chad’s Blog

Senate
Former President Bill Clinton visited Senate Democrats on Capitol Hill this week, urging them to quickly pass health care reform by the end of the year. Senate Leadership continues to work pulling its final merged bill together and Majority Leader Harry Reid (D-NV) says that he will introduce the legislation on the Senate floor the week of November 16th.

Under Senate rules, a 60-vote majority is required to move the bill forward before official debate can begin. It is likely that Democrats will receive the 60-votes needed to move the bill to the Senate floor, but it remains to be seen whether Reid has the full 60 votes to overcome a filibuster for bill’s official passage. Reid is still aiming to pass the legislation by the Christmas holiday.

Quoting & Saving just got easier…EasyToInsureME Health Insurance Quotes… Quote all carriers in seconds

Individual health insurance
Health insurance quote

House
After passing its health care reform legislation, the “Affordable Health Care for America Act” (H.R. 3962), the House of Representatives was quiet this week.

Overview: Medicare Payroll in Senate Health Care Reform Legislation

The Senate’s health care reform legislation has still not yet been unveiled, but there are reports that an analysis from the Congressional Budget Office has found the bill to be more costly than expected, so Senate Democrats are already considering new ways to pay for the bill.

One of the options is an increase to the Medicare portion of the payroll tax on individuals making $250,000 per year or more. Currently, workers and employers each pay a 1.45 percent payroll tax for Medicare and the new proposal would increase that to 2.5 percent payroll tax bracket for those making $250,000 per year or more.

By including this new approach, it would allow the Senate to either reduce or eliminate altogether the controversial excise tax on “Cadillac” or high-cost insurance plans, passed in the Senate Finance Committee’s bill last month. Under legislation (S 1796) approved by the Senate Finance Committee, individual insurance plans costing more than $8,000 and family plans costing more than $21,000 would face a 40 percent excise tax on any amount above that level.

This week focused on the unveiling of Senate Majority Leader Harry Reid’s (D-NV) proposed health care reform legislation.

Quoting & Saving just got easier…EasyToInsureME Health Insurance Quotes… Quote all carriers in seconds

Individual health insurance
Health insurance quote

House and Senate Negotiations

Reid Unveils Senate Bill: Senate Majority Leader Harry Reid unveiled his version of health care reform legislation on Wednesday night after receiving cost estimates from the Congressional Budget Office (CBO). With a price tag of $849 billion over ten years, the bill will reduce the deficit by $127 billion over a decade and cut Medicare spending by $500 billion, while increasing taxes by $500 billion. In addition, the bill will:

* Provide coverage for 31 million Americans who currently lack health insurance - accounting for 94 percent of eligible Americans
* Offer a government-run option of which states can opt out
* Expand Medicaid
* Require most Americans to carry health insurance, providing subsidies for those who cannot afford it and imposing weak penalties for violations
* Bar insurance companies from denying coverage based on pre-existing conditions or dropping coverage for those who become sick
* Impose penalties on medium and large sized employers for not providing health insurance to employees
* Increase the Medicare payroll tax on higher-income workers
* Imposes fees totaling $101.9 billion on insurance companies, drug makers, and medical device manufacturers over ten years
* Impose a tax on high-cost health insurance plans provided by employers to their employees.

While Democrats remain committed to passing the legislation, it is not certain that Reid has the 60 votes needed to bring the measure to the floor for debate. Several moderate democrats, including Sens. Mary L. Landrieu of Louisiana, Blanche Lincoln of Arkansas and Ben Nelson of Nebraska have expressed concerns over the inclusion of a government-run plan. Sen. Sherrod Brown (D-OH), however, expressed in a meeting Monday night with Reid that liberal lawmakers had conceded enough ground on the government-run plan and that he should push forward with the bill.

Members of the Senate will convene on Saturday for a rare weekend session to hold a procedural vote, deciding whether or not to bring the legislation to the Senate floor for debate.

Immigration and Abortion Remain Central to the Debate: Access to care for illegal immigrants will continue to be contentious as lawmakers work to reconcile the health care legislation passed by the House and pending in the Senate. Under the bill approved by the House, illegal immigrants would not be barred from using their own money in the newly-created insurance exchanges. White House officials and members of the Senate Finance Committee, however, pledged that undocumented workers be barred not only from receiving subsidies but also from buying insurance through federally sponsored exchanges - even with their own money.

As Senate Majority Leader Harry Reid works to finalize the legislation, he will also need to address the question of federal funding for abortions, an issue that has proved starkly divisive. Because of pressure from the Catholic Church and anti-abortion groups, the House-approved bill restricts the use of taxpayer funds for abortions, a decision that has sparked a heated debate among pro-choice and pro-life advocacy organizations. In contrast, the Senate’s proposed bill would allow the use of federal funds for abortion in cases of rape and incest, requiring insurers that cover elective abortions to segregate money from Americans who get government subsidies.

Public Opinion

Polls Continue to Show Deep Divisions: A new Washington Post-ABC News poll shows that Americans are deeply divided over the current health care proposals and that the majority believes costs will rise. Forty-eight percent say they support the proposed changes to overhaul the health care system, whereas 49 percent are opposed. In addition, 52 percent say an altered system would probably make their own care more expensive, and 56 percent see the overall cost of health care in the country going up as a result of the reform.

Furthermore, a recent Associated Press (AP) poll shows that Americans are split (43 percent opposed; 41 percent support) over the health care plans being discussed in Congress. The AP poll also suggests that the public is becoming more attuned to the details of the proposals, including the cost implications and the public option. And, according to a Quinnipiac University poll released Thursday, 53 percent of voters disapprove of President Barack Obama’s handling of health care reform.

However, a new CBS News poll shows that only one in four Americans prefer to have no health care legislation at all, while 51 percent support a bill with a public option.

Other Activities

CMS Report Indicates Costs Would Rise Under House Bill: According to a report issued by Richard Foster, the chief actuary at the Centers for Medicare and Medicaid (CMS), overall spending on health care would rise as a result of the legislation approved by the House. Specifically, the measure to reduce more than $500 billion from future Medicare spending would sharply reduce benefits for some seniors and may jeopardize access to care for millions of others.

Drug Makers Increase Price, Anticipating Health Reform: The media has reported that the drug industry has been raising prices at its fastest rate in years, in anticipation of the costs associated with health care reform. These costs include the $80 billion in fees over the next decade that the industry agreed to in order to help pay for coverage of the uninsured.On Wednesday, Democrats in Congress asked for two separate investigations of drug industry pricing.

Economists Endorse Health Care Reform Bill: Twenty-three high profile economists from universities and think tanks sent a letter to President Obama on Tuesday to support four important elements of health reform legislation critical to its success: deficit neutrality, an excise tax on high-cost insurance plans, an independent Medicare commission, and delivery system reforms.

Looking Ahead

The Senate will convene on Saturday for a procedural vote, deciding whether or not to bring the legislation to the Senate floor for debate. Debate could continue throughout the weekend.

Week of November 16, 2009

The Business Roundtable released a report late last week that found key components of existing health care reform legislation could slow the growth of health care costs and offer real savings for companies and their employees. The results were immediately welcomed by the White House. Yet, the report goes on to warn that certain provisions within the legislation could actually accelerate costs. “The report also shows that reform done wrong won’t work and could make a bad situation much worse,” said Antonio M. Perez, Chair of Business Roundtable’s Consumer Health and Retirement Initiative. Aetna, a supporter of bipartisan health care reform, has expressed similar concerns. Specifically, the report notes changes that threaten to increase health care spending include failure to implement a strong individual mandate, increases in the cost of health care to individuals from changes to consumer spending accounts, and increased cost shifting to the private sector from reduced reimbursements to providers and the public plan option.

Quoting & Saving just got easier…EasyToInsureME Health Insurance Quotes… Quote all carriers in seconds

Health insurance
Health insurance quotes

Federal

The Democratic leadership continues to play an “inch-by-inch” game on health care reform. In the House, Speaker Pelosi is fully aware of the fact that the very bill she managed through the House would very likely not pass a second time because of the abortion issue. But she succeeded in inching the bill forward, which was the plan all along. In the Senate, Majority Leader Harry Reid continues weaving policy substance with political reality in order to create a mosaic that can inch forward to the next milestone, which is getting the 60 votes needed to allow the Senate to proceed to debate. He has yet to release the final “merged” bill; Senator Reid is going one-on-one with the Senate to sort out the combination of provisions that will allow him to get past the next hurdle. The abortion issue is the latest stumbling block, as at least one Senator is saying “no” to proceeding without this very provision. To jump start the process, Senator Reid is using the first of myriad procedural tactics to get the bill to the Senate floor. But if Republicans stand their ground, Senator Reid probably can’t get to that next step (the “motion to proceed”) until Friday. That would leave only enough time to make a few introductory speeches and go home for Thanksgiving.

On Thursday, the House is expected to proceed to debate and possibly pass a permanent “fix” to the perennial problem of what to do about scheduled cuts to physician reimbursement in Medicare. The House leadership wants to spend $210 billion (with no good funding source) to eliminate the upcoming 21 percent cut in 2010, along with all future cuts. The Speaker needs to make the gesture, given the AMA’s support for her health care reform bill. It is unclear whether this measure will pass in the House; however, it is clear that such a measure will have a more difficult time in the Senate. For one, the Finance Committee reform bill already contains a one-year “fix” costing $10.9 billion, which is the best Chairman Max Baucus thinks is currently possible. The Senate already tried two weeks ago to pass a permanent fix, and Senator Reid was soundly rebuffed in the effort.

States

ILLINOIS: A leader in the Senate has prefiled a bill to amend Illinois’ HIPAA law with a proposal that group and individual health insurance carriers be prohibited from imposing any pre-existing condition exclusions. Current limitations imposed by state law would be deleted. While the issue is being discussed on the federal level, this issue has had a lot of traction with both House and Senate Insurance Committee members for the past six months. As amended, the current proposal may not meet current federal HIPAA requirements. The bill will not be considered until January 2010.

MICHIGAN: The Office of Financial and Insurance Regulation (OFIR) has scheduled a hearing on November 23 to review Blue Care Network’s proposal to buy Physicians Health Plan. In late September, Blue Care Network, a Michigan nonprofit HMO, filed a statement with OFIR regarding its intention to acquire control or merge with Physicians Health Plan of Mid-Michigan-Family Care and PHPMM Insurance Company. OFIR has 90 days to review the statement. Various parties have requested that OFIR conduct public hearings before making a decision on the sale, due to concerns raised regarding the size of the Blue Cross Blue Shield of Michigan.

NEW JERSEY: The governor has directed state departments and agencies to collectively cut $400 million from the state budget due to state revenue collection falling well short of budget projections. Furthermore, the Governor requested that the legislature not pass any spending bills during the upcoming “lame duck” session. This nearly half-a-billion dollar shortfall, coupled with a projected $8 billion budget deficit for next fiscal year, puts the state in dire fiscal straits. With options limited for making up the lost revenue, businesses operating in the state will be closely monitoring this developing situation.

NEW YORK: The legislature has passed a bill that prohibits all subrogation (collateral source or third party) recoveries by an insurer for medical expenses. The former collateral source rule eliminated the potential windfall of double recoveries by plaintiffs who receive medical benefits and win recoveries from defendant payments. The old rule of law allowed insurance companies to offset potential premium increases to consumers by authorizing them to recover medical costs from payments made to an injured plaintiff from a jury award or settlement. With that option no longer available, insurance premiums in New York will be further stressed. In addition, Governor Paterson and the hospital sector are proposing that the current Patient Services Assessment (PSA) of 9.63 percent be increased by 0.25 percent to generate an additional $54 million as part of the Governor’s second Deficit Reduction plan (DRP) for 2009. The hospitals are advocating for this insurance tax increase to offset some of the governor’s proposed Medicaid cuts on hospitals. The $800 in insurance taxes adopted this year already includes an increase in the PSA, and the new proposal would make the latest increase retroactive to November 1, clearly not included in premium increases for 2010. The legislature is set to return to the Capitol for two more special session days to address the DRP.

OKLAHOMA: Two Republican State Senators are sounding the alarm bell regarding both U.S. House and Senate versions of health care reform, charging that either would devastate at least one new health care facility in Oklahoma City and cost Oklahoma County and surrounding environs more than 500 jobs. State Sen. Jim Reynolds and Sen. Harry Coates say both bills would financially devastate many top-quality health care facilities, including Oklahoma Heart Hospital’s $98 million South Campus, which is set to open soon. The bills would financially undermine the facility by denying the facility federal reimbursement for services such as Medicare and Medicaid. A joint venture of Mercy Hospital, Midwest City Regional and a group of local physicians, the facility will serve much of southeast Oklahoma County along with hundreds of active-duty military and veterans. Both Sen. Coates and Sen. Reynolds say they will ask Gov. Brad Henry to intercede quickly to remove the onerous provisions.

UTAH: The Department of Insurance is circulating a draft bill to amend the state’s uniform electronic standards law to require insurers to provide coverage eligibility and detailed coordination of benefits information to physicians. Aetna will be submitting comments, including the fact that an insurer is not the repository of each member’s applicable insurance coverage information and that a July 1, 2010, effective date does not allow sufficient time for implementation.

This Week in Health Reform: November 13, 2009

This week’s debate focused on last Saturday’s approval of health care reform legislation by the House of Representatives. Some members of the media have raised concerns over the costs associated with the Democrat version of health care reform, highlighting the challenges Democrats might face politically as health care reform legislation evolves in Congress.

Quoting & Saving just got easier…EasyToInsureME Health Insurance Quotes… Quote all carriers in seconds

Individual health insurance
Health insurance quote

House and Senate Negotiations

House Passes Health Care Reform Legislation: Late last Saturday, the House narrowly passed its health care reform package with a 220-215 vote, which included opposition from 39 Democrats. One Republican, Rep. Joseph Cao (R-LA), voted in favor of the bill. President Barack Obama visited Capitol Hill on Saturday morning to encourage House Democrats to pass the legislation.

The $1.1 trillion legislation passed by the House would extend coverage to an estimated 36 million Americans, vastly expand Medicaid, establish a government-run option, and create individual and employer mandates. It would also bar insurers from denying coverage based on pre-existing conditions or from dropping coverage for those who become sick. To pay for the expansion, the House passed measures including a $400 billion cut in Medicare spending over the next 10 years and new taxes on the wealthy. While the Congressional Budget Office (CBO) estimates that the bill will reduce the federal deficit by about $104 billion over a decade, the bill’s longer term impact remains unclear, and some Democrats are still raising concerns over its costs.

In order to secure enough votes for passage, House Speaker Nancy Pelosi (D-CA) agreed to hold a vote on an amendment that would specifically bar the public plan from covering abortion and prohibit those who receive insurance subsidies from using the subsidy to purchase private plan options that cover abortion. The amendment was approved 240 to 194, with 64 Democrats in favor. Abortion rights supporters, however, vowed to oppose the final legislation if it remains in the amendment, highlighting the difficult road ahead.

AARP and AMA Back House Bill: The House reform legislation received a boost last Thursday, winning the support of two highly influential lobbies - AARP and the American Medical Association (AMA). The announcements came at a critical time as the House Speaker was working to shore up the last votes needed to pass the reform legislation.

Small Businesses Voice Concern: Groups and coalitions representing small businesses showed their opposition to the health care reform late last week, sending letters to lawmakers urging them to vote against the House health care reform bill. In a statement Saturday, Susan Eckerly, Senior Vice President of the National Federation of Independent Business, said, “With unemployment at a 26-year high, the punitive employer mandates and atrocious new taxes will force small business owners to eliminate jobs and freeze expansion plans at a time when our nation’s economy needs small business to thrive.”

Obstacles Remain for Senate: While Senate Majority Leader Harry Reid (D-NV) waits for the CBO to review the Senate’s health care proposal, many hurdles remain before securing the 60 votes needed for it to pass. These obstacles include the incorporation of a public option, issues associated with federal funding for abortion, and how to pay for the health care overhaul. Recent reports indicate that Sen. Reid is favoring an increase in payroll tax on the wealthy to help pay for reform. In addition, U.S. drug makers, medical-device manufacturers and insurers are gearing up for another opportunity to reduce proposed industry fees in the Senate version of reform legislation.

With continuing pressure from White House officials to pass health care reform legislation by the end of the year, Sen. Reid has indicated that he will bring the reform package to the Senate floor for debate as early as Monday. However, Senators have indicated that, more realistically, voting will take place before Christmas, with the final passage in mid-January. In an effort to spur on Senate Democrats, Former President Bill Clinton - whose health care reform efforts failed 15 years ago - told the senators over lunch last Tuesday that “passing health care reform is not only a moral issue but also an economic imperative.”

Public Opinion

American Support Slips for Passing a Health Care Reform Bill: A new Gallup Poll released last Monday shows that Americans have moved in a more negative direction on whether or not a new bill should be passed into law. Thirty-eight percent of Americans now say they would advise their member of Congress to vote against a new health care bill this year, while 29 percent would advise their member to vote for it. In addition, 41 percent say a new health care bill would make the U.S. health care system better in the long run, while 40 percent say it would make things worse.

Other Activities

Republicans Mobilize to Increase Opposition: In an effort to drum up opposition to the Democratic health care reform bills, Senate Republican Conference Chairman Lamar Alexander (R-TN) indicated that Republicans are “quietly” planning approximately 50 in-person and telephone town hall gatherings over the next three weeks.

Looking Ahead

CBO estimates of the cost of the Senate health care reform package are expected late this week or early next week, which will clear the way for Senate Majority Leader Harry Reid to bring the legislation to the Senate floor for debate as early as Monday.

Week of November 9, 2009

Given that the Senate is expected to require much more time than the House to vote on a health care bill (see below), it is likely there is not enough legislative time left in 2009 to wrap up a bill for Christmas delivery to the White House. Senate Majority Leader Harry Reid fueled concerns about the schedule last week when he refused to commit publicly to passing an overhaul bill this year. This makes a “conference” between the House and Senate MORE likely in January 2010 THAN IN 2009, and that could require some time since the current House and Senate versions are vastly different on several key provisions. If the Conference pathway proves too contentious, House Speaker Nancy Pelosi and Reid could play legislative “ping-pong,” whereby each Chamber makes a modest change and ships if off to the other, back and forth, until they both approve the same language.

Quoting & Saving just got easier…EasyToInsureME Health Insurance Quotes… Quote all carriers in seconds

Health insurance
Health insurance quotes

Federal

Late Saturday night the House of Representatives approved its version of health care reform by the slim margin of 220 to 215 (218 was the minimum needed). The core of the approved House bill remained unchanged from the version the Speaker introduced a few weeks ago and includes: an employer mandate to provide and pay for coverage; a fairly strong individual coverage requirement; a public plan option set up by government that would pay “negotiated” rates to providers; and insurance reforms, including guaranteed issue and modified community rating. It does not include the “Cadillac” plan tax or the insurer tax provisions currently in the Senate bill. The House bill would be paid for in part with cuts to Medicare Advantage and a surcharge on the “wealthy.”

On the Senate side, Majority Leader Reid is waiting for the revenue score from CBO on several different Senate Bill scenarios, given that several Senators have publicly stated opposition to going forward without a hard and fast number on both cost and impact on bending the spending curve. He also needs this time to win over the 60 votes needed to even proceed with consideration of the bill, let alone the 60 needed to cut off debate once the debate begins; he may not have either right now. The earliest the Senate could start debate would be the week of November 16, but a date in December seems more likely. Approval of the House bill will surely put increased pressure on the Senate to move forward but to do so cautiously, given the slim voting margin in the House, as the issue moves closer to the finish line.

Bills to extend and expand COBRA have been introduced in both the House and Senate and could well be part of the final push on health care reform. Both versions extend the Special COBRA subsidy program from end of 2009 to June 30, 2010 and maintain the government’s 65 percent subsidy. The Senate version increases this subsidy to 75 percent, and the House extends basic COBRA eligibility from 18 to 24 months. Given the unemployment numbers, it seems likely that, whether as part of health reform or on its own, a COBRA extension (including the subsidy) will be enacted in 2009.

States

ARIZONA: Governor Jan Brewer and legislative leaders have reached a tentative agreement to reconvene to address the projected 2010 budget shortfall, which ballooned from $1 billion in early September to $2 billion by the end of October. Although the governor favors a temporary tax increase to boost revenue, she is unlikely to float that idea this time around to help limit the length of the session. Governor Brewer is expected to announce her candidacy for re-election. Although the former lieutenant governor is now the incumbent and has never lost an election, she is viewed as vulnerable by some Republicans because of budget concerns and her continued focus on obtaining additional revenue through taxation.

CALIFORNIA: California’s state budget deficit could reach $7 billion for the current fiscal year in part because of recent court decisions blocking state funding cuts. For example, a federal judge recently blocked the state’s plans to cut $80 million from its budget for In-Home Supportive Services, and Insurance Commissioner Steve Poizner has filed a suit to block the sale of part of the State Compensation Insurance Fund, which was projected to generate $1 billion. Some analysts project that the state’s budget deficit will range from $10 billion to $20 billion in the upcoming fiscal year. In other developments, Lt. Governor John Garamendi won a special election to fill the Congressional seat vacated by U.S. Representative Ellen Tauscher (D). Garamendi was elected lieutenant governor in 2006 after 16 years in the legislature and two terms as insurance commissioner.

COLORADO: Senator Betty Boyd, President Pro Tem and Chair of the Health and Human Services Committee, met with insurer representatives to highlight the issues likely to get attention in the upcoming session. A proposal to prohibit the use of gender in rating individual policies has a high likelihood of passing, she said. Senator Boyd also advised that efforts will be made to ensure that the Cover Colorado program remains solvent, as it has potential to be used as the state’s public plan option. Speculation has it that Colorado could become one of the first states to act on federal health care reform if it is enacted. Finally, she expressed a strong interest in authorizing the DOI to establish standardized policy forms.

DELAWARE: Department of Health and Social Services Secretary Rita M. Landgraf has issued an update to existing statutes adding virtual colonoscopy as an approved colorectal screening modality. Delaware law requires coverage for colorectal screening modalities and empowers the Secretary to add modalities as recommended by the Delaware Cancer Consortium. Accordingly, all contracts for health insurance issued, delivered or renewed after December 1, 2009 must include coverage for virtual colonoscopy for colorectal cancer screening.

DISTRICT OF COLUMBIA: Newly passed legislation requires individual and group health plans to provide coverage for orally administered chemotherapy medication in a manner no more restrictive than intravenously administered treatment or injected cancer medications. In other business, the Council of the District of Columbia confirmed Acting Commissioner Gennet Purcell as Commissioner for the District of Columbia Department of Insurance, Securities and Banking (DISB). Commissioner Purcell, who served as DISB’s Deputy Commissioner since 2008, is an attorney and member of both the State of Maryland Bar and the Commonwealth of Virginia Bar. As deputy, her primary responsibilities included oversight of the agency’s core functional areas, including the divisions of Insurance, Securities, Banking, Fraud Enforcement and Investigation, and Risk Finance.

GEORGIA: A meeting was held last week between health insurance representatives and the Chairman of the Senate Insurance Committee to discuss legislation for 2010 that would restrict rental networks. The Medical Association of Georgia also was represented. Aetna has committed to work with all interested parties on the legislation.

ILLINOIS: A fall veto session concluded at the end of October, and three health insurance bills of import passed both chambers. The first bill creates external review requirements for all commercial insurance products, rather than just HMOs, effective July 1, 2010. The bill also establishes committees to create a uniform small-employer group health status questionnaire and an individual health statement for use on January 1, 2011. The legislation also requires insurers to semi-annually prepare and provide the Department of Insurance a statement on aggregate administrative expenses and other information. It is a good compromise versus what was originally proposed. In addition, both chambers passed an orthotics and prosthetics mandate on health carriers and HMOs for policies amended, delivered, issued, or renewed six months after the effective date of the amendatory act. The third bill changed the requirements to obtain a producer license. The Illinois General Assembly is not expected to reconvene until January 2010.

MISSOURI: The Secretary of the State recently approved a ballot initiative proposal for the November 2010 ballot that would essentially eliminate network-based health care delivery in Missouri. The move follows unsuccessful efforts to enact an any-willing-provider bill in past legislative sessions.The petition effort behind the ballot initiative appears to have been spearheaded by a local surgical practice that has been excluded from the medical staffs of local hospitals. Any willing provider is only one portion of the proposal. It would apply to health carriers and health benefit plans, including Medicare and Medicaid, and facilities. It would, for example, prohibit carriers from: Imposing on a beneficiary any co-payment, fee, or condition that is not equally imposed on all other beneficiaries in the same benefit category, co-payment level, or class; prohibiting or limiting a provider from the opportunity to participate in the network if that provider is willing to accept the carrier’s operating terms and conditions, fee schedule, covered expenses, utilization and quality standards. The State Auditor is preparing an assessment of the fiscal impact of the proposed measure as well as a brief summary of the fiscal impact for the petition. Legal challenges to the ballot initiative are permitted. A group of stakeholders, including Aetna, are discussing strategy.

NEW JERSEY: Health insurance issues were front and center in a bitter battle for the governor’s office, which ended last week when Republican candidate Chris Christie defeated Democratic Governor Jon Corzine. The governor-elect has publicly supported greater flexibility for carriers to make health coverage more affordable via mandate-free plan designs and interstate sales of health policies. The Democrats remain in firm control of the legislature, which will make the governor-elect’s agenda an uphill battle. Also, the Department of Banking and Insurance (DOBI) adopted a regulation standardizing the information and format on health identification cards. Additionally, DOBI initiated a meeting with the state’s major health plans seeking guidance as to how the state might proceed in limiting plans,’ and members,’ exposure to exorbitant out-of-network provider charges. This is one in a series of meetings aimed at developing consensus on an appropriate fee schedule or other mechanism for non-par provider charges. Lastly, the NJ Department of Health & Senior Services (DHSS) has launched a six-month Hospital Newborn Pilot Program. Nine hospitals throughout the state are participating in a pilot to ensure no newborn leaves the hospital without health insurance. The participating hospitals are expected to submit data to the DHSS.

NEW YORK: Governor David Paterson is calling for a special session to address the current state budget deficit. The Governor’s two-year, $5.2 billion Deficit Reduction Package would have a current-year impact of $3.2 billion in 2009-10 and a recurring impact of $2 billion in 2010-11. The components include across-the-board spending reductions and a tax penalty forgiveness program. The Governor indicated that his agenda will include a bill that would completely prohibit all subrogation (collateral source) recoveries on any insured or self-insured plans. The existing collateral source rule eliminates the potential windfall of double recoveries to plaintiffs who receive benefits and make recoveries from both their insurance coverage and defendant payments, while still ensuring that uncompensated losses are fully compensated. This subrogation legislation passed the Senate earlier this year, but it has not passed the Assembly. In other business, State Sen. Eric Schneiderman, chairman of the Codes Committee, and Sen. Neil Breslin, chairman of the Insurance Committee, introduced a bill known as “Ian’s Law,” which is named after a patient with muscular dystrophy. The proposed legislation would prohibit non-renewal of group policies and would require heath plans to get state Department of Insurance approval before discontinuing a class of insurance. The bill also would require plans to continue covering a totally disabled policyholder for 18 months, even if the plan gets state permission to cancel an entire class of policies.

This Week in Health Reform: November 6, 2009

As we near the end of a busy week in Congress, WellPoint sent a letter to Congressional Members highlighting the detrimental impact of current legislation on our health care system. The letter focuses on the potential impact of the Affordable Health Care for America Act (HR 3962) currently being debated in the House of Representatives.

WellPoint also provided Congress with a point-by-point response to the White House Blog’s criticism of its actuarial analyses released late last week.

And, earlier this week, The Wall Street Journal published alead editorial highly critical of House Speaker Nancy Pelosi (D-CA) and the House bill. In addition, House Republicans proposed their own health care reform legislation.

Quoting & Saving just got easier…EasyToInsureME Health Insurance Quotes… Quote all carriers in seconds

Health insurance
Health insurance quote

URGENT ACTION IS NEEDED

On Saturday, November 7, the House of Representatives is scheduled to vote on health care reform legislation that would force individuals to purchase coverage through the government health care exchange. Section 202(c) of HR 3962 prohibits individual coverage from being sold outside of the government health care exchange.

Forcing individuals to purchase coverage through the exchange reflects a sharp departure from the current system, and we believe Americans should have the choice of not buying coverage through the government exchange if they choose not to do so.

We encourage you to take action and contact your Congressional Member today.

House and Senate Negotiations

House Republicans Offer Health Care Reform Plan: On Tuesday, House Republican Leader John Boehner (R-OH) described key aspects of the newly proposed health care reform bill that focus more on controlling health care costs than on expanding coverage. The proposed bill will:

* cap medical malpractice damages;
* increase incentives for people to open health savings accounts;
* allow insurance companies to sell insurance across state lines;
* allow trade associations and guild members to band together to purchase group insurance , and
* create state-based, high-risk insurance pools for individuals who have difficulty obtaining health care coverage.

The bill does not bar insurance providers from denying coverage based on pre-existing conditions, nor does it create individual or employer mandates. It also does not raise taxes. The media suggest that Republicans may galvanize around their newly introduced bill. However, the media also speculate that the proposed legislation may make Republicans more vulnerable to criticism. Late Wednesday, the Congressional Budget Office (CBO) indicated that the bill would only cover 3 million additional people at a cost of $60 billion through 2019.

Biofuel Tax Credit Restrictions Added to House Health Care Reform Legislation: A measure introduced by Rep. Chris Van Hollen (D-MD), a member of the House Democrat leadership, would save the federal government $24 billion in biofuel tax credits over 10 years.

The measure would restrict the paper industry from claiming tax incentives for use of a fuel known as “black liquor.” The tax credit savings could be used to offset costs of the health care bill, Van Hollen said.

Abortion and Immigration Issues May Imperil House Legislation: As House Speaker Nancy Pelosi works to shore up 218 votes for the House health care reform legislation introduced last week, two key contentious issues remain at the center of debate - funding for abortions and coverage for illegal immigrants . This week, anti-abortion Democrats circulated legislation to strengthen prohibitions in the bill against federal funding of abortion. It is also still up for debate as to whether or not illegal immigrants would be allowed to shop for insurance within the new exchange.

Senate Leader Signals Delay: Senate Majority Leader Harry Reid (D-NV) signaled Tuesday that Congress may fail to meet the end-of-year deadline for health care reform imposed by President Barack Obama. Senators are currently waiting for CBO cost estimates on their health care reform proposal, which may not come until late next week. Given this timeline and the upcoming Thanksgiving holiday, a bill may not reach the Senate floor until December.

Public Option Developments

CBO Indicates House Bill Would Attract Less Healthy: According to the CBO, the House health care reform legislation would attract less healthy enrollees in its version of the public option and would subsequently result in higher health care costs. In addition, the CBO predicted that of the 30 million Americans likely to purchase insurance through the insurance exchanges, one fifth would purchase insurance from the public option.

Looking Ahead

President Obama indicated that he will visit Capitol Hill late this week to address House Democrats and encourage a final push towards health care reform legislation. While House leaders plan to hold a rare Saturday vote on their proposed measure, Senate leaders still await a CBO cost estimate.

Oct. 30, 2009

This Week in Health Care Reform

This week, lawmakers fine-tuned their reform proposals and, once again, the public option became the central issue of the health care reform debate.

Quoting & Saving just got easier…EasyToInsureME Health Insurance

Health insurance
Health insurance quote

Senate and House Negotiations

Senate Majority Leader Announces Senate Bill that Includes Public Option: On Monday, Senate Majority Leader Harry Reid (D-NV) announced that the health care reform package from the Senate is expected to include a public option with an opt-out provision should a state choose to not participate in the government plan. While liberal Democrats cheered the inclusion of the government-run plan, some moderates - including Sens. Joe Lieberman (I-CT), Blanche Lincoln (D-AR), Evan Bayh (D-IN) and Mary Landrieu (D-LA) - all voiced concerns.

Sen. Lieberman said that he would vote to block the passage of the Senate health care reform bill in Sen. Reid’s proposed form. In addition, Sen. Olympia Snowe (R-ME), the only Republican to vote in favor of any health care reform legislation to date, stated that she is “deeply disappointed” with the inclusion of the public option.

This backlash comes as a blow to Sen. Reid and calls into question whether he has the 60 votes needed for final passage of the bill without an anticipated Republican filibuster. Sen. Reid has delivered a variety of proposals to the Congressional Budget Office (CBO) for cost estimates as he works to finalize the legislation.

Pelosi Unveils House Health Reform Bill: On Thursday, following weeks of negotiations to merge three bills passed by House committees last summer, House Speaker Nancy Pelosi (D-CA) unveiled the House’s 1,990-page health care reform legislation.

The merged legislation includes a version of the public option, favored by moderate Democrats, that uses reimbursement rates negotiated with private insurers rather than the option favored by liberal Democrats that pegs rates to Medicare. The bill also includes:

*
Mandates for individuals and employers to purchase coverage (with some exemptions)
*
Subsidies to help lower-income individuals purchase insurance
*
An expansion of Medicaid eligibility to include individuals and families with incomes of up to 150% of the federal poverty level
*
Taxes on the wealthy of 5.4% for individuals who earn more than $500,000 and for couples who earn more than $1 million
*
Significant insurance market reforms
*
Fees collected from the medical device industry totaling $20 billion

The House bill does not include the “Cadillac Tax,” a controversial tax on high-end insurance plans. And, House Democrats indicated that party leaders have yet to resolve long-standing disagreements regarding coverage for abortion and illegal immigrants.

This bill is estimated to cost just under $900 billion over the next 10 years. However, the legislation does not address Medicare physician payments and instead moves this portion of the proposal to a separate bill, which is anticipated to increase the U.S. budget deficit by more than $200 billion over 10 years.

Senate and House Propose Lower Medical Device Industry Fees: In the bill originally passed by the Senate Finance Committee, fees collected from the medical device industry would have totaled $40 billion over 10 years. Lawmakers from both the Senate and the House are proposing lower fees. In the emerging Senate legislation, Sen. Reid is expected to adjust the fees to between $15 and $20 billion over 10 years. By comparison, the House version includes a tax that would be imposed at the point of sale, thereby spreading its impact across manufacturers, wholesalers and distributors, and would yield $20 billion between 2013 and 2019.

Additional Activities

U.S. Business Group Opposes Public Option: On Wednesday, The Business Roundtable, comprised of chief executives at Verizon Communications, JPMorgan, General Electric, Wal-Mart and other companies, said the federal government is inefficient and would underpay providers while driving up costs for employers and their workers.

Public Opinion

American Opinion on Public Option Remains Steady: The October Kaiser Family Foundation poll found that 55% of Americans believe that it is now more important than ever to take on health care reform, while 41% say the country cannot afford it, results that are unchanged from the previous month. Other findings include:

*
Americans’ support for taxing the wealthy to pay for reform decreased slightly in October, while support for taxing insurance companies increased.
*
Americans still worry about the potential impact of the reforms on measures such as wait times, cost and choice of providers.
*
Most Americans believe that health care reform will deliver changes immediately. About half of Americans believe that if Democrats pass health care reform legislation, help for the uninsured and consumer protections in the insurance market will begin within a year. In actuality, however, most of the reform provisions will take years to kick in.

Looking Ahead

Sen. Reid awaits CBO financial estimates to finalize the Senate bill before bringing it to the Senate floor. The House bill will be submitted to the full House for debate as early as next week.

Week of October 26, 2009

While Aetna and the rest of the insurance industry continue to focus on important health care reform issues, some members of Congress and The White House appear unwilling to stop or even slow the political attacks against insurers. Even as yet another analysis released last week showed real concerns persist that current proposals will worsen, rather than alleviate, rising health care costs, the House Judiciary Committee used its powers last week to try to punish the industry for speaking out (see below). Actually, the industry remains committed to seeing meaningful health care reform passed this year, a view made clear in a Washington Post op-ed authored by the President of America’s Health Insurance Plans. The reactions on the Hill continue to largely side-step the specific cost concerns raised in the past two weeks. But Aetna remains hopeful that the dialogue may yet return to substantive issues before bills are brought to the floor of the House and Senate in the next several weeks.

Quoting & Saving just got easier…EasyToInsureME Health Insurance

Individual health insurance
Health insurance quotes

To ease the burden of a scheduled 21-percent pay cut for Medicare doctors in 2010, Senate Democrats tried to pass a stand-alone bill that would have wiped out both next year’s cut and all future cuts. Eliminating the cut for one year would cost $10.9 billion — such a provision is in the Finance Committee version of health care reform and would be fully funded. To totally wipe out the fee cuts for all years would cost $245 billion. Without a “pay for” such a bill would add close to a quarter-trillion dollars to the deficit. This is precisely the bill Majority Leader Harry Reid brought forth. Senator Reid needed 60 votes; he got 47 as all Republicans and 13 Democrats voted against cutting off debate. Senate Democrats had hoped to gain physician support for health care reform by providing relief from the cuts. But the results should serve as a “wake-up” call to the Democratic leadership that health reform will not be a walk in the park. The strong vote could also embolden moderate Democrats to band together and make “hard votes” on health care reform as well.

In the House, legislative activity for the week came down to passage in the Judiciary Committee of a bill that Democratic sponsors describe as repeal of the health insurer antitrust immunity known as the McCarran-Ferguson Act. The bill more accurately can be described as codifying various court interpretations of the Act, all of which the industry lives with day in and day out. The bill specifically says health insurers (and MedMal insurers) can’t hide behind McCarran-Ferguson to price-fix, bid-rig or engage in market allocations with competitors. Insurers can’t do that now. Thus, the bill is much more of a vehicle for some in Congress to further demonize a well thought-out piece of legislation with positive policy underpinnings. Whether this item gets added to a health care reform bill or progresses on its own remains to be seen.

The timing for floor debate on health care reform will likely ebb and flow for several weeks, but the current thinking is that this process may take all of 2009 and possibly into 2010 to complete. The House merging process is all but done along with the CBO review of the House bill. The House bill could be released this week, go to the Rules Committee on Thursday/Friday and on to the House floor the first week of November. This schedule requires that everything fall into place and that the Speaker be willing to begin floor debate before the Senate, which seems to be the case. On the Senate side, merging the HELP and Finance Committee bills seems to be picking up speed, particularly with reports of an emerging public plan compromise. But the process will not be finished until later this week, which would bring the bill to the floor the week of November 2 at the earliest. There is a real chance that too many variables will get in the way and neither Chamber will get to the floor until December, which, if true, would translate into a January Conference.

States

COLORADO: The Colorado Health Care Task Force has voted several bills out of committee, including: a prohibition on the use of gender in developing rates for individual policies; a maternity coverage requirement in individual policies; and a requirement that the Department of Insurance develop standardized formats for such things as policy forms and explanations of benefits. Aetna will provide comments.

GEORGIA: Commissioner Oxendine signed the regulation allowing health insurers to utilize health status at renewal when underwriting small groups (2-50). Aetna has worked with the Georgia Association of Health Plans for some time to help enact this regulation. The Commissioner has also scheduled a meeting with health plan representatives to discuss his 2010 legislative agenda, which will include a bill similar to one defeated this year that would have regulated rates for individual policies.

ILLINOIS: The legislature last week completed the first week of a two-week veto session and took on two insurance-related issues. One bill would create external review requirements for all commercial insurance products, rather than just HMOs, effective July 1, 2010. The bill also would establish committees to create a uniform small-employer, group-health status questionnaire and an individual health statement for use beginning January 1, 2011. Lastly, the bill would require insurers to semi-annually prepare and provide the Department of Insurance a statement on aggregate administrative expenses and other information. Surprisingly, Chairman of the Executive Committee Mary Flowers stated that she was not going to allow the bill to be called for a vote until she had an opportunity to question the sponsor. Thus, no vote was taken, even though there was no opposition. It appears the bill will be moved for a vote this week in a different committee. Also, negotiations have begun on an insurance mandate bill for prosthetics and orthotics. The General Assembly has indicated that when they adjourn late this week, they will not return again until January.

PENNSYLVANIA: Governor Ed Rendell signed spending, revenue and fiscal code bills earlier this month, ending the 101-day budget standoff. But negotiations continue over the unresolved issue of expanding legalized gambling to include table games. Of primary interest, one bill signed into law embraces an extension of the 5.9 percent gross receipts tax on Medicaid MCOs as an alternative to the Administration’s proposed 2 percent health insurance tax as the basis for federal matching Medicaid funds. The final bill also dropped the proposed “trigger provision,” which would have authorized the Department of Public Welfare to abrogate its Medicaid MCO contracts if the Centers for Medicare & Medicaid Services were to disapprove the GRT approach for fund matching.

UTAH: The Health Reform Task Force has drafted two proposals to recommend to the 2010 legislature. The first, under the guise of administrative simplification, would establish procedures to be followed for coordination of benefits for dependents subsequent to a divorce, superseding the provisions in the applicable insurance contract. The second proposal would require the DOI to develop standards for the use and electronic exchange of uniform claim forms, billing and claim codes, eligibility and coverage information and coordination of benefits.

Week of October 19, 2009

Inside-the-Beltway politics were in full swing last week as the insurance industry came under heavy fire from some members of Congress and the media for releasing a PricewaterhouseCoopers report prior to the Senate Finance Committee’s scheduled vote on its health care reform proposal. The report found that the Committee’s reform package would drive up the cost of private insurance coverage for individuals, families and businesses. As a result, the industry was openly accused of trying to scuttle health care reform, even though America’s Health Insurance Plans (AHIP) stated clearly in a press release and a letter to key Senate leaders that the industry was simply fulfilling its responsibility to bring to light serious flaws in the bill. The industry still intends to work toward bipartisan reform. By the time the furor died down, no one had seriously refuted the substance of the report. In fact, just a day later a new report from Oliver Wyman arrived at very similar conclusions. Regardless of these reports, Aetna has consistently warned that meaningful health care reform must address rising costs and that insurance market reforms must be linked with a strong individual coverage requirement to work effectively. Aetna will continue to deliver this message and help others understand how the market works.

Quoting & Saving just got easier…EasyToInsureME Health Insurance

Individual health insurance
Health insurance quotes

Federal

While there was some drama, the actual outcome of the Senate Finance Committee’s vote to approve its health care reform bill was never really in doubt. By a vote of 14 to 9, the Committee approved the bill with all Democrats and one Republican, Olympia Snowe of Maine, saying yes. The drama was two-fold: a) would Snowe agree or hold her powder dry until the floor debate to improve her ability to bargain for changes; and b) would Ron Wyden (D-OR) and/or Jay Rockefeller (D-WV) vote no or hold their vote to protest the absence of the public plan. Neither possibility materialized, but the “drama” could merely have shifted from the Committee to the Senate floor. The Finance Committee approval of health reform set in motion the next step in the process, as the Senate Democratic leadership began the process of melding the Finance and HELP Committee bills. Majority Leader Harry Reid is working with Finance Chairman Max Baucus, HELP Vice-Chairman Christopher Dodd and Chairman Harkin to hammer out a single bill, and three issues appear the most contentious: the Finance Committee’s weak individual mandate vs. HELP’s stronger one; a HELP public plan vs. the co-op approach from Finance; and the HELP employer mandate vs. no mandate from Finance.There are hundreds of subordinate issues as well, all of which translates into a contentious merging process that will likely delay debate on the floor to late October/early November.

Senate Democrats, led by Senator Stabenow (D-MI), will likely vote this week on a stand-alone bill to eliminate a scheduled 21 percent cut in physician Medicare reimbursement on a permanent basis. The one-year cost of this doctor “fix” in the current Senate Finance Committee bill is $10.9 billion; the permanent fix (buried in the House reform bill) would cost upwards of $250 billion. The idea behind this maneuver is to pull out a costly item from the health reform bill, which is supposed to be deficit-neutral, in order to free up more money to spend on other items or to reduce the total cost of health reform, e.g., the House Democrats want to get their bill under $1 trillion. While most agree that the payment level for physicians should be much more aligned to quality and performance, the debate will likely turn on whether Democrats can shift to the deficit another $250 billion in money for doctors without stirring up the American public.

States

COLORADO: The Colorado Division of Insurance adopted amendments revising the state’s early intervention services (EIS) benefit mandate in accordance with newly adopted legislation. Individual and group policies or contracts that include dependent coverage are required to cover EIS delivered by qualified providers to eligible children through age 3. The new law modifies this mandate by requiring, among other things, an increase in the reimbursement rate for EIS by carriers, if the base rate for state-funded EIS increases by more than the cost-of-living adjustment. The amended rule was effective October 1. The DOI also adopted amendments establishing standards for the sale of limited benefit plans by HMOs. This legislation allows HMOs to offer access to basic health care services through limited benefit plans to employer groups that have not offered health coverage to their employees for the previous 12 months and to individuals who have been uninsured for the previous 12 months. HMOs are prohibited from offering limited health benefit plans in Colorado counties with a population of more than 25,000 people.

ILLINOIS: The Department of Insurance (DOI) has taken the position that carriers cannot require, in their contracts, that claims for proceeds on a life insurance policy be made “in writing.” The insurance industry has requested that the DOI reconsider its position. The DOI maintains that the only required documents for a life insurance claim are the insured’s death certificate and a copy of the claim check. The insurance industry believes that this interpretation of the law runs contrary to generally accepted claim procedures that were put in place to confirm that coverage was in force, that a covered loss occurred, and that there are no exclusions or limitations that affect the claim payment. Illinois statute directs a life insurer to settle a death claim within two months of the receipt of due proof of the insured’s death and places no limit on what an insurer may reasonably require during the statutory period to assure proper verification of the insured’s death, as well as verification that claim proceeds are being correctly paid to the proper claimant.

KENTUCKY: Last week the Department of Insurance held a public meeting at which it briefly discussed its proposed 2010 legislative package, approved by the Governor’s office, for the upcoming session. The proposals include updating state laws to incorporate federal changes with respect to mental health parity, Michelle’s law, HIPAA clarifications; updates to the limits under the life and health guaranty model; and uniformity changes to the producer licensing law. Also discussed was the possible elimination of the requirement that insurers offer a standard benefit plan under the Kentucky Access law.

MASSACHUSETTS: The Commonwealth Health Insurance Connector Authority is proposing amendments to the Minimum Credible Coverage (MCC) regulations, with a public hearing on the matter scheduled for Nov. 17. The MCC regulations set the standard for minimum benefits Massachusetts residents must carry in order to be considered insured and avoid penalties. The proposed regulation changes were approved by the Connector Board and filed with the Secretary of State. They would: make prescription drugs one of the categories of services/benefits that are considered “core services” under minimum creditable coverage, thus prohibiting the imposition of dollar caps on its prescription drug benefit; require a health benefit plan covering dependents to provide coverage to all “broad range of medical benefits” as provided to subscribers in order to ensure that maternity benefits are extended to pregnant dependents; and allow employer groups to pair a high-deductible health plan with a Health Reimbursement Arrangement (HRA), as an alternative to a Health Savings Account (HSA). There likely will be some push back on the additions to the MCC standard. However, some version of the amendments is expected to pass. If enacted, the prescription and dependent benefits amendments would be effective in 2011; the HDHP/HRA amendment would take effect on 1/1/2010.

NEW JERSEY: The state has launched a database designed to track autism cases and direct affected families to health care and other services. The New Jersey Autism Registry requires psychiatrists, psychologists, neurologists and medical professionals to register children diagnosed with autism and birth defects such as Down’s Syndrome, cleft palate, and heart or muscular defects. The registry is confidential and will be used to enable officials to better assist New Jersey’s families with autism and other special needs. Access to the database is restricted to medical professionals.

NEW YORK: Governor David Paterson last week proposed a new two-year, $5 billion deficit-reduction package (DRP) that will fill the $3 billion (and growing) gap in the 2009-2010 spending plan and have a recurring impact of $2 billion in 2010-11. The new proposal does not include new taxes or assessments, a reflection of the extraordinarily high taxes already imposed on health plans in the main ‘09-’10 budget. The Governor’s new DRP focuses on across-the-board Medicaid cuts, a $14.7 million cut in the managed long-term care program, a $14 million reduction in the Child Health Plus program, and a $7 million reduction in section 332 assessment sub-allocation, which includes both the Healthy New York and Timothy’s Law programs. The budget announcement was sharply criticized by the hospital industry and hospital workers’ union SEIU/1199. Assembly Democrats have already scheduled two hearings on the Governor’s proposed DRP for Wednesday, October 21st, in Albany and Friday, October 23rd in Syracuse.

OREGON: The state Insurance Department has issued a second bulletin regarding legislation that established a premium assessment on health insurers. The primary purpose of the new bulletin is to provide information about the approved manner of calculating premium increases to offset the cost of the new assessment. The bulletin states that the law limits the amount carriers are allowed to increase premiums, as a result of the assessment, to one percent. The amount derived from dividing premiums by .99 is greater than one percent and is therefore illegal. Any insurers that calculated the increase in the .99 manner and have already collected premiums are required to issue refunds.

TEXAS: The Department of Insurance held a stakeholder meeting last week to discuss implementation of the new “Healthy Texas” program, legislation that passed in May. The program is modeled after Healthy New York and will offer state re-insurance for up to 80 percent of the claims corridor of $5,000-$75,000 for an insurance product, which can be sold only to small groups that have been uninsured for at least a year and have at least 30 percent of their employees’ salaries at a maximum of 300 percent of the federal poverty level. The employer must agree to pay at least 50 percent of the premiums, and at least 60 percent of the employees must enroll. The legislature provided $17.5 million dollars annually to fund the program for the next 2 years. TDI and the Texas HHSC have been awarded almost $5 million a year for the next five years in HRSA grant money to assist with costs of actuarial contracts, marketing contracts and additional staff to help fully implement the program. They have posted informal rules to implement the program and plan to adopt a formal rule by the end of 2009. They would like to see members enrolled in qualifying plans by June 1, 2010, at the latest. Aetna has been involved with the drafting of legislation for this program from the beginning and will continue to be involved throughout the rulemaking process.

WASHINGTON: The state Office of the Insurance Commissioner has released its legislative agenda for 2010. The OIC proposals include; 1) new and extended grace periods for individuals to take up conversion coverage — 31 days after a person has received notice of termination of coverage; 2) a revised definition of emergency services and the elimination of a requirement that the covered health care services are provided in a hospital emergency department; and 3) a health care reform proposal that would cover catastrophic medical costs over $10,000 per year and limited preventive care for all state residents. The catastrophic health plan was also proposed in 2009 but failed to gather much attention in the legislature.

October 21, 2009

The Week in Health Care Reform

Federal Legislative Overview
Senate
On Tuesday, October 13 the Senate Finance Committee approved Chairman Max Baucus’ amended “America’s Healthy Future Act” by a vote of 14-9. Olympia Snowe (R-ME) was the only Republican who joined all 13 Democrats in supporting the bill. After the vote Snowe stated, “Is this bill all that I want? Far from it. Is it all that it could be? No. But when history calls, history calls. And I happen to think the consequences of inaction dictate the urgency of Congress to take every opportunity to demonstrate its capacity to solve the monumental issues of our time.” She went on to say, “My vote today is my vote today, it doesn’t forecast what my vote will be tomorrow,” quelling any predictions for what her vote will be on the Senate floor.

The legislation has now moved to Majority Leader Harry Reid’s (D-NV) office, who will work hand-in-hand with key Democratic leadership in the Senate, as well as the White House, to craft a single bill. This process will likely take weeks and we do not expect it to reach the Senate floor until November.

Quoting & Saving just got easier…EasyToInsureME Health Insurance

Individual health insurance
Health insurance quotes

House
Speaker Nancy Pelosi (D-CA) continued to say this week that the merged bill in the House of Representatives will have a “robust” public plan – meaning that provider reimbursement rates will be tied to Medicare. This is the opposite of the agreement made in Henry Waxman’s (D-CA) Energy & Commerce Committee with Blue Dog Democrats, in which payment rates would be negotiated.

Interestingly enough, Rep. Mike Ross (D-AR), the leader of the Blue Dogs’ Health Care Task Force, who was vehemently against a public health insurance option during reform debates in July, came out this week saying that he supported the idea of opening Medicare to those under 65 without insurance. He later backpedalled and said, “I do not endorse this idea, as it was just one of many ideas we, as legislators, have brought up and discussed in the numerous, ongoing negotiations and discussions we have had on healthcare reform over the past several months.” Ross has changed his mind numerous times during this debate. After he negotiated the deal in the Energy & Commerce Committee in July he faced significant opposition from conservative constituents during the August recess. He then returned from recess stating that he couldn’t support a public option. Ross’ statements show how difficult the push and pull will be in the upcoming weeks over key provisions in the health care reform bills.