerce and Insurance regarding its proposed changes to the external review law. The bill proposed by the TDCI most closely mirrors the model legislation proposed by the National Association of Insurance Commissioners.

UTAH: The Speaker of the House has introduced a health reform bill addressing health information technology, individual and small group market reforms and transparency. The overarching theme of the reforms is micromanagement of rates and rating factors, and a broadening of the Insurance Commissioner’s authority. The transparency provisions apply plan designs and benefit descriptions submitted by carriers, and would require providers to make available, upon request, a price list for services on both an inpatient and outpatient basis.

Has anyone else been unfairly untargeted due to the misnomer, el coeda (transgendered student). I find that being a bisexual transgendered student has led me to more difficult situations and confrontations from the Right win than necessary. It seems that at present we have some military tracking transgendered women and men down as some type of hearing problem.

This Week in Health Insurance Reform EasyToInsureME FEBRUARY 5, 2010

Despite proclaiming to focus on other issues, such as the economy and jobs, President Barack Obama injected new energy into the health insurance reform debate this week.

On Monday, President Obama held a Q&A session via YouTube in which he responded to questions submitted during his State of the Union address. He commented that “it is my greatest hope” to have health care reform legislation “not just a year from now, but soon.” He also responded to criticisms regarding the lack of transparency around the reform negotiations.

On Tuesday, at a town-hall-style meeting in New Hampshire, President Obama rejected the notion that health care reform was dead, saying “we’ve got to punch it through.” Further, on Wednesday, he met with Senate Democrats reiterating his commitment to reform and encouraging lawmakers to press forward. He also suggested that Republicans play at least some role in negotiating a final bill.

Health Care Reform Negotiations

Democrats Look for Path Forward: Recent statements made by Rep. Charles Rangel (D-NY) are the first concrete signs that Democrats have started working to revive comprehensive health care reform legislation. Rep. Rangel indicated to the media that lawmakers have begun writing a compromise bill based on the legislation passed by the Senate last December. The bill will incorporate changes agreed upon last month by White House negotiators and members of the House and Senate.

Senate Majority Leader Harry Reid (D-NV) did not commit to a timeline for reform, but hopes that Democrats can agree to a path forward by next week. So far, he has been unable to identify compromise language that will win the needed 51 Senate votes.

At the same time, Speaker of the House Nancy Pelosi (D-CA) indicated that the House would vote on a small piece of the overall health care reform package next week. The proposed bill would overturn the insurance industry’s exemption from federal antitrust laws. The Senate version of health care reform did not include this measure because Sen. Reid could not secure the 60 votes needed to include it; however, Sen. Reid indicated the Senate would reconsider the measure.

Additional Activities

President Obama’s Budget Assumes Health Care Reform: On Monday, White House officials released a proposed $3.8 trillion 2011 budget including several measures aimed at improving health care:

· Hiring more fraud detectives to root out waste in Medicare and Medicaid

· Providing $25.5 billion to help state Medicaid programs swelling with enrollment due to unemployment

· Eliminating Congressional earmarks for building hospitals and other facilities, including $10 million for Alaska and $35 million for Mississippi

· Initiating or increasing funds for the following research projects:

o quality improvements for seniors with chronic conditions

o effective medical treatments for the costliest conditions

o expeditious ways to adopt electronic medical records

o medical fields such as genetic medicine that may provide breakthrough treatments.

Further, the budget assumes that some form of health care reform legislation will pass Congress. It includes a “reserve fund for health care reform” totaling $634 billion as a “down payment” for the legislation and also assumes that the reform effort will generate $150 billion in savings over 10 years.

States Begin Initiatives to Expand Coverage: With the fate of national health care reform in question, state legislators are pushing their own bills to expand coverage. Last Thursday, California’s State Senate passed a measure to create a government-run health care system, ignoring a veto threat from Gov. Arnold Schwarzenegger. The measure is now with the State Assembly. Missouri legislators have introduced a similar bill to create a government-run plan whereas lawmakers in other states, including Virginia and New Jersey, are working to tweak existing state programs to expand coverage. Tight budgets in all of those states may hinder these efforts.

Virginia Senate Says No to Individual Mandates: On Monday, Virginia’s Democratic-controlled State Senate passed measures that would make it illegal to enforce an individual health care mandate. This decision comes in direct conflict with the House and the Senate health care reform bills, both of which require all individuals to purchase health insurance.

Public Opinion

Majority of Americans Doubt Passage of Health Care Reform, but Growing Optimism: A survey released by the Pew Research Center on Wednesday shows growing optimism around the passage of health care reform. While the poll indicates that the majority of Americans (60 percent) do not believe health care reform legislation will pass this year, the figure is down from the 67 percent who said – just after a special Senate election was held last month in Massachusetts – that such legislation would not pass.

Poll Indicates Damage Done On Health Care Reform: A poll released Tuesday by Public Policy Polling shows that Republicans currently have the advantage over Democrats in the ballot races for Congress, regardless of the final outcome of health care reform. In general, the poll shows that 43 percent of voters surveyed would vote for a Republican, whereas 40 percent would vote for a Democrat. When asked about the implications of the health care overhaul.

* If health care reform passes, 45 percent would likely vote Republican and 40 percent would likely vote Democrat.
* If health care reform does not pass, 43 percent would likely vote Republican and 38 percent would likely vote Democrat.

The poll also shows that 36 percent of respondents support the President’s health care reform effort, while 51 percent oppose it.

Looking Ahead

Currently there is no timeline for the development of a comprehensive health care reform package. However, Speaker Pelosi is moving forward with smaller pieces of the bill, starting next week with the repeal of the antitrust exemption for insurance companies.

On Friday, January 29, the Departments of Health and Human Services, Labor and Treasury jointly issued significant new interim final regulations for implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).

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The regulations are 154 pages long and will require detailed reviews of applicable plan documents and insurance policies, as well as current processes regarding management of mental health benefits, claims, and the relationship Plans have with outside organizations that provide and manage mental health and substance abuse benefits.

These are “interim” final regulations, meaning that they are essentially final but are nonetheless subject to later changes as the result of the official 90-day public comment period.

For purposes of enforcement, regulators have emphasized that they will take into account a health plan’s good faith efforts to comply with a reasonable interpretation of the statute for violations that may occur with implementations by the original Act deadline (plan year renewals on or after October 3, 2009). The interim final regulation generally applies to group health plans and health insurance issuers for plan years beginning on or after July 1, 2010. Collective bargaining entities have a different applicability provision to align with their agreements.

The interim final rules provide substantial clarification as to the definitions and tests that must be used in establishing parity between mental health and substance use and medical/surgical benefits with respect to financial requirements and treatment limitations, as required under MHPAEA.

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House and Senate
House and Senate Democratic leaders remain at an impasse on merging their respective health care reform bills. Senate Majority Leader Harry Reid (D-NV) stated that they will not move forward on any health care reform measures before Republican Scott Brown is sworn in as Massachusetts’ junior senator.

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Both party leaders decided to wait and hear what President Obama was going to say about health reform in his first State of the Union Address on January 27. In it, he urged Congress to continue its work on health care reform and outlined his agenda that focused heavily on reviving the economy to boost employment and reduce the budget deficit.

In an excerpt on health care reform from President Obama’s speech, he states, “Our approach would preserve the right of Americans who have insurance to keep their doctor and their plan. It would reduce costs and premiums for millions of families and businesses. And according to the Congressional Budget Office – the independent organization that both parties have cited as the official scorekeeper for Congress – our approach would bring down the deficit by as much as $1 trillion over the next two decades.”

The Republican response was given by newly-elected Governor Bob McDonnell at the Virginia State House. In an excerpt from his speech, McDonnell stated that “All Americans agree – we need a health care system that is affordable, accessible, and high quality. But most Americans do not want to turn over the best medical care system in the world to the federal government. Republicans in Congress have offered legislation to reform healthcare, without shifting Medicaid costs to the states, without cutting Medicare, and without raising your taxes.”

Health Care Reform Next Steps
Congressional leaders continue to consider options for moving forward on health reform legislation following President Obama’s State of the Union address. Serious consideration is being given to taking action – possibly as early as next week – on a number of narrowly focused bills, some of which may be structured with the goal of attracting bi-partisan support. Consideration of these bills is not intended to preclude action on comprehensive health reform at a later date.

One of the first bills likely to move to the House floor could be an antitrust bill that would repeal portions of the McCarran-Ferguson Act pertaining to health insurance issuers and medical malpractice issuers. This legislation was proposed last year in the Senate by Senator Patrick Leahy (D-VT) and in the House by Rep. John Conyers (D-MI) and is known as the Health Insurance Industry Antitrust Enforcement Act of 2009. It was ultimately included in the House health care reform bill, but not in the Senate reform bill.

As we reported last week, one of the potential options for Democrats to pass health care reform legislation was to use the budget reconciliation process. Democratic leaders are purportedly continuing to weigh a two-track process in which the House would clear the Senate health bill and then the Senate would use the filibuster-proof reconciliation process to incorporate a series of compromises with the House. Senate Majority Leader Reid said this week, “[Budget reconciliation is] something that we’re looking at, very closely. That’s where a lot of the procedural problems come in. It’s real tough to do it the right way, and we don’t know how to do that yet.”

In the meantime, the House will continue to focus on smaller health care bills. Speaker of the House Nancy Pelosi (D-CA) stated this week that her party will successfully complete their work on health care reform that they began last year. Pelosi said, “We’ll go through the gate. If the gate is closed, we’ll go over the fence. If the fence is too high, we’ll pole vault in. If that doesn’t work, we’ll parachute in. But we’re going to get health care reform passed for the American people.”