EasyToInsureME Individual Health Insurance Reform Weekly

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.