Week of October 5, 2009

The Senate Finance Committee
essentially wrapped up its work on a health care reform bill last week,
though additional changes are still possible as the bill is put to a
vote of the full Committee later this week. A number of changes made to
the bill at the 11th hour last week already are generating concerns
about the direction of the legislation. For example, one amendment
approved by the Committee would result in a significant weakening of
the individual coverage requirement (see below). This requirement is
the cornerstone on which a host of insurance market reforms are
supported. The bill also would levy significant new fees and taxes on
different sectors of the health care system, such as health insurance,
without adequately tackling the true drivers of health care costs.
Clearly the rubber is now meeting the road as health care reform moves
toward floor debate in the House and Senate. Aetna will monitor events
closely and weigh in on issues of substance. While this summer's town
hall meetings were an important part of the process, there will be no
more important time for all Americans to stay informed and be involved
than in the weeks ahead.

Quoting & Saving just got easier...EasyToInsureME Health Insurance

Federal

The
Senate Finance Committee last week finished slogging through dozens of
amendments, paving the way for a vote on the finished bill sometime
this week after the Congressional Budget Office provides a cost
estimate. While many amendments were rejected, the panel did approve at
the last minute some significant changes to the bill introduced by
Chairman Max Baucus (D-MT) in mid-September. One amendment adopted
would weaken the individual coverage requirement by delaying and
reducing penalties attached to the requirement. The maximum penalty for
a family of four would start at $200 in 2014 and rise to $750 in 2017.
Also, an estimated 2 million people who would face financial
difficulties would be exempt from buying even the cheapest insurance
available -- those who would have to pay more than 8 percent (a change
from 10 percent) of their adjusted gross income for the cheapest plan
would be exempt. The Committee rejected amendments for a public plan
option, but it did include a mini-public plan option for those under
200 percent of the federal poverty level. To help pay for the
legislation, new fees and taxes would be levied on insurance companies,
drug makers, medical device manufacturers, and some families. Senate
leaders already have begun looking at ways to blend together the Senate
Finance Committee bill and a competing Senate HELP Committee bill so
that floor debate can begin later in October.

States

INDIANA:
Hearings resumed last week on the Health Provider Patient Limit Study
supported by the Indiana Medical Association. The Health Finance
Commission is required to study: 1) health plan provider contract
provisions that would require a contracted provider to mandatorily
accept more than a certain number of patients (open access clause); and
2) whether an insurer should be required to directly reimburse an
out-of- network health care provider (assignment of benefits).
Arguments were presented on both sides of these issues. In addition,
HEA 1300 requires the Indiana Department of Insurance (DOI) to collect
information regarding the costs of initiation and operation for
recognizing assignment of benefits and report to the Health Finance
Commission on its actuarial findings. The data has been collected by
DOI, which will present its final findings on assignment at the October
19 Health Finance Commission meeting. A final report from the Health
Finance Commission is due to the Legislative Council by November 1.

TEXAS Health Insurance
: The Department of Insurance has prepared a working draft of rules
concerning physician ranking requirements and notice requirements that
would limit health plans' ability to publish physician rankings. These
draft rules would implement the provisions of legislation recently
passed establishing standards for the use of physician ranking systems
by health plans. The legislation outlines a process to be used by the
TDI in determining nationally accepted standards for provider rankings.
The standards used must be disclosed to each affected provider, as well
as the details of a process that may be used to dispute the rankings.
The measure also prohibits physicians from taking action that would
prevent a patient from participating in an evaluation of the
physician’s performance. Aetna worked throughout the session with the
bill’s authors to ensure that the final version tracked the patient
charter and national best practices. Aetna will continue to work with
TDI in the crafting of its final rules.

WASHINGTON: Aetna is
working with the state and other industry stakeholders to determine the
feasibility of maintaining the state's Universal Vaccine Program for
children. Due to budget cuts, the state is scaling back the vaccine
program next spring to cover only low-income children. Currently, the
program is available for all vaccinations for any child residing in the
state, even those with private insurance. Due to the state's purchasing
power and its ability to distribute vaccine effectively, there are
multiple benefits to the state continuing the program.