Archive for the ‘health insurance reform’ Category

« Older Entries

Health Insurance Reform Washington Update

Thursday, August 12th, 2010

Summary of what has been happening in Washington as of Aug. 6, 2010.

Senators Introduce New Legislation to Increase Transparency and Competition in Insurance Industry
Senators Mark Pryor (D-AR), Jay Rockefeller (D-WV) and Barbara Boxer (D-CA) introduced “The Insurance Competition and Transparency Act” (S. 3685) in the Senate Committee on Commerce, Science and Transportation on Aug 2. The legislation would authorize the Federal Trade Commission (FTC) to use its authority under the Federal Trade Commission Act to “investigate and disclose information about practices employed by insurance companies that may reduce competition in the marketplace.”

The bill goes a step further and explicitly states that since many insurance companies have non-profit status, it would eliminate the exemption under the Act for non-profit insurers. S. 3685 is based on an amendment that was filed by Senators Pryor, Rockefeller and Boxer during the Senate’s health reform debate in December 2009.

Senate Passes Child Nutrition Bill
Led by the Senate Agriculture Committee Chairwoman Blanche Lincoln (D-AR) and Ranking Member Saxby Chambliss (R-GA), the Senate passed the “Healthy, Hunger-Free Kids Act of 2010” (S. 3307) by unanimous consent on Aug. 5. The legislation authorizes a $4.5 billion increase over 10 years for school lunches and other nutrition programs. It also gives the Agriculture Department authority to set nutrition standards for foods sold in vending machines and in a la carte lines in schools.

Of the $4.5 billion, the legislation provides $1.2 billion to increase the number of children receiving food, in an effort to meet President Barack Obama’s pledge to end childhood hunger by 2015. The remaining $3.2 billion would be used to improve the quality of school meals. The cost of the legislation is entirely offset. Review the Congressional Budget Office’s budgetary impact report.

Chairman Tom Harkin (D-IA) of the Senate Health, Education, Labor and Pensions Committee commended Agriculture Committee Chairwoman Lincoln for her work on the bill, noting that it passed both the Agriculture Committee and the full Senate without a single dissenting vote.

The House of Representatives still needs to pass its version of the bill, “The Improving Nutrition for America’s Children Act” (H.R. 5504), in order for President Obama to sign the bill before Sept. 30, when many of the programs are set to expire. The House Education and Labor Committee approved the measure on July 15.

The American Academy of Pediatrics also commended the Senate for its action on the legislation and pushed the House to follow the Senate’s lead. “The AAP urges the House to follow the Senate’s swift action on this bill and pass strong child nutrition legislation when Congress reconvenes in September. All children deserve a healthy future, which starts with access to healthy, nutritious meals every day.”  See the American Academy of Pediatrics’ entire statement.

Tags: ,
Posted in health care overhaul, health insurance reform | No Comments »

Health Insurance Reform Schedule

Wednesday, July 21st, 2010

2010
New programs:

  • Temporary retiree reinsurance program.
  • National risk pool, small business tax credit.
  • $250 rebate for Medicare members who reach the “doughnut hole”.

Health Insurance Reforms:

  • No lifetime benefit limits based on dollar amounts.
  • Allowed restricted yearly limits on the dollar value of certain benefits.
  • No coverage rescissions/cancellations (except for fraud or internal misrepresentation).
  • No cost-sharing obligations for preventive services.
  • Must have dependent coverage up to age 26.
  • New internal and external appeal process.
  • No pre-existing condition exclusions for dependent children (under 19 years of age).
  • New health plan disclosure and transparency requirements.

2011
Insurance Reforms:

  • New uniform coverage documents and standard definitions are developed.
  • Must have minimum medical loss ratios.

Medicare Reforms:

  • Start of Medicare Advantage cost-sharing limits.
  • Medicare beneficiaries who reach the doughnut hole to get a 50% discount on brand name drugs.
  • Primary care doctors and general surgeons practicing in underserved areas, such as inner city and rural communities to get a 10% bonus.
  • Medicare Advantage plans begin having payments frozen.

Other:

  • Yearly fee for brand-name drug manufacturers.
  • Start of voluntary long-term care insurance program giving a cash benefit to help those with disabilities stay in their homes or pay nursing home cost: benefit starts 5 years after paying coverage fee.
  • Increased funding for community health centers to provide care for many low-income and uninsured people.

2012

  • Hospitals, doctors and payers encouraged to join forces in “accountable care organizations”.
  • Hospitals with high rates of preventable readmissions facing reduced Medicare payments.

2013

  • Individuals making $200,000 a year or couples making $250,000 would have a higher Medicare payroll tax of 2.35% on earned income – up from the current 1.45%. A new 3.8% tax on unearned income, such as dividends and interest, also added.
  • Contributions to flexible spending accounts (FSAs) limited to $2,500 a year – indexed for inflation. And the threshold for deducting medical expenses on taxes goes from 7.5% to 10% income.
  • Medical device manufacturers have a 2.9% sales tax on medical devices; with exemptions for some, like eyeglasses, contact lens, and hearing aids.
  • No more deduction for expenses allocable to Medicare Part D subsidy for employers who maintain prescription drug plans for their Medicare Part D-eligible retirees.

2014
Coverage Mandates & Subsidies:

  • New Individual and employer coverage responsibilities.
  • New Individual affordability tax credit and expanded small business tax credits.

Health Insurance Exchange & Insurance Reforms:

  • State individual and small group health insurance exchanges operational.
  • Guaranteed issue, guaranteed renewability, modified community rating and minimum benefit standards (“essential benefits” plan) effective.
  • No more lifetime and yearly dollar limits for essential benefits.
  • New taxes on health insurers.

2018

  • New tax (“Cadillac tax”) on employer-sponsored health plans that offer policies with generous coverage levels.

2020

  • Doughnut hole coverage gap in Medicare prescription benefits is fully phased out. Seniors continue to pay the standard 25% of their drug costs until they reach the threshold for Medicare catastrophic coverage.

Tags: , , , , , ,
Posted in health care overhaul, health care reform, health insurance exchange, health insurance reform, obama care, pre existing condition, prescription | No Comments »

Health Insurance Reform News July 2010

Friday, July 9th, 2010

Health insurance reform will inevitably add to the already unsustainable federal deficit. In addition, it will prove impossible for the government to create and establish a more efficient system than the one now in place.

These are some of the arguments of more than a dozen states that have filed lawsuits. The lawsuits challenge the constitutionality of the reform. Their arguments also include that the government should not force citizens to buy health insurance.

It will be several years before the reforms take effect, and opponents are trying to ensure that they never will.

But significant improvements have already been made and insurers are also moving into compliance ahead of schedule. New rules forbid insurance companies from denying coverage to children, young adults can now stay on their guardians’ policies until age 26, and setting a lifetime limit on benefits will be banned soon.

Let’s not forget the true objective and that is to reduce costs. The Obama administration  must demonstrate that reforms will eventually bring down costs. This is the true test.

Tags: , , ,
Posted in children, health care reform, health insurance reform, obama care | No Comments »

This Week in Health Care Reform

Friday, June 11th, 2010

Primary elections were held in 11 states this week as lawmakers returned to Washington, D.C., to face a growing list of unfinished legislative business including a jobs bill and environmental issues stemming from the Gulf crisis. Meanwhile, President Barack Obama launched a public relations campaign to combat skepticism around his new health insurance reform legislation and to promote the early implementation of certain provisions of the law.

Health Care Reform
Health Care Reform Debate Alive and Well: Democrats continue to sell their plan for health care reform to Americans in the face of mixed public opinion, simultaneously battling Republicans pushing for its repeal.

Congressional lawmakers address concerns about the new health care reform legislation, particularly among senior citizens , who make up a disproportionate share of voters in midterm elections. Democrats and the administration are eager to publicize certain provisions of the bill, like retaining young adults on their parents’ plans until age 26, as a way to gain support and to turn voters away from Republicans who called for its repeal.

On Tuesday, President Obama held a nationally televised town hall meeting at a senior center in Maryland to highlight the distribution of $250 rebate checks for senior citizens who hit the so-called “doughnut hole ” in Medicare’s prescription drug coverage. The first round of checks was mailed yesterday and serves as the law’s first monetary benefit.

State Battle Against Health Care Reform Law Continues: On Monday, Virginia Attorney General Ken Cuccinelli disputed the administration’s claim that the state lacks standing to challenge the new federal health care reform law. The lawsuit filed by Cuccinelli in the Eastern District Court cites a Virginia law that exempts state residents from being required to have health care coverage. Sebelius argued that states cannot simply pass a statute that would nullify a federal law. A hearing to determine next steps is set for July 1.

Public Opinion
Americans Want Repeal of Health Care Reform: A recently released Rasmussen report suggests that Americans are strongly in favor of repealing President Obama’s health care reform law. Fifty-eight percent of those polled favor repeal, while 62 percent believe the new legislation will increase the budget deficit. In addition, 57 percent predict health care costs will increase, while 51 percent feel the quality of care will decrease as a result of the new health care reform law.

Looking Ahead
Democrat lawmakers are expecting to pass the jobs bill next week but will need Republican support in order to get the 60 votes needed for passage. One provision of the bill, a 21 percent cut in Medicare payments to doctors, is being delayed as the bill moves through Congress and would ultimately be blocked if the legislation passes.

Tags: , , ,
Posted in health care reform, health insurance reform, prescription, virginia health insurance | No Comments »

Health Insurance Reform Update June

Thursday, June 3rd, 2010

Congress has once again left town for a recess, until June 7, allowing two key health benefit items to expire at the end of May. One is the “doc fix,” which is needed to stave off a pending 21 percent cut in Medicare physician reimbursements. Aetna favors a multiple-year change to bring stability and certainty to the Medicare Advantage market. While the House passed a bill to extend the fix for 19 months until the end of 2011, the Senate left town without addressing the issue. Although the current short-term fix lapsed on Monday, CMS has alerted its contractors to “hold” claims for the first 10 days of June in the hopes that the “fix” will be fixed by June 10.

Similarly, the House approved, but the Senate did not, a jobs and extenders bill dealing with other expiring items. However, the House-approved package does not contain an extension of the enhanced Medicaid FMAP formula desired by the states, nor does it include an extension of eligibility for the COBRA 65 percent-subsidy program. It also expired at the end of May.

The issue of whether a non-federal government has the authority to tell an employer how to administer a self-funded health plan has been heading to the U.S. Supreme Court for well over a year. The case comes from California where the 9th Circuit ruled in 2008 in favor of the City of San Francisco by deciding that ERISA was not a barrier to San Francisco’s “play or pay” law.  Since the 4th Circuit had ruled just the opposite a few years before in a Maryland case, the conflicting outcomes makes this case ripe for resolution by the Supreme Court. Late last week, the Solicitor General’s office recommended that the Supreme Court not take up the case because, in part, the new health care reform law may dramatically reduce the number of state or local governments following San Francisco’s lead. The SG’s position is unfortunately influential, but it is not determinative. Aetna prefers that the Court take up the case as the ERISA preemption question presented is so fundamental to the employer-sponsored marketplace. Aetna also believe ERISA preemption would be re-affirmed.

Tags: ,
Posted in aetna health insurance, health insurance reform | No Comments »

Health Insurance Reform Capitol Update

Thursday, June 3rd, 2010

House Splits Extenders Bill, No Senate Bill until June
Last week’s Capitol Update discussed the “tax extenders” package that is currently being debated in the House, saying that Democratic leaders hoped to pass it by the Memorial Day recess.

House Democratic leaders made the decision last week to split the American Jobs and Closing Tax Loopholes Act (H.R. 4213) – or “tax extenders” package – into multiple bills that would extend dozens of tax provisions, the Medicare physicians’ payment “fix,” unemployment insurance and COBRA subsidies, after it was made clear that the larger bill could not gain the votes required for passage. The House conducted votes on some measures prior to adjourning for the Memorial Day recess.

Democratic leaders in both chambers had been working to gather support for the bill over the past week, but Blue Dogs and a number of fiscally conservative Democratic senators complained that earlier versions of the bill would have added more than $80 billion to the deficit.

Friday, the House adopted an amended rule (H Res 1403) to govern debate on a bill consisting of the unemployment insurance extension and tax extenders provisions, with revenue offsets that are expected to include international tax and a delayed effective date on carried interest provisions.  Members will then consider a separate bill with a stand-alone physicians’ payment update. A third bill addressing the 65 percent COBRA premium subsidy and Federal Medical Assistance Percentages for Medicaid (FMAP) could be considered by the House in June.

House leaders developed the plan in an effort to reduce the cost of the unemployment insurance and tax extenders legislation to win the support of fiscally conservative Democratic members.

Majority Leader Reid (D-NV) said the tax extenders legislation would be open to amendment when brought before the Senate the week of June 7. His remarks came prior to a series of votes in relation to the supplemental appropriations bill, which were the chamber’s final votes before adjourning for the Memorial Day recess.

Legislation Could Allow Americans to Stay on COBRA Health Coverage Until 2014
Senator Sherrod Brown (D-OH) and Representative Susan Davis (D-CA) have introduced new legislation that aims to “permanently” extend COBRA to help unemployed workers and early retirees purchase health coverage before the major insurance market reforms, such as guaranteed issue and the establishment of health insurance exchanges, are in place in 2014.
The “COBRA Health Benefits Extension Act of 2010” has been referred to the Health, Education, Labor, and Pensions (HELP) Committee in the Senate, and the Education and Labor, Energy and Commerce, and the Ways and Means Committees in the House. Each bill has numerous sponsors; all are Democrats.

“Passage of the historic health reform bill was the first of many steps we’ll take so that middle-class families who work hard and play by the rules can still get ahead. But until those provisions take effect, we must ensure that Americans have access to health insurance,” Brown said.  “Unemployed workers and early retirees should have the option of purchasing health coverage through COBRA.”

“Losing a job that has health insurance coverage while treating an illness at the same time is a frightening prospect for so many people and their families. We need to give people a bridge between coverage,” Davis said.
For more information about the legislation, visit these Senate and House websites.

House Republicans Release Legislation to Repeal Health Care Reform Law
On May 27, seven Republican Members of Congress introduced the “Reform Americans Can Afford Act,” a bill that proposes to repeal the current Patient Protection and Affordable Care Act of 2010 and replace it with reforms addressing the interstate sale of health insurance, coverage for persons with pre-existing conditions, medical malpractice reforms and other issues.

Also, the “House GOP Health Care Solutions Group” sponsored a public forum to highlight concerns about the impact the health reform law will have on taxpayers, employers and the physician-patient relationship.

Tags: ,
Posted in cobra, health insurance reform | No Comments »

Health Insurance Reform Legislative Update

Thursday, June 3rd, 2010

HCSC President and CEO Meets with HHS Secretary Sebelius
On May 27, Pat Hemingway Hall, President and CEO of Health Care Service Corporation (HCSC), which operates Blue Cross and Blue Shield divisions in Illinois, New Mexico, Oklahoma and Texas, joined executives from Cigna, WellPoint and the Blue Cross and Blue Shield Association in meeting with Health and Human Services (HHS) Secretary Kathleen Sebelius to discuss the implementation of the Patient Protection and Affordable Care Act of 2010 (PPACA).

Ms. Hemingway Hall was able to share the company’s views on implementing some of the provisions of this sweeping and complex law, and she reported that there was a spirit of cooperation and good dialogue around key issues.

In a press conference after the meeting, the Secretary stated that federal officials are reaching out to self-insured plans to encourage them to permit young adults to remain on their parents’ policy this year. She also said that she has spoken with state governments, large universities, and large employers about the issue and that approximately 65 employers have already agreed to cooperate. HCSC implemented this provision on May 1, for its individual, small and large group fully insured customers.

Secretary Sebelius also said that the National Association of Insurance Commissioners will provide HHS with their medical loss ratio (MLR) recommendations by the end of June. She noted that conversations are ongoing about what types of health plan activities should be included as medical expenses under MLR. During the meeting with the Secretary, Ms. Hemingway Hall cited HCSC’s efforts to reduce hospital acquired infections as an example of activities that should be considered as quality improvements when calculating MLR. Later, Secretary Sebelius noted that example in her press conference.

Premium Subsidies Lapse during Congressional Recess
Federal COBRA and state continuation premium subsidies began lapsing June 1, at least temporarily, because the Senate adjourned for its Memorial Day break last week without taking action on any short-term extension of the subsidies. Without the extension, workers laid off after May 31 will not be eligible for the subsidy.

The bill under consideration would provide the 15-month, 65 percent COBRA premium subsidy through Nov. 30, 2010. If passed, the bill could be applied retroactively so there is no break in eligibility of newly terminated employees.

The House and Senate will return from recess the week of June 7, and will likely take up the issue again.

Tags: , , ,
Posted in blue cross, blue shield, cigna, health insurance reform | No Comments »

Health Insurance Reform Provisions

Thursday, May 27th, 2010

Health Provisions in the Tax Extenders Legislation
Chairmen of the House and Senate tax-writing committees, House Ways and Means Committee Chairman Sander Levin (D-MI) and Senate Finance Committee Chairman Max Baucus (D-MT), introduced the “The American Jobs and Closing Tax Loopholes Act of 2010″ (H.R. 4213 amended) on May 20. This longer-term tax and benefits extension package includes a four-year Medicare “doc fix” that further delays physician payment cuts, and extends the COBRA premium subsidy increase through Dec. 31, 2010.

Congressional leaders are focused on passing the bill before the Memorial Day recess, which is scheduled to begin May 28. At this time, it is not clear whether congressional leaders have the votes needed to win passage of the newly released extenders bill in both chambers. A number of fiscally conservative Democrats and Republicans are reportedly concerned about the overall cost of the package, which is still being scored by the Congressional Budget Office (CBO) and is expected to have a price tag of approximately $200 billion over ten years.

Financial Reform Legislation Clears Senate without Feinstein, Leahy Amendments

By a vote of 59 to 39 on May 20, the Senate approved the “Restoring American Financial Stability Act,” S.3217. Four Republicans broke with their party to vote in favor of the bill: Maine Senators Susan Collins and Olympia Snowe, Senator Scott Brown (MA) and Ranking Member on the Finance Committee Charles Grassley (IA). Two Democrats, Senators Russ Feingold (WI) and Maria Cantwell (WA), opposed the measure, saying that the bill’s provisions did not clamp down hard enough on Wall Street.

The legislation did not include two amendments relevant to health insurers:

  • A measure by Senator Dianne Feinstein (D-CA) to create a federal authority to review health insurance rates; and
  • An amendment offered by Senator Patrick Leahy (D-VT) that would have amended the “McCarran-Ferguson Act” to state that it does not prevent the application of federal anti-trust laws to the “business of health insurance.”

Tags:
Posted in health insurance reform | No Comments »

CBO Adds Billions of Dollars for Discretionary Spending Cost Estimate

Thursday, May 20th, 2010

On May 11, the Congressional Budget Office (CBO) released a report with additional information about the potential effects of the new health insurance reform law, the Patient Protection and Affordable Care Act (PPACA), on discretionary spending that the CBO initially provided on March 13, prior to the legislation being passed.

The updated analysis adds a minimum of $115 billion over 10 years – more than twice the initial estimate released before President Barack Obama signed the bill into law. This new estimate brings the cost of the new law to well over $1 trillion.

CBO Director Douglas Elmendorf stated that while the CBO does not have a comprehensive estimate of all the potential discretionary costs, they provided information on the major components broken down into three general categories:

  • Costs incurred by federal agencies to implement the new policies
  • Explicit authorizations for grant and program spending for one or more years
  • Explicit authorizations for grant and program spending for which no specific funding levels are specified

Minority Leader John Boehner (R-OH) immediately released a statement admonishing the Administration, saying that the new estimate “provides ample cause for alarm,” and nearly wipes out “the purported deficit reduction in the law.”

A Senate Finance Committee Democratic aide said, “The bulk of discretionary spending referenced in the report is for programs – like the Indian Health Service, the National Health Service Corps and Federally Qualified Health Centers – that were not created under health care reform and would have been funded through the appropriations process, like they have for decades, with or without health care reform.”

Tags: , ,
Posted in health care overhaul, health care reform, health insurance reform | No Comments »

Health Insurance Reform Update for May

Wednesday, May 19th, 2010

As the comment period ended with respect to medical loss ratio (MLR) regulations, a flurry of letters were sent last week to both the National Association of Insurance Commissioners and the U.S. Department of Health and Human Services. In addition to Aetna health insurance and other insurers, several employer groups have written with comments and concerns, including the American Benefits Council, the National Coalition on Benefits and the National Retail Federation. In all cases, the comments point out that it’s important to assure that positive, quality-oriented elements of health care, such as health information technology, disease management and wellness programs, fraud and abuse regimens, all should count as quality measures when calculating a company’s MLR. The National Retail Federation in particular noted the need for a national MLR for large employer business, a position well embraced by Aetna.

In the never-ending roll-out of proposed health care reform regulations, the Administration last week published yet another set of Interim Final Regulations. This set deals with coverage for dependent children up to age 26 pursuant to the requirement that insurers and group plans allow kids to stay on their parents’ policies or coverage until age 26.  Comments are due by August 11, but the rule is effective July 12, 2010. Many insurers have already announced that they will implement this provision early (e.g., May 31 for Aetna) to cover graduating college students who may have otherwise faced the summer without insurance. Whether self-funded employers follow suit is not as clear. Also, with the temporary fix of Medicare physician reimbursement rates set to run out the end of May, the House is expected to take up a more lasting fix sometime this week. If the House proceeds as expected it will attempt to install a five-year suspension of any physician rate cuts. Aetna supports the change, as it will give this market predictability.

Tags: , , ,
Posted in aetna health insurance, health care overhaul, health insurance reform, obama care | No Comments »

« Older Entries