New Direction for Health Care Reform

By: - June 16th, 2011  Filed under: Health Add Comment

New Direction for Health Care Reform

The Patient Protection and Affordable Care Act became the law of the land in 2010, but debate over its existence and implementation will rage on in the New Year.  The law’s serious policy flaws are already impacting health insurance and costs, but these are part of a deeper and broader issue: the proper role for the federal government in Americans’ health care.  The public’s stance on this issue has been anything but settled in the wake of the new law’s passage. Easy To Insure ME has the answers

As ramifications of Obamacare continue to play out, it becomes clearer that the changes made are the wrong ones. The new law cuts 5 billion from Medicare, but uses the savings to fund a new health entitlement, rather than deal with the financial insolvency that Medicare faces. “Bending the cost curve” was one of Obamacare’s original goals, but Medicare’s actuary reports that while the the new law indeed bends the curve, it is in the wrong direction: up, not down.

Furthermore, countless employers have said Obamacare accelerated increases in their health insurance premiums, prompting them to consider dropping coverage or pass more of the cost onto employees and their families. Mandates and new regulations are likely to further inhibit businesses’ ability to offer health insurance to employees, and also threaten to negatively affect the economy at large. Finally, when the law comes fully online and the true costs are accounted for, Obamacare is expected to significantly increase the nation’s deficit spending.

But the debate extends beyond these policy errors and into the realm of the federal government’s rightful role in health care. Obamacare significantly increases Washington’s influence over every aspect of the U.S. health care system—not just in the insurance market, but right down to the patient’s bedside. Medicare beneficiaries will be especially affected by the creation of new bureaucratic entities and top-down, cost-containing mechanisms included in the law.

Meanwhile, Americans continue to oppose parts or all of the new health reform law. Pollsters like Rasmussen show that Americans’ support for repealing Obamacare has ranged from 50 percent to 63 percent since the law’s passage.  In November, American voters chose to send a wave of new lawmakers to Congress, many of whom campaigned in support of repealing the law.  The provisions in Obamacare are not consistent with what Americans want, strengthening the case for repeal and a new direction for health care reform.

So what’s the alternative? Reform should transform the health care system to strengthen individuals’ control over their health care spending and decision-making. Patients, including those covered by Medicare and Medicaid, should have the opportunity to choose health care plans in the private insurance market that best suit their needs.

Market-based reforms would foster greater competition among insurers and more choices for consumers, enabling them to seek out the best value for their dollar.  This bottom-up approach to reducing health care costs would maintain the quality of care available in the United States.  It would put doctors and patients, not Washington bureaucrats, in charge of decisions relating to individuals’ care.

As the conversation continues, plans that embody these principles are gaining greater traction.  U.S. Rep. Paul Ryan’s “Roadmap for America’s Future” would drastically change Medicare, Medicaid, and the health care system at large, to put patients in the driver’s seat.  Ryan and Alice Rivlin, both members of the National Commission on Fiscal Responsibility and Reform, together offered a similar plan for Medicare and Medicaid that would replace the highly centralized, bureaucratic system with a defined-contribution program, offering beneficiaries greater autonomy.

In 2011, repeal must remain a priority for the new Congress, not only to undo the disastrous consequences of Obamacare, but as the first step to reform that will fix the health care system in ways that empower patients, not bureaucrats.

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Health Insurance Reform Weekly Easy To Insure ME

By: - June 7th, 2011  Filed under: Health Add Comment

Health Insurance Reform Weekly Easy To Insure ME

Week of November 15, 2010

State budget problems are so dire and rising Health care costs so worrisome that some states are considering what may have been unthinkable just a year or two ago — opting out of the federal Medicaid program. The New York Times reported last week that Texas (see below) and a handful of other states are considering doing exactly that, especially given that federal Health care reform will expand (as of 2014) the number of residents who are eligible for the state-administered Health care program. In South Carolina, state officials there are considering not paying Medicaid claims as of March 2011 unless they can secure permission to run at a deficit. Some state leaders concede dropping Medicaid could have a devastating effect on their local economies, making such a course unlikely. The fact that it’s on the table, however, speaks volumes about the growing problem of runaway Health care costs, and the need to develop systematic solutions in the way that the Patient Protection and Affordable Care Act (PPACA) addressed access issues. Easy To Insure ME has the answers

Health Care Reform Implementation
For more detail about the ongoing implementation of the new Health care reform law and its potential impact on you, read a new edition of our Eye on Implementation feature.

Federal

With Congress on recess last week, there is no Federal summary for this week.

States

ALASKA: A state Health commission created by the legislature this year has begun reviewing rapidly rising medical costs and patterns of Health care pricing among providers. Alaska’s Health care costs are rising faster than the national average. The commission held its first meeting in Anchorage October 14 and 15 after its members were appointed by Gov. Sean Parnell. Most members of the panel were on an earlier Health care task force, but this panel has five new members, including two state legislators. In an effort to provide the Commission with relevant cost and quality data, Aetna has forwarded several relevant studies and documents produced by its Public Policy Department.

CALIFORNIA: The state is yet again facing a massive budget deficit — .4 billion projected for 2011, according to the nonpartisan Legislative Analyst Office (LAO). Governor Arnold Schwarzenegger will call a budget special session starting December 6 to resolve the current-year .1 billion deficit. Next year’s budget process will be impacted by two propositions passed during the November election. Voters approved Proposition 22, which limits the state’s ability to borrow money from local governments, and they also approved Proposition 26, which makes it harder to raise fees. It also rolls back fees that were passed by less than a two-thirds vote this year. The LAO estimates these two propositions will create a billion hole in the budget. Democrat Governor-elect Jerry Brown, who campaigned on a pledge of no new taxes, will release his budget proposal in early January.

NEW JERSEY: Last week the Assembly Financial Institutions & Insurance Committee took up legislation that clarifies out-of-network payment responsibilities under Health benefits plans, requires certain coverage and procedure disclosures to consumers, and revises procedures for changes to managed care plan contracts. After more than two hours of testimony, Chairman Schaer used his discretion to withhold formal action on the bill. In his comments the chairman noted, “The rising cost of Health coverage is crowding out other socially important efforts for government and resulting in economic stress for employers.”  Led by the New Jersey Hospital Association and Medical Society, the provider community was virtually unified in its opposition to the legislation. The business community, NJ Association of Health Underwriters, and a large contingent of trade unions expressed their support for the bill.  Aetna, along with other commercial plans, remains concerned about provisions in the bill concerning non-participating, hospital-based physicians and the ability of out-of-network providers to waive member copayment, coinsurance, or deductibles. Aetna will continue to closely monitor the legislation.

TENNESSEE: The Tennessee Insurance Exchange Planning Initiative has announced the members of two newly created Technical Advisory Groups (TAGs). Members of these groups will provide expertise on specific analytical questions to help in the state’s insurance exchange planning process. The state is in the process of deciding whether it will operate a Health insurance exchange. Mark Schmidt, Aetna Market President, Southeast, has been appointed to the Governor’s TAG for State Insurance Exchange Planning. The members of the Actuarial/Underwriting TAG and the Agent/Broker TAGs will provide expertise on specific analytical questions to help in the state’s insurance exchange planning process. The volunteer members of each TAG will meet in Nashville this fall and winter. Members of the Agent/Broker TAG will provide a detailed inventory of options for state decision-makers and then post any resulting discussion papers. Once additional information is received from the federal government, the state also intends to convene TAGs of Health care providers, consumer representatives, and marketing and outreach experts.

TEXAS: Several Republican lawmakers are proposing an unprecedented solution to the state’s estimated billion budget shortfall: dropping out of the federal Medicaid program. The Heritage Foundation, a conservative think tank, estimates Texas could save billion between 2013 and 2019 by opting out of Medicaid and the Children’s Health Insurance Program, dropping coverage for acute care but continuing to fund long-term care services. With 3.6 million children, people with disabilities and impoverished Texans enrolled in Medicaid and CHIP, the Texas Health and Human Services Commission will release its own study on the effect of ending the state’s participation in the federal match program. Some lawmakers say not being able to reduce benefits or change eligibility to cut costs is “bankrupting our state.” State Rep. John Zerwas, an anesthesiologist who authored the bill commissioning the Medicaid study, said early indications are that dropping out of the program would have a tremendous ripple effect monetarily, and he worries about who would carry the burden of care without Medicaid’s “financial mechanism.” Currently, the Texas program costs billion per biennium, with the federal government footing 60 percent of the bill. As a result of federal Health care reform, millions of additional Texans will become eligible for Medicaid. Lawmakers want to examine whether Medicaid enrollees could be served more cost efficiently with better outcomes in a state-run program.

WASHINGTON: Governor Chris Gregoire says she gets the message following the recent elections, and as a result has announced that she will seek supplemental budget cuts of million before the end of the year. Voters signaled a strong aversion to additional tax hikes to balance the budget by recently passing initiative 1053, which restores the two-thirds vote requirement for the legislature to raise taxes, and initiative 1107, which repeals a tax on bottled water and carbonated beverages. Also, voters rejected initiative 1098, which would have instituted a state income tax. Among the programs Gregoire is considering for possible cuts is the state’s Basic Health Plan. The Governor said she is open to the idea of a one-day special session if there is agreement with legislative leaders on quick action.

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Health Care Reform March 15 2010

By: - May 19th, 2011  Filed under: Health Add Comment

Health Care Reform March 15 2010

Week of March 15, 2010

The White House last week continued to rail against rising health insurance premiums to help build popular support for his health care reform package. But the effort to focus the blame for rising costs on insurers was questioned, in particular, by state insurance experts and economists quoted in a New York Times story last week. Insurance commissioners said that trying to hold down premiums before costs were under control would be very risky. This approach could mean solvency issues in some cases, they told the Times. To help educate Americans about the true drivers of rising health care costs, America’s Health Insurance Plans, the industry trade association, last week launched a new national ad campaign. The ad demonstrates that health insurance company costs represent a small slice of the overall health care cost pie.

Federal

With a cadre of staff operatives searching for the right health insurance reform provisions among those previously discarded from the House, Senate and the President’s proposals, Democratic leadership has been relentlessly pursuing every possible pathway to pass a final bill. The expected process would have: 1) the House pass the Senate-adopted reform bill (which most House members hate), 2) the House passing a bill to “fix” all the things it hates using a reconciliation legislative vehicle, followed by 3) the Senate passing the very same reconciliation bill — requiring only 51 votes in the Senate. The House Budget and Rules Committees are expected to start the review, hearing and mark-up process of the reconciliation bill this week. The Senate commitment to using reconciliation was made official in a scathing letter from Leader Harry Reid to the Minority Leader. Along the way the two Chambers will need to see the latest CBO “scores” on the bill before voting, and 216 House Democrats will have to resolve policy disagreements over abortion, federal health insurance rate review and authority, and other substantive issues. Additionally, the House will have to trust that the Senate can pass the reconciliation measure without changing one comma. Partisanship has blossomed into open hostility over health reform. Whether Congress can overcome these policy, process and political mine fields remains as murky as ever, but Democrats have chosen to try and will push for resolution by the Easter recess.

The Senate has passed Jobs Bill II and shipped it off to the House, where passage is not certain. Within the bill are two health-related items of note. First, the COBRA eligibility and subsidy program will be extended to the end of 2010. (These provisions are set to expire at the end of March.) Second, the bill contains a suspension until September 30, 2010 of the cut to physician Medicare reimbursements for the current calendar year. (This provision is also set to expire at the end of March.) Aetna urged Congress to apply the “doc fix” to next year’s reimbursement as well, since insurers’ Medicare rates are based on what doctors are paid, but in the end Congress failed to make this change. Aetna and the industry will continue to find ways both to establish a more lasting, if not permanent, doc fix and to devise a legislative solution to the disconnect between doctor reimbursement and Medicare Advantage rates for 2011 and beyond.

States

ARIZONA: Budget issues remain front and center as the governor and Republican leadership proposed a plan they hope will close the 0 million deficit this year and reduce the anticipated .6 billion deficit in 2011. Righting the state’s fiscal ship has become a very partisan exercise, with the Republicans supporting reductions in Medicaid and KidsCare, and the elimination of full-day kindergarten. As the special session on the budget is running concurrently with the regular session, no other bill hearings were held. The oral chemotherapy parity bill may be dead for this year as proponents did not meet the deadline for submitting amendatory language.

CALIFORNIA: The Assembly Accountability and Administrative Review Committee chaired by Assemblyman Hector De La Torre held a hearing last week to examine how the Department of Managed Health Care (DMHC) and the Department of Insurance (CDI) has handled issues surrounding the rescission of policies in the individual market. According to a report prepared for the committee by Bryan Liang, director of the Institute of Health Law Studies at the California Western School of Law, fewer than 300 of 6,000 former policyholders are participating in health insurers’ agreements to settle such cases. Republican committee members were highly critical of this witness, while De La Torre was critical of the Departments. The DMHC reported that since their settlements were completed there have only been nine rescissions over the past two years, proof that the DMHC and the health plans have revamped their processes for rescission and have worked to address the problem.

COLORADO: A bill mandating maternity and contraceptive coverage in individual policies continues to receive significant attention in the Senate. The most recent amendment proposes requiring maternity coverage in at least three of the plans marketed by an insurer. It would also allow a current member of a plan without maternity coverage to switch to a plan with maternity coverage from the same carrier during the first trimester. The other major bill would require that second level appeals be performed by physicians who are actively involved in clinical practice. This measure is counterintuitive in the current economy, since it would result in outsourcing appeals and drive up costs for plan sponsors and their employees.

CONNECTICUT: A proposal that would require health insurance plans to cover oral chemotherapy in the same way that intravenous chemotherapy is covered made it through the legislature’s Insurance and Real Estate Committee last week. Currently, many health plans treat the two kinds of cancer treatments differently. Chemotherapy treatments that come in pill form are often categorized as prescription drug benefits that can require patients to pay a larger share of the cost. Cancer patients, doctors and patient advocates spoke in favor of the bill, while insurers and the Connecticut Business and Industry Association opposed it, arguing that it would put a mandate on health plans that could raise costs and make it more difficult for employers to afford insurance.

GEORGIA: A bill restricting the use of rescissions in individual health insurance policies passed a Senate committee last week. Aetna continues to work with its trade organizations to educate legislators about the adverse effect of this type of legislation. Discussions also continue regarding legislation affecting the use of rental networks.

KANSAS: Roughly half way through the legislative session, several health care bills are still moving through the process. On the regulatory front, the Insurance Department has proposed a regulation that would mandate coverage of routine patient care costs while the insured is enrolled in a cancer clinical trial – a mandate that was rejected by the legislature in 2008. A hearing will be held on April 20, and Aetna will have an opportunity to present testimony on this issue. Bills still alive include mandates for autism and orally administered chemotherapy, legislation prohibiting dental contracts that require the dentist to follow a fee schedule for non-covered services, and a ban on “most favored nation” clauses by some insurers. Another bill would allow small employers to create individual HRAs to fund premium payments on individual policies, require administering insurers to offer employees the option of receiving health insurance coverage through a high-deductible health plan with an HSA, and requiring insurers who offer small group health plans to offer high-deductible health plans with HSAs, while authorizing tax deductions for health insurance premiums for individual insurance policies. Separate legislation would amend the definition of “eligible employee” to include part-time workers (currently less than 30 hours per week). Pending legislation concerning hospital charges would prohibit charging private-pay patients more than 25 percent of what the hospital’s highest volume private payer would pay for the same goods or services. Legislation that died includes a telemedicine mandate and creation of a health care insurance database for employers.

KENTUCKY: Health issues that are being hotly debated by the legislature right now include an autism mandate, a dental bill that would not allow insurers to hold dentists, optometrists or ophthalmologists to a fee schedule for non-covered services, and a bill setting a reimbursement floor for chiropractic services. The chiropractic services proposal would allow chiropractors to bill, and would require insurers to reimburse, an evaluation and management (E&M) CPT code on each and every visit. In addition to billing for follow-up services for manipulations and other therapies, the chiropractor would be allowed to submit, and the insurer required to pay, for another E&M code on each and every visit. The legislation would also add a new mandated benefit to the Kentucky statutes. Currently, reimbursement for chiropractor visits is required only if the chiropractor performs a service already covered by the health benefit plan. Under the proposal, any service within the scope of practice of a chiropractor that is billed would become a mandated benefit. Finally, the bill would require health benefit plans to provide reimbursement without the chiropractor having to provide any documentation that the services were medically necessary. Each of these bills has, or is expected to, pass at least one chamber.

SOUTH DAKOTA: Several important legislative deadlines are approaching, resulting in a flurry of activity. Bills or resolutions not passed by the second chamber by March 9 died. But the Governor has already signed a bill that amends the premium rate-setting procedure for the high-risk pool so that rates for a given classification are 150 percent of the average actively marketed premium. The pool will have to offer three or more plan designs, remove coverage requirements for the plans (such as Disease management) and remove set cost-sharing values. The bill was signed by the Governor on March 1 and will become effective on July 1, 2010. The Governor has also signed a bill prohibiting rating based on injuries caused by domestic violence and legislation requiring refunds of premiums for partial months, in the case of mid-month cancellations. Both chambers have passed legislation prohibiting contract language requiring dentists to accept a fee schedule for non-covered services, and the bill awaits the Governor’s signature. Finally, the legislature passed a resolution opposing the federal health care reform proposals passed in the U.S. Senate and House.

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Health care reform law">Wisconsin fights Health care reform law

By: - May 5th, 2011  Filed under: Health Add Comment

Wisconsin fights Health care reform law

At some point after Jan. 3, when Scott Walker becomes governor, Wisconsin will challenge the constitutionality of the federal law to overhaul the Health care system.

Wisconsin Attorney General J.B. Van Hollen has not decided whether the state will join the lawsuit filed in Florida by 20 other states, the National Federation of Independent Business and two uninsured individuals, or file its own lawsuit.

“That work is under way,” Van Hollen said. “I have been in discussions not only with my staff but also with staff of both the Florida AG’s office and the Virginia AG’s office.”

Joining a lawsuit filed by the Virginia attorney general would be more difficult because that case includes legal issues surrounding a state law.

Van Hollen expects to make a decision in the next month or so.

The key issue in the legal challenges is whether the federal government can require people to buy Health insurance or fine them for failing to do so. That requirement is considered essential if Health insurers must cover people with pre-existing Health problems.

Wisconsin joining the legal challenges to the law would fulfill a campaign promise by Walker while making the state a participant in a historic case almost certain to be settled by the Supreme Court.

“It is the biggest ongoing constitutional law dispute in the country, certainly the one with the most far-reaching effect,” said Andrew Coan, a professor at the University of Wisconsin Law School.

More than 20 separate challenges to the law, including lawsuits by conservative groups and individuals, have been filed in federal courts throughout the country. And most legal experts agree that both sides raise valid questions.

“This case could be decided either way without overturning any existing Supreme Court precedents,” Coan said.

So far, federal judges have dismissed two of the lawsuits – one filed in Virginia by Liberty University, founded by Jerry Farwell, and the other filed in Michigan by the Thomas More Law Center, a public interest law firm that focuses on defending the religious freedom of Christians, family values and other issues.

But federal judges in Florida and Virginia have denied the federal government’s motions to dismiss the lawsuits by the states.

Van Hollen, a Republican, wanted to challenge the Health care law immediately after it was passed but needed Democrat Gov. Jim Doyle’s approval – and the governor in a strongly worded letter made clear that wasn’t going to happen.

“The State of Wisconsin will not enter into litigation intended to deny Health care for tens of thousands of residents,” Doyle wrote in March.

The state also has estimated that the law would save Wisconsin 5 million to 0 million from January 2014 through June 2019 as the federal government picks up a larger share of the cost of insuring residents with limited incomes.

But Van Hollen said Wisconsin should bring a lawsuit to protect the balance of powers between the federal government and states.

“This is an issue that needs to be clarified one way or another,” he said.

If people are not required to buy Health insurance, they could wait until they are sick to buy it. Health insurers regularly liken it to being able to buy homeowner’s insurance while your house is on fire.

Subsidies

The Health care law provides subsidies for people and families with low to moderate incomes to buy insurance, if they don’t get affordable Health benefits from an employer. The legislation specifically notes that people who don’t buy insurance – out of choice or necessity – saddle hospitals and doctors with large unpaid bills that raise costs for people with insurance.

That’s one reason for the so-called individual responsibility requirement.

But the uninsured population disproportionately includes people in their 20s and 30s. Many of them could afford to buy insurance. Economists call them “free riders.” They also tend to be Healthy – and their premiums are needed to offset the cost of providing Health insurance to people who are sick.

People with Health problems who don’t get Health benefits from an employer now are effectively locked out of the insurance market in many states because Health insurers will not cover them. Changing that is one of the key provisions in the new law.

States can require people to have Health insurance; Massachusetts does so now. And the federal government’s right to regulate the insurance industry is clear. The issue is whether that right also gives it the authority to require people to buy Health insurance.

Opponents note that the federal government has never passed a law requiring citizens to buy a private product or service or pay a penalty.

Congress passing a Health care law requiring people to buy Health insurance, opponents contend, is no different from requiring people to buy vitamins or join a gym.

Ilya Shapiro, a senior fellow in constitutional studies at the Cato Institute, a libertarian think tank in Washington, D.C., said no principled limits on federal power will exist if the Health care law is allowed to stand.

Economic activity

The legal arguments hinge at least to some extent on whether deciding not to buy Health insurance is an economic activity.

Here’s why:

Since the 1940s, the Supreme Court has given broad authority to regulate interstate commerce under the Commerce Clause of the Constitution.

Those powers, though, are limited to economic activities.

The Constitution, under the Necessary and Proper Clause, also gives Congress the authority to enact regulations needed to regulate interstate commerce.

The Department of Justice contends that the decision not to buy Health insurance is an economic decision that affects the entire Health care system. It also contends that everyone, even people who are Healthy, is part of the Health care market.

But Shapiro and other opponents contend this reasoning would lead to a federal government of unlimited powers.

“Everything is an economic decision in some way,” he said.

Opponents contend that requiring people to buy Health insurance regulates an economic inactivity.

To Coan, the UW law professor, this isn’t the key issue in the case.

“If Congress needs to regulate inactivity to make its regulation of commerce effective, the Necessary and Proper Clause gives it that power,” Coan said. “That’s how I would analyze the case.”

The federal judges in the lawsuits brought by the Thomas More Law Center and Liberty University agreed.

But Shapiro has noted that there are “many, many rulings yet.”

The lawsuits raise other issues – including complex tax issues – but more legal experts have said the most important issues involve the mandate to buy Health insurance.

No one expects that issue to be resolved until 2012 at the earliest.

Deciding what to do

Van Hollen now must decide how to proceed.

Joining other states in the Florida lawsuit would give Wisconsin less control over the direction of the case.

The Florida case also may be too far along for Wisconsin to intervene.

The state also could file a friend-of-the-court brief. That would give it more flexibility in its arguments. It also could file its own lawsuit.

“We, in further analysis, may decide we want to take a little different legal or augmentative tack than them,” Van Hollen said. “There are a number of different considerations and, once again, we’ve got a little bit of time to figure out which ones prevail.”

The cost of challenging the law will depend on whether the lawsuit is handled by his staff and how the state proceeds.

Van Hollen acknowledged people have asked what difference Wisconsin could make in the outcome given the number of lawsuits already filed. But he said a multitude of parties can give a position more legal authority.

“I really do believe it makes a difference,” he said.

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Health Insurance Reform Issues Student Health Insurance

By: - May 5th, 2011  Filed under: Health Add Comment

Health Insurance Reform Issues Student Health Insurance

With a law as complex as the Patient Protection and Affordable Care Act (PPACA), unintended consequences are always a concern. Last week The Wall Street Journal reported that the physician community is witnessing the emergence of a significant unintended consequence — since tax-advantaged flexible spending accounts can no longer be used to pay for over-the-counter medications without a prescription, under the law, many patients are now visiting their doctors expressly for the purpose of getting new prescriptions for the OTC medications. The change in the law was meant to discourage wasteful spending on some health products and raise revenue. Instead, critics say the provision is driving up health care costs. Unintended consequences of the health care reform law is an area of focus for Aetna insurance, and will continue to urge flexibility in the implementation process to help address potential unintended consequences.

Federal
In response to various requests for clarification (including from Aetna insurance), federal regulators last week issued a Question & Answer document that further refines the previous proposed rule on student health. In short, this clarification makes it clear that nothing from PPACA applies to student health plans until policy years beginning in 2012 or until academic year 2012-2013. The Q & A also clarified that the proposed regulation must be finalized to show what parts of the PPACA would apply to student health plans. This is welcome news in the college and university community. Aetna is communicating with its clients in a manner that is consistent with last week’s clarification, though many schools were hearing conflicting advice from state regulators.

The House-passed continuing resolution includes language that would “prohibit the use of funds to pay any employee, officer, contractor, or grantee of any department or agency to implement the provisions” of the PPACA. In a letter to Finance Committee Chairman Max Baucus, HHS Secretary Kathleen Sebelius made several claims that, should the de-funding provisions in the resolution be enacted into law, seniors will lose access to Medicare Advantage plans and other services. Senate Republicans were quick to dispute these allegations stating, the scenarios the Secretary envisions are not allowed under Congressional rules, are not assumed by the Congressional Budget Office (CBO), and can be prevented by HHS.  Senator Orrin Hatch and Ways and Means Committee Chairman Dave Camp also sent Secretary Sebelius a letter expressing their disappointment in what they called the letter’s “baseless allegations,” and expressing hope that “the urgency with which this letter was sent to Chairman Baucus is also being applied in answering a growing backlog of serious questions.”  The CBO also released a letter regarding the impact of the resolution, including the impact of the de-funding provisions on Medicare Advantage. The letter shows the de-funding provisions would have a minimal MA budgetary impact of .7 billion over 10 years.

States
Governor Jan Brewer’s Special Advisor on Arizona health insurance Health Care Innovations held a meeting last week with the state’s major health insurers, including Aetna insurance, to discuss identifying IT gaps the state must address to develop the online product selection and enrollment mechanism for an insurance exchange. Social Interest Solutions, the organization that developed the enrollment form currently used by Medicaid applicants, provided a demonstration of that application process. Individual interviews will be conducted with the IT staff of each company to obtain recommendations for the new system.

The Real Estate Committee last week voted out a substitute prior-approval rate bill that retains all the problematic sections of the original bill. The sections of concern cover public hearings, new subpoena powers for the Attorney General and Connecticut health insurance Healthcare Advocate, multiple notice requirements, and new definitions of inadequate, excessive, and unfairly discriminatory. The only change is that the Commissioner would have to promulgate regulations to carry out the proposed public hearing process. The full contingent of Republicans and Rep. Linda Schofield (Dem.) voted against the bill, with Schofield stating that she was concerned the bill gets rid of any timeline under which the Department must act and would require public hearings, nonsensically, for group rates. She also said the bill would provide the Attorney General and Advocate with extraordinary subpoena powers. The Chairs indicated that the bill is a work in progress.

Florida health insurance Insurance Commissioner Kevin McCarty has disclosed that he will be submitting a medical loss ration (MLR) waiver request to HHS this week.

Georgia health insurance Insurance Commissioner Ralph Hudgens has indicated he will be submitting an MLR waiver request to HHS within a week.  Aetna insurance continues to work with the Chamber of Commerce and plan sponsors to help defeat legislation that would apply prompt-pay requirements to self funded plans, in violation of ERISA.

Oklahoma health insurance Last week State Rep. Mike Ritze, one of two doctors serving in the Oklahoma legislature, called on state officials to turn down million that would be used to implement the new federal health care law. Shortly thereafter, Governor Mary Fallin joined other state leaders in announcing that Oklahoma will accept the grant to help design and implement the information technology infrastructure to operate an Oklahoma health insurance exchange. Fallin listed the creation of such an exchange as one of her top priorities in her State of the State address earlier this month. She and others announced their support for the grant after working with state agencies to ensure that no unworkable federal mandates were included.

Later in the week, the legislature continued taking steps forward to reduce the number of uninsured Oklahomans. House Speaker Kris Steele authored a bill that defines the membership and appointments to the Health Care for the Uninsured Board (HUB), which is designed to establish a system of counseling, including a website, to educate and assist consumers in selecting an insurance policy that meets their needs.  The seven-member HUB consists of representatives from the Insurance Commissioner’s Office, the Oklahoma Healthcare Authority, insurance companies, agents and also consumers. The purpose of HUB is to implement a market-based insurance exchange.  The bill passed the House Public Health Committee at the end of the week and will proceed to the floor of the House.

Texas health insurance Legislators are wrestling with to what extent they should intervene in what residents eat, drink and breathe. In a state with some of the nation’s highest obesity and diabetes rates, supporters of various proposals say they are trying to give Texans more ways to combat unhealthy decisions by others, as well as make good choices for themselves. The president of the Texas Medical Association testified last week in favor of a bill banning the sale of unhealthful drinks (sugary fruit juices, sodas, whole milk) to students during school hours. Other related bills would allow the state to raise taxes on sweet sodas and fine restaurants for not posting nutritional information.

About 30 percent of Texas schoolchildren are obese or overweight, according to the Texas Public School Nutrition Policy. And last month, Republican Comptroller Susan Combs released a report saying obesity cost Texas businesses .5 billion in 2009 — that could rise to billion by 2030 due to the cost of health care services, absenteeism, decreased productivity and disability. Legislators will continue debate on these bills until the session adjourns on May 31.

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