Archive for the ‘health insurance reform’ Category

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Problematic Health Insurance Reform One Year Anniversary

Friday, March 25th, 2011

Senate Finance Republicans are using the one-year anniversary of the PPACA to question Health and Human Services (HHS) Secretary Kathleen Sebelius on what they call the administration’s lack of transparency in the law’s implementation.  During a Senate Finance Committee hearing, Sen. Orrin Hatch (R-UT) said that the Congressional Research Service (CRS) has found that Sebelius has the authority to waive the PPACA’s maintenance-of-effort requirement penalizing states whose Medicaid enrollment levels drop below where they stood when the law was enacted. Sebelius had previously told governors, in response to their requests that she waive the requirement, that she would continue to review whether she had the authority to do so. Sen. Charles Grassley (R-IA) asked the Secretary why Iowa and other states shouldn’t be allowed to establish their own medical loss ratio (MLR) standards, given that HHS recently granted a waiver exempting the individual health insurance market in Maine from the federal MLR. Secretary Sebelius said that Maine is unique because only two insurers currently offer coverage in that state’s individual health insurance market. She added that HHS is continuing to listen to state regulators across the nation.

After a lengthy discussion with the private sector, including Aetna health insurance, the Department of Labor has issued favorable guidance on government enforcement of certain internal claims and appeals rules as originally authorized under PPACA.  The current grace period, which runs out in July of this year, has now been extended to plan years beginning on or after January 1, 2012 with respect to four key areas of major insurer and employer concern, including the cultural and linguistic notice requirements, disclosure of treatment and diagnostic codes and their descriptions to members, the urgent care turnaround timeframe for initial requests, and the strict compliance standard. Aetna health insurance is concerned that these requirements could be confusing to members and will be costly and burdensome. These requirements are no longer subject to a good faith implementation requirement during the enforcement grace period, and the DOL has indicated that an amendment will be issued to the original 2010 interim final regulations in this area. For the rules on which the enforcement grace period expire in July (i.e., other required notices on statements of adverse determinations), implementation will take effect on plans written or renewed beginning July 1, 2011.

External review standards continue to be discussed. HHS is expected to issue future guidance on whether a state external review process meets the federal standard for external review.  The scope of federal external review process (for self funded, or the federal-operated process applicable to certain insured business) was not addressed by this guidance but may be addressed in the future.

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Individual Health Insurance Reform Update January 2011

Thursday, January 27th, 2011

Last Wednesday, Jan. 19, the United States House of Representatives voted 245-189 to repeal the nation’s individual health insurance reform law, the Affordable Care Act. While a full repeal is not expected, we should see a number of congressional hearings on the topic over the next few months.

The Affordable Care Act extended to insured group health plans the non-discrimination provisions found in the Internal Revenue Code, which previously had been applicable only to self-insured group plans. Effective for Plan Years which begin after Sept. 23, 2010, non-grandfathered health insurance plans are prohibited from discriminating in favor of highly compensated employees, and a penalty is imposed of $100 per day per participant on plans that discriminate. However, in Notice 2011-1, the IRS has delayed the application of the non-discrimination provisions of the Affordable Care Act until after regulations or other administrative guidance of general applicability have been issued. Notice 2011-1 also indicates that the penalty for failure to comply with the non-discrimination provisions will also not apply until the required regulatory guidance is issued.

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Health Insurance Medical Loss Ratio and Exchanges

Wednesday, November 24th, 2010

The Department of Health and Human Services (HHS) has released two new sets of guidelines: the long-awaited regulations governing the Affordable Care Act provision on Medical Loss Ratio (MLR) and the first of a series of guidance and rules to aid states in complying with a health care reform law to set up insurance exchanges by 2014. The MLR regulations, which go into effect in January 2011, require that large group plans spend at least 85 percent and small group and individual health insurance plans at least 80 per cent of premiums on clinical services and activities related to quality of care. Insurers who don’t meet the standards in 2011 will be required to issue rebates for that amount in 2012. We are now evaluating the new regulations and you will be hearing more about both in the near future. Health insurance quotes

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Health Insurance Quotes for Children Don’t Exist

Friday, September 24th, 2010

All insurance carriers are halting sales of individual health insurance for children policies based on confusion over a federal reform provision that takes effect today.

The health insurance reform act that was passed in March requires that policies starting now or in the future cannot exclude, limit, or deny medical coverage to children under 19 based on any health problems that developed before seeking medical coverage. Therefore, there will be no more exclusions for children with pre-existing conditions.

Premiums could double for everyone by mid 2011. Your best choice is to buy health insurance now and lock in a low rate for several years. Many carriers allow you to lock in rates for more than a year at a very small cost per month.

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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.

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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.

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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.

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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.

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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.

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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.

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