Health Insurance Quotes Reform Weekly EasyToInsureME

Week of December 14, 2009

Health care reform provisions are
changing fast as the Senate considers numerous amendments on the floor,
and there is no better example of how fast than the much-reported
government plan option. Senate leaders announced last week that a deal
had been struck to remove the public plan from the bill in favor of a
not-for-profit private insurance option and an expansion of Medicare to
allow people 55 or older to buy in. The deal was quickly lauded by the
White House and others, but concerns soon emerged about the new
approach from various sectors of the health care system. A day or two
later, the Associated Press reported that Senate Democrats were
changing the "breakthrough" provisions in response to those concerns.
The anticipated impact of the reform bill (especially its raft of
proposed health care sector taxes and fees) on costs continues to be
the focus of most critics, from labor unions to hospitals.

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Federal

The
Senate last week barely moved forward on health care reform. Although
the Senate focused on health care issues the entire week, there were no
votes past Tuesday and the key amendment of the week (reimportation of
cheaper drugs from Canada and overseas) is in limbo though the
amendment clearly has majority support. Off the floor the action is
more intense and meaningful. Earlier in the week Majority Leader Harry
Reid announced a "deal" on the public plan. As it turned out the deal
was among 10 Democrats only, and no details of any consequence were
released. Reid himself was closed-mouthed claiming everyone had to wait
until the CBO had a chance to "score" this newest iteration of health
reform. The deal is in three parts: 1) use of the Federal Employee
Health Benefit Plan model in which a federal agency would administer a
national plan with private carriers in the mix; 2) triggering a true
public plan if too few carriers participate in this national plan; and
3) allowing seniors 55 to 64 years old to buy in to Medicare. Even
before the CBO score is back we already know that Senator Joseph
Lieberman (D-CT) is opposed to the Medicare piece alone, if not the
rest, and would filibuster the overall bill; Senator Ben Nelson (D-NE)
is not far behind. And, if the score is bad and turns away additional
moderate Democrats, Reid may have to go back to the drawing board for
yet another twist to the never-ending saga of health care reform.

States

FLORIDA:
A final draft of the voluntary compact regarding coverage for cancer
clinical trials was circulated to interested parties late last week by
legislative leadership. Aetna has been working with leadership, both
directly and through the Florida Association of Health Plans, to assure
the language follows current coverage guidelines. Aetna anticipates
being a signatory to the compact.

MASSACHUSETTS: The
Massachusetts Joint Health Care Financing Committee held a hearing on
legislation requiring every full-and part-time college student in
Massachusetts to have at least the basic level of health insurance
required under the state's 2006 health reform law. If enacted, the new
law would require students to carry the minimum credible coverage to be
considered insured. Universities and colleges that fail to carry out
their "responsibilities" to ensure student compliance would be fined a
penalty of $1 per student for every day their "failure" continues. The
bill also would require the Division of Insurance to issue regulations
establishing procedures for implementation and monitoring of
compliance. Massachusetts' existing individual mandate applies to
students age 18 or older who pay in-state tuition rates for themselves
at a Massachusetts community college, state college, or university.

MISSOURI:
The pre-filing of bills for the second regular session of the Missouri
95th General Assembly began on December 1, and several new bills
concern federal health care reform. Several pre-filed bills that failed
to pass in the first regular session included an autism spectrum
disorder mandate as well as a bill to amend the current prompt-pay
statute. Both are expected to continue to be debated again in 2010. New
to the Assembly are bills to pursue a constitutional amendment to
prohibit compelling a patient, employer or health care provider to
participate in any government- or privately run health system and to
prohibit banning a person or employer from paying directly for legal
health care services. Another new bill would pursue a constitutional
amendment to penalize a political subdivision for participating in a
health insurance option sponsored by the federal government. New also
is a bill to provide premium refunds for consumers with cancelled
long-term care and/or Medicare supplement policies and to make it an
unfair trade practice to engage in certain practices when selling
Medicare products. Aetna will continue to monitor the pre-filing of
bills through the start of the next legislative session in January 2010.

NEW
YORK: In a press release issued last week, Governor David Paterson is
calling for the reinstatement of prior approval of insurance premium
rates. The Governor introduced a bill during 2009 that would have given
the Superintendent of Insurance sole authority to approve rates at his
or her discretion, but that bill failed to pass. Given this latest
press statement, it is expected that the Governor will ask the
legislature to re-introduce his program bill for 2010. The Governor
tied his support for the prior approval of rates to plans' dividend
requests. The dividend requests were $800 million from Oxford (18.7
percent of 2008 New York premiums), $200 million from Empire (2.5
percent) and $134 million from Aetna (16 percent). The state's
insurance lobby, the HPA, responded that the dividends reflect multiple
years' earnings, and the plans' margins are in the 2 percent to 3
percent range.

OHIO: Resolutions continue to be introduced in
Ohio with respect to implementation of anticipated federal health care
reform. Specifically, a new resolution was recently introduced
requesting all members of the General Assembly to support the public
plan option as part of national health care reform. This resolution
adds to other pending resolutions on health care reform, such as one
supporting rights for people to enter into private contracts with
health care providers for health care services and to purchase private
health care coverage; and another to amend Ohio's Constitution to
prohibit a law or rule from compelling a person, employer, or health
care provider to participate in a health care system. They are not
expected to pass, as the legislature continues to focus mainly on
budgetary matters.

OKLAHOMA: While testifying at a hearing
before the House Appropriations and Budget Subcommittee, the Oklahoma
State Auditor and Inspector suggested eliminating all health insurance
options except for “HealthChoice” to cut $100 million in state employee
benefits costs. Currently state employees can enroll in one of eight
health insurance plans offered by four HMOs through the Employees
Benefits Council or one of the HealthChoice plans offered by the
Oklahoma State and Education Employees Group Insurance Board. Employees
receive an allowance to offset the costs of the plans. According to
state law, the allowance is calculated based on the average cost of the
high-option health insurance plans, plus the average of the dental plan
costs, plus the cost of life insurance, plus the cost of disability
insurance, plus 75 percent of the dependent health costs, if
applicable. Steve Burrage said the current arrangement creates a
situation of "adverse selection" where healthy, younger employees
purchase the less expensive health insurance policies offered by the
HMOs, and less healthy, older employees buy the more expensive
HealthChoice policies. However, both employees receive the same benefit
allowance. In his FY2009 executive budget, Governor Brad Henry proposed
adjusting the benefit allowance formula by giving the HealthChoice
high-option plan a 40 percent weight. The proposed adjustment did not
make it into the final budget.

WISCONSIN: Proposed legislation
is circulating in the Senate that would create explicit statutory
authority for the Wisconsin Office of the Commissioner of Insurance
(OCI) to oversee operation of self-funded plans serving public-sector
employees, resolve consumer complaints, and monitor reserve and
reinsurance levels. Additionally, the bill would apply state minimum
coverage requirements, such as mammograms, chiropractic care, diabetes
education and care, and require a governmental body that provides a
self-funded health plan to provide reports and replies to requests for
information to the OCI as they relate to the plan. This bill is aimed
at self-funded plans offered by cities, towns, villages, counties and
school districts.