Archive for the ‘health insurance reform’ Category

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.

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.”
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.”

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.

Friday, May 7th, 2010

In the new health insurance reform law the states are permitted to create their own high risk pools, expand existing pools, or allow the federal government to create and administer the pools for them.

The following states will operate their own pools:
Alaska, Arkansas, California, Colorado, Connecticut, Illinois, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Missouri, Montana, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Vermont, Washington, West Virginia, Wisconsin, and District of Columbia.

The following states will allow the federal government to create and manage the pools:
Alabama, Delaware, Georgia, Hawaii, Idaho, Indiana, Louisiana, Minnesota, Mississippi, Nebraska, Nevada, North Dakota, South Carolina, Tennessee, Texas, Virginia, and Wyoming.

Tuesday, May 4th, 2010

While the underlying cost of health insurance services remains an under-reported issue, there are signs that this may be changing. The California legislature, for example, is beginning to turn its attention to rising hospital and provider costs, and not just the rising cost of premiums. Just in time, the U.S. Justice Department announced last week that California’s largest health care purchasers can proceed with an extensive study of the costs of care at more than 300 hospitals statewide. The California Hospital Association tried to block the project claiming antitrust concerns, but the Justice Department rejected the claim. Only by addressing costs throughout the health care system will the nation begin to slow the overall cost of health care and truly deliver on the promise of health care reform. Transparency remains a very important part of the equation.

Federal
In January, the U.S. Supreme Court ruled in the Citizens United case that the First Amendment protects the right of corporations, as citizens, to spend corporate funds on political advertising advocating the election or defeat of a particular candidate. In an effort to stave off an anticipated onslaught of corporate money infusion in this year’s elections, the Democratic majority introduced legislation last week to curb any such corporate activity. The core component of the legislation would require corporations (and unions) in the name of transparency to disclose their spending on political advertisement. This legislation is very likely to be a key subject of debate for the rest of the legislative year as Democrats seek to rally consumers and other groups in favor of the bill, and Republicans use the measure as a rallying cry against what they view as an infringement on the First Amendment.  It is not at all clear, at this stage, whether this bill has legs or whether corporations will even take advantage of the Supreme Court’s ruling. What is clear is that the issue will further drive a wedge between the two parties.

In response to WellPoint’s proposed rate increase in the California individual health insurance market in January (now rescinded), Senator Dianne Feinstein (D-CA) had proposed legislation to establish a Federal Rate Authority to both review “potentially unreasonable” increases in health insurance rates (in conjunction with the states) and to endow the federal government with new regulatory powers with respect to the Authority’s findings. Although this provision was not included in health care reform, Senator Feinstein now is poised to offer her bill as an amendment to other legislation moving through the Senate — starting with the financial regulatory reform measure currently before the Senate. The Feinstein proposal would further erode the traditional role of the states with respect to insurance matters and was opposed by Aetna and the insurance industry. Aetna will oppose this new tactic as well.

Wednesday, April 21st, 2010

The Senate reconvened on April 12, following its two-week recess.  That day, by a vote of 60 to 34, the Senate approved a cloture motion paving the way for Senate floor action on H.R. 4851, the “Continuing Extension Act.”  This bill, which the House approved on March 17, includes a temporary extension – through April 30 – of the Medicare physician payment fix and the eligibility period for premium assistance for COBRA and state continuation coverage.

The Senate passed the legislation by a vote of 59-38, on April 15. Three Republicans supported the bill, Sen. George Voinovich (OH) and Maine Senators Olympia Snowe and Susan Collins and three Democrats did not vote – Evan Bayh (Indiana health insurance), Bill Nelson (Florida health insurance) and Mark Warner (Virginia health insurance).  An amendment to the legislation offered by Senator Max Baucus (D – MT), which was passed by a voice vote, would extend most of the benefits for another month – until the end of May – so as to avoid a repeat battle over this legislation two weeks from now.  President Obama signed the bill into law Thursday night, April 15th.

Under previous law, these legislative provisions expired on March 31, so this bill offers the retroactive benefits to those people laid off between April 1, and when the bill becomes law. It would guarantee that people who enroll for the subsidy by the end of April will get the entire 15 months of federally subsidized health premiums.

It should be noted that Congressional leaders are also focused on passing a longer-term benefit extensions bill, H.R. 4213.  The longer-term options being considered include a Senate bill that would extend the subsidy through the end of the year. A House bill also offers a longer extension, but the two bills would have to be reconciled, prior to becoming law.

Consideration of the annual budget resolution will be another high priority during the next several weeks, beginning with markups in the Senate and House Budget Committees.  One of the key issues the committees will consider is whether to adopt language allowing the budget reconciliation process to be used to advance any major legislative priorities later this year.

The next stretch of the 2010 legislative session will run for seven weeks before Congress recesses again around Memorial Day.

Monday, April 19th, 2010

In Sunday’s edition of the NY Times, buried in the Regional section, comes an analysis of the current health insurance reforms in the state of New York that were implemented over fifteen years ago.  Similar to Obama Care, the state of New York required all health insurance carriers to issue guaranteed acceptance policies to people with pre existing conditions as a means of making the health industry fair and imposes community pricing rather than risk based insurance premiums.  So how did this work for New Yorkers?  About the same way Obama Care critics predict.

According to the New York Times Sunday Edition
“New York’s insurance system has been a working laboratory for the core provision of the new federal health care law — insurance even for those who are already sick and facing huge medical bills — and an expensive lesson in unplanned consequences. Premiums for individual and small group policies have risen so high that state officials and patients’ advocates say that New York’s extensive insurance safety net for people like Ms. Welles is falling apart.

The problem stems in part from the state’s high medical costs and in part from its stringent requirements for insurance companies in the individual and small group market. In 1993, motivated by stories of suffering AIDS patients, the state became one of the first to require insurers to extend individual or small group coverage to anyone with pre-existing illnesses.
New York also became one of the few states that require insurers within each region of the state to charge the same rates for the same benefits, regardless of whether people are old or young, male or female, smokers or nonsmokers, high risk or low risk.

Healthy people, in effect, began to subsidize people who needed more health care. The healthier customers soon discovered that the high premiums were not worth it and dropped out of the plans. The pool of insured people shrank to the point where many of them had high health care needs. Without healthier people to spread the risk, their premiums skyrocketed, a phenomenon known in the trade as the “adverse selection death spiral.”

That death spiral has nearly wiped out the individual health insurance market in the state.  New York has the highest annual premiums for individual policies in the country, at over $6600 for an individual and double for families.

Obama Care supporters argue that the federal individual health insurance mandate will solve this problem. However, the mandate in Massachusetts hasn’t kept costs in line. The New York Times is also skeptical.

“The new federal health care law tries to avoid the death spiral by requiring everyone to have insurance and penalizing those who do not, as well as offering subsidies to low-income customers. But analysts say that provision could prove meaningless if the government does not vigorously enforce the penalties, as insurance companies fear, or if too many people decide it is cheaper to pay the penalty and opt out.

Under the federal law, those who refuse coverage will have to pay an annual penalty of $695 per person, up to $2,085 per family, or 2.5 percent of their household income, whichever is greater. The penalty will be phased in from 2014 to 2016.”

The math is very simple. If an individual has to pay $6600 per year for a policy they feel they don’t really need or pay $2500 on a salary of $100,000, which one will healthy young earners take? Of course this is based on the assumption that the government will actually enforce the mandate, which Democrats insisted the Obama Care bill couldn’t do.

Arguments to this will be that most young  people earn much less and will get federal subsidies, but that still depends on them deciding whether to pay anything for a policy that clearly doesn’t suit them.  The argument has neglected the fact that the actual costs will absolutely skyrocket and that taxpayers will be on the hook for the subsidies, which will have to increase to match the premium hikes to remain effective.  Instead of having premiums based on a rational risk assessment, we have the young and healthy subsidizing premiums for the older and the much less healthy in comparison, who then subsidize the younger and healthier through federal handouts. A crazy way to run health care in the U.S.

The individual health insurance mandate is nothing more than a way to get young people to create a proxy welfare state by forcing them into a extorting health insurance model.  It does nothing to reduce actual costs at all, and in fact makes cost increases both more frequently and more rapidly.

Easy To Insure ME .com would also like to note that this story was buried in the regional section and not the front page.  This reflects on the arrogance of the whole Obama administration and their gag orders on speaking out about health insurance reform.

Tuesday, April 13th, 2010

Republicans in Georgia are continuing fight against health insurance reform passed by the Democratic Congress.

State Insurance Commissioner John Oxendine announced on Monday that the state will not participate in a $5 billion temporary high risk Georgia health insurance pool established under the new law.

Oxendine is concerned that the financial burden of this program will fall into the lap of tax paying residents. Georgia is also among the 19 states that have questioned the constitutionality of the new law and is currently in battle with the federal government through the U.S. court system. They have filed a lawsuit claiming the federal government doesn’t have the right to require individual, family, and businesses to buy health insurance.