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Health Insurance Reform Weekly Easy To Insure ME

Wednesday, January 12th, 2011

Health Insurance Reform Weekly Easy To Insure ME

A new study released last week adds to the growing evidence showing that many Americans go without medical care or skip filling a prescription because of high costs. Published in the journal Health Affairs, the study also shows that Americans are less happy with their health care than those in many other countries. Rising health care costs are clearly a major public policy challenge, but new research from the Center for Studying Health System Change shows where significant attention needs to be focused to meaningfully address the problem. The study found that some providers and hospital systems have significant market power to negotiate higher-than-competitive rates. In some cases, they command almost five times what Medicare pays for inpatient services and more than seven times more for outpatient care. As the author puts it: “Few would characterize the variation in hospital and physician payment rates found in this study to be consistent with a highly competitive market.” Easy To Insure ME has the answers

Congress returned last week for the first of two lame duck sessions; the first one for the week of November 15 and the second to start November 29 and last until mid-December. Given the results of the election and the size of the Republican majority in the House (largest since 1948), the first week back was more about organizing and posturing than anything called legislation. As to leadership, each party in the Senate re-elected the very same team from the last Congress to serve in the upcoming 112th Congress (2011-2012).  As expected, the House Republicans elected Ohio Congressman John Boehner as the incoming Speaker, with the remaining Republican leadership posts aligning with the same pecking order as in the 111th Congress.  House Democrats pretty much followed the same pattern with Nancy Pelosi (soon to be ex-Speaker) elected as Minority Leader, even though conservative Democrats waged a futile battle to oust her. Once Democrats created a brand new 4th spot within leadership for current # 3, James Clyburn (South Carolina), the battle for Minority Whip dissipated and went to current Majority Leader, Steny Hoyer (Maryland).  As for legislation, Congress did nothing on many key issues but is expected to act in the second lame duck session on the expiring Bush tax cuts, the Continuing (budget) Resolution to keep the government operating (expires December 3), and repeal of the new 1099 reporting requirement that PPACA imposes on small business.

The Senate, however, took a baby step toward staving off  a  23 percent cut to Medicare physicians, set to begin on December 1, by approving a measure halting the cut until until January 2011. The House is expected to pass this measure when Congress returns for its second lame duck session. Just in case there are Congressional delays, CMS has already announced a suspension of claims processing until December 14 so that any delay in House passage does not lead to an actual cut in physician payments. Just how Congress will deal with the scheduled 2011 cut of 26 percent remains an open question, one that must be answered by the next Congress.

Only the regulators are pumping out paper with meaning. This week HHS announced that it was issuing regulations that follow closely the National Association of Insurance Commissioner’s (NAIC) recommendations for implementing a new medical loss ratio (MLR) requirement as part of the Patient Protection and Affordable Care Act PPACA). Starting next year, PPACA requires that insurers spend 80 (small group and individual) to 85 percent (large group) of the premium dollar on medical services or face the prospect of providing rebates to consumers. The new regulations outline disclosure and reporting requirements and how insurers must calculate MLRs.

Last week key federal agencies (Labor, Treasury, HHS) issued a revision to a previously issued Interim Final Regulation on grandfathering that set forth the rules allowing consumers to “keep the coverage they have” as of March 23, 2010, the date the President signed PPACA.  The revision announced last week provides additional flexibility for fully insured grandfathered plans by allowing them to change insurers without jeopardizing their grandfathered status the same way a self-insured plan can change third-party administrators (without losing grandfathered status).

What is wrong with American health care, and the simple steps you can take to start fixing it. References: www.fdrurl.com
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Health insurance quotes reform weekly Easy To Insure ME

Wednesday, January 5th, 2011

Health insurance quotes reform weekly Easy To Insure ME

As the 111th Congress (2009-2010) comes to a close, it passed, and the President has signed, a tax bill with multiple moving parts. The bill was part of an end-of-session deal forged by President Obama and Republicans, with little Democratic input. The bill preserves the Bush-era tax cuts (with no carve-out to tax millionaires), extends a number of otherwise expiring individual and business tax provisions, reinstates the estate tax on Republican terms, and provides a 2 percent payroll tax cut for 2011 and a 13-month extension of unemployment benefits.  It remains to be seen whether this collection of legislative goodies will improve the public’s rather low (11 percent) approval rating of Congress, considering that it carries a 0 billion price tag that will be added to the national debt.

Over the weekend, the Senate passed the repeal of the military’s “don’t ask, don’t tell” policy, which is now expected to be signed by the President this week. But Republicans in the Senate blocked Majority Leader Harry Reid’s effort to pass an omnibus appropriations bill for fiscal year 2011 (September 2010 to October 2011) because of the earmarks hanging on the bill. Consequently, Reid has pulled the bill and opted for a Continuing Resolution approach to keeping government afloat into the New Year.  With this funding measure fairly completed, the Senate and the House are likely to adjourn for good sometime this week.


COLORADO: A draft bill regarding child-only coverage is being circulated. With an effective date of Jan. 1, 2012, the bill would require all carriers in the individual market, as of that date, to offer such coverage. The bill includes two open enrollment periods, notice of availability on a carrier’s website and data reporting to the Commissioner on the number of applicants, enrollees and denials. Coverage may be denied if other creditable coverage is available, and a surcharge of up to 50 percent may be charged if a policy lapses for more than 63 days before an applicant seeks coverage again.

KANSAS: Insurance Commissioner Sandy Praeger recently appeared before a public meeting of Kansas’ Joint Committee on Health Policy Oversight to give an overview of PPACA. Her presentation included Kansas-specific data on the uninsured population (18 percent), the newly established high-risk pool (currently 121 enrollees), reforms already in place, status of grant monies received, and plans for the future, including creation of an insurance exchange. Praeger explained that the federal government will take over creation of an exchange if the state declines to do so. Saying she ”wants to make sure it is done right,” Praeger encouraged the legislators on the committee to move forward with implementation. While the committee members were in agreement that federal control of an exchange in Kansas would not be desirable, they were also hesitant to support legislation that will enact anything related to ”Obama-care.” They expressed concern about whether the federal government will actually provide funding to cover the costs and stated their preference for supporting a “repeal and replace” approach.

OKLAHOMA: Members of the Oklahoma Association of Health Plans (including Aetna) recently met with Mike Rhoads, the incoming Deputy of Health Insurance, to talk about insurance exchanges and other topics. Set to serve under Commissioner-elect John Doak, Rhoads is a former BlueCross BlueShield executive. Rhoads was very interested in input on the topic of exchanges, whether one should be created by the state, what it should look like and what flexibility the state would have in creating one. While the new Republican Congressional leadership is discouraging state officials from taking any action to implement PPACA, Rhoads explained that he and Commissioner-elect Doak prefer to make plans to implement what is currently the “law of the land” and take an active role in exchange creation. They would rather not allow the federal government to take over the exchange or waiting for the Supreme Court to finally decide the issue of constitutionality. He was very interested in feedback on the current state exchanges in operation in Utah and Massachusetts, as well as any “models” that have been generated by working groups. Health plans also used the opportunity to discuss the topics of rate review, implementation of medical loss ratios (MLRs), the possibility of a phase-in for the individual market, and a new potential “pass through” fee on hospitals, intended to maximize federal Medicaid matching dollars.

TEXAS: Last week, a historic super-majority of Republicans was created after two Democrat House members announced they were officially switching political parties. Both members explained their decisions were due to political changes within their districts and a desire to ”be what the majority of the district is now.” Republicans  now can pass constitutional amendments and legislation without seeking Democratic support. By having two-thirds of the votes, Republicans have the ability to suspend parliamentary rules and begin debate on partisan issues that Democrats were unwilling to even discuss in the past. Some of those issues include Immigration and Voter ID, which had previously been blocked by Democrats. The legislature goes back into session January 11, 2011.

Health Insurance Quotes Reform Weekly

Tuesday, December 14th, 2010

Health Insurance Quotes Reform Weekly

CALIFORNIA: The California Department of Insurance (CDI) has announced the release of e-mail notification system that will alert consumers when new individual health insurance rate filings are submitted.  CDI has previously announced that it would begin publicizing rate filings for individual health insurance policies.  Consumers are able to sign up online in the manner used for traditional e-mail updates.  CDI has also developed a consumer website with rate filing information.

NEW JERSEY: Following recent enactment of Governor Chris Christie’s budget, the Democrat-controlled legislature passed supplemental appropriations bills to restore million in funding for state’s uninsured health coverage program, known as FamilyCare, as well as .4 million in aid for women’s health and family planning programs. The FamilyCare restoration, if signed into law, would have allowed adults with income between 134 to 200 percent of the federal poverty level to remain in the program. Despite bipartisan support in the Senate, Governor Christie vetoed the legislation, saying that the state has reset spending to a level that taxpayers can afford. Legislative leadership has indicated they may try to override the governor’s veto. Overriding the governor’s veto would require a two-thirds majority in both houses.

NEW MEXICO: The Public Regulation Commission (PRC) has appointed John G. Franchini as the new Superintendent of Insurance, a position that has been vacant since the May 4 resignation of his predecessor, Morris Chavez.  Franchini was selected from among five finalists and will assume his new duties in mid-August.

OHIO: While the Strickland Administration has advised state agencies to begin planning for the next biennium at both current levels and with a 10 percent cut in funding levels, the Budget Planning and Management Commission has been conducting hearings preparing for Ohio’s biennial budget adoption. The current budget ends on June 30, 2011 and is billions in the red. Testimony before the Commission has focused on increasing efficiencies by combining certain administrative functions of local and state governments and utilizing performance audits to determine if tax dollars are being spent efficiently. The Center for Community Solutions suggested to legislators that principal stakeholders in Medicaid (such as managed care companies and hospitals) be given budget targets and be asked to come up with ways to slow the growth of Medicaid. Conversely, the Health Policy Institute of Ohio guided legislators to the possibility of Ohio “rebalancing” its long-term care spending to shift utilization from long-term care facilities to home and community-based services.

While PPACA-related budget priorities will take place after the next biennial budget is adopted, it was previously determined that the federal expansion of Medicaid eligibility as part of health care reform will cost the state 0 million in 2014 –rising to 2 million by 2019. Absent any federal law changes, annual costs will rise substantially in 2020 and beyond, as the federal government’s match for new enrollees will drop to 90 percent of the total cost. The total state cost of Medicaid expansion from 2014 to 2019 is projected to be .45 billion.

OKLAHOMA: The Department of Insurance (DOI) announced last week that a final contract for the new temporary high-risk pool has been signed and sent back to HHS.  The DOI is in the process of drafting the application that will be used with the pool.  Oklahoma was awarded million for use over 40 months.  Several candidates are being interviewed to be the High Risk Pool Manager.  Open enrollment will begin August 1 with an effective date of September 1.  Additionally, Oklahoma was the only state to request an open enrollment period for the PPACA provision requiring coverage of children under 19 in the individual market.  HHS has decided open enrollment periods will be permitted at the discretion of insurance companies.  On a separate issue, the Oklahoma Supreme Court has scheduled oral arguments to take place on August 4 in the lawsuit filed by Commissioner Kim Holland, on behalf of the DOI, challenging the constitutionality of a new 1 percent claims-paid fee passed by the legislature in late May.  The bill is scheduled to take effect August 27, absent court intervention.

 

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