Health Insurance Reform

A weekly compilation from Aetna of health care-related developments in Washington, D.C. and state legislatures across the country Week of March 22, 2010 Late in the night Sunday, the House of Representatives helped President Obama deliver what no other President has been able to do -- a significant reform of the nation's health care system. The process is complicated by the fact that the House first had to pass the Senate's version of health care reform, and then pass a package of fixes that the Senate will have to take up separately through a "reconciliation" procedure requiring only a simple majority vote. To help figure out what health care reform will look like if the reconciliation bill is adopted, a number of news organizations are offering their own summaries or guides to the changes, including: The New York Times, USA Today, and the Chicago Tribune. Also, you can read online what theCongressional Budget Officehad to say about the bill it estimates will cost $940 billion over the next decade. Federal On Sunday, the House approved the previously passed Senate version (219 to 212) of health care reform, which sends this measure to the President for signature on Tuesday.The House also approved (220 to 211) the House-initiated "fix" to this Senate bill (called the Reconciliation bill) to revise items in the Senate bill that are repugnant to the House. This Reconciliation measure has to be approved by the Senate (scheduled for this week) to legally change the Senate bill. While Republicans in the Senate have more procedural tools at their disposal to derail the Reconciliation bill, the very nature of a reconciliation bill is that it only takes 51 votes, rather than the "normal" 60 filibuster-proof votes in the Senate on such major items as health care. Therefore, it seems likely that the Senate will indeed approve the changes, though perhaps not this week. If there are any changes on the Senate floor to the Reconciliation bill, even one word, it would have to go back to the House for yet another vote. Since the beginning of the year, Congress has extended for one month at a time two health-related items: 1) suspension of imposition of a 21 percent cut in doctor reimbursements under Medicare; and 2) continuation of worker eligibility for a 65 percent subsidy to pay for COBRA coverage. The end of March deadline will be extended yet again through April, once the Senate agrees with the extenders bill passed by the House last week. Both chambers have passed a lengthier extension of these two items (the "doc fix" would go through September and the COBRA item would go to the end of 2010) as part of a separate larger bill, but with no compromise in sight Congress may have to extend these two items yet again at the end of April. States COLORADO: The bill requiring maternity and contraceptive coverage in individual policies and eliminating pregnancy as a pre-existing conclusion took a turn for the worse last week.Originating in the House, the measure had been amended to only require that a coverage option be provided. The Senate, which was expected to accept the bill as amended, passed a version requiring that coverage for reproductive services be included in the majority of the individual plans marketed by a carrier. At the request of the governor, the bill has now been referred to a conference committee. CONNECTICUT: The Insurance and Real Estate Committee reported out a number of bills of interest last week, including: An Act Concerning Rate Approvals For Individual Health Insurance Policies-- the committee substituted language 1) removing the ability of AG and Health Care Advocate (HCA) to bill the plans for consultants, 2) removing the ability of the HCA and AG to appeal to the court, 3) narrowing the filing time frame for the approval to 120 days, and 4) starting to define terms and processes. The Committee's Republicans all voted no on the bill, indicating that they were concerned that the Committee hadn't gotten it right yet. An Act Concerning Appeals of Health insurance Benefits Denials -- the bill currently requires that upon the request of a member that a health plan provide all specific documents and information that were NOT provided by the enrollee or their provider that were considered in the denial. An Act Concerning Standards in Health Care Provider Contracts-- although a "standards in contracting" bill was enacted into law last session, providers continue to push for even greater limitations on contracting, including prohibitions on down-coding of claims. Other bills reported out include bleeding disorder coverage bill, a bill that would require hospitals to charge uninsured patients no more than 110 percent of Medicare, and a bill that would raise the medical malpractice threshold requirements for various providers. GEORGIA: The legislation imposing limitations on the use of rental networks was deferred after Aetna helped educate legislators about the need for further amendments to the bill.Most importantly, the bill still does not contain an exemption for the requirements of ERISA plans and non-ERISA self-funded plans. Aetna continues to work with the legislators on this issue and anticipates the bill may be heard next week. No further action has been taken on the House bill imposing a 1.6 percent tax on the premiums of health plans. Indications from the Governor's office are that it may decide not to pursue this bill. However, we are watching the issue closely. INDIANA: The legislature adjourned March 13 with no resolution to the major issues in Indiana.Specifically, the Republicans were unable to move a bill to delay imposition of new taxes to support the unemployment compensation fund or authorize a ballot initiative to permanently cap property taxes, and the Democrats were unable to move their agenda on education funding, creating jobs and providing greater assistance to the unemployed. With the exception of a bill dealing with emergency medical treatment of employees covered by workers' compensation, no insurance bills survived. Bills defeated included a push by the Indiana State Medical Association (ISMA) to allow providers to pick and choose the plans offered by an insurer that they would participate in and an initiative that would have required health insurers to provide extensive data to Indiana DOI regarding premiums and loss ratios. In addition mandatory recognition of assignment of benefits for out-of-network providers and the Indiana Dental Association's initiative to prohibit dental plans from imposing or negotiating fee schedules on non-covered services were defeated. Of note is that ethics legislation did pass both houses, and it is expected that the Governor will sign the bill impacting lobbying registration and reporting; it also limits who may serve as a lobbyist. MISSOURI: With eight weeks to go in the legislative session, the House overwhelmingly approved the "Freedom of Health Care Act," which would send voters a constitutional amendment to prevent them being compelled to participate in any federal health care plan. The "yes" votes included all House Republicans and more than a third of Democrats. The Senate gave final approval to a bill requiring health plans to cover the diagnosis and treatment of autism spectrum disorders. On the budget front, Governor Nixon cut another $126 million in state spending, which means he has now vetoed or withheld almost $850 million from the budget the General Assembly approved last May. Because falling revenues show no immediate signs of improving, further cuts appear certain before the fiscal year ends on June 30. Analysts are projecting a $500 million shortfall in the budget blueprint the Governor proposed in January, prompting serious talk about restructuring state government and broad promises of bone-nicking budget cuts. One large target is the Medicaid program, and a preliminary draft of the appropriations bill is holding $100 million for physician services contingent upon a $300 million windfall that might come Missouri's way if the U.S. Congress extends the federal budget stimulus package. NEW JERSEY: The governor recently gave his fiscal year 2011 budget address to a joint session of the legislature, outlining his plan for addressing a $10.7 billion state deficit.The proposed budget calls for drastic cuts across all sectors of government including: schools districts, FamilyCare (the state health program for the uninsured), the earned income tax credit, and the elimination property tax rebates. In contrast to past years, there were no new proposed tax increases. However, some cost shifting is anticipated in the form of increased assessments on individuals and businesses. Of note is a $2 million expenditure increase at the Department of Banking & Insurance, which will be borne by insurers in the state. In his effort to stimulate the state economy, the governor proposed discontinuing a 4 percent corporate business tax surcharge as well as allowing the surtax on high income earners to sunset. Further analysis will be done in the coming months, as the legislature begins its deliberation of the budget, to determine what, if any, impact the budget could have on Aetna. The budget must be signed by into law by June 30. The Senate unanimously confirmed Tom Considine as the next commissioner of the Department of Banking & Insurance. During his testimony before the senate judiciary committee, Considine advised that Horizon Blue Cross Blue Shield of New Jersey application to convert to a for-profit entity has been put on indefinite hold at the request of Horizon. In addition to Considine, the senate confirmed Dr. Poonam Alaigh as commissioner for the Department of Health and Senior Services. NEW YORK: According to data recently released by the Department of Insurance to bolster the Governor's demand for prior approval of insurance rates, New York HMOs had premium increases of 17 percent on average this year, with some increases as high as 51 percent. The data showed that premium changes varied widely between companies and between counties. The state continues to claim that reinstating prior approval will save $70 million. A coalition of insurers, business groups and providers strongly opposed the prior approval proposal as a measure that would impose price controls on insurance. In both press statements and full-page ads, the coalition underscored that reinstating prior approval ignores the real reason for rising health insurance premiums-increases in the underlying cost of health care services-and does nothing to address those costs. Real reform is needed that addresses the underlying costs of care, reduces the hidden taxes and ensures that health plans can continue to provide coverage to New Yorkers. The prior approval opposition group includes the Health Plan Association, the Employer Alliance, the hospital associations HANYS & GNYHA, the Business Council of New York State, the National Federation of Independent Business and several upstate business alliances. OKLAHOMA: Two bills seeking to streamline state employee health insurance benefits, in an effort to improve choice and lower costs, passed the House last week. The bills are based on recommendations made in a report by Milliman Inc. to the Oklahoma State Employee Health Insurance Review Working Group, which met during the interim last year. The report was requested to examine the functions of the Employees Benefit Council (EBC) and the Oklahoma State Education and Employees Group Insurance Board (OSEEGIB) and to determine if a duplication of efforts existed between the two agencies. The report concluded that the functions of the two groups should be integrated to form a new organization focused not only on the payment of health and other insurance claims but also on the wellness of the covered individuals; one oversight board should be created that would include members from backgrounds that include medical and employee benefits, as well as those from legal and fiscal backgrounds; the new organization should include a stronger wellness component; the state employee benefit allowance is artificially inflated and should be recalculated; and more choice is needed in rural areas of the state. The bills now move to the Senate for consideration. WASHINGTON: Legislation authored by Democrat Eileen Cody to allow health insurance consumers the opportunity to purchase health insurance across state lines failed to gain traction in the legislature, despite support from the small business community and an endorsement from the chair of the health committee.Although some regional insurance carriers had expressed concerns, the main opposition came from chiropractors and mental health providers who believed that provider protection laws would be uncut by the legislation. Resources Transforming Health Care in America America's Health Insurance Plans Insurance Available Online

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Obama: Health insurance mandate no tax increase

WASHINGTON - President Barack Obama says requiring people to get health insurance and fining them if they don't would not amount to a backhanded tax increase. "I absolutely reject that notion," the president said.

Blanketing most of the Sunday TV news shows, Obama defended his proposed health care overhaul, including a key point of the various health care bills on Capitol Hill: mandating that people get health insurance to share the cost burden fairly among all. Those who failed to get coverage would face financial penalties.

Obama said other elements of the plan would make insurance affordable for people, from a new comparison-shopping "exchange" to tax credits.

Telling people to get health insurance is absolutely not a tax increase, Obama told ABC's "This Week."

"What it's saying is, is that we're not going to have other people carrying your burdens for you anymore," said Obama. "Right now everybody in America, just about, has to get auto insurance. Nobody considers that a tax increase."

Obama faces an enormous political and communications challenge in selling his health care plan as Congress debates how to pay for it all.

He told CBS' "Face the Nation" that he will keep his pledge not to raise taxes on families earning up to $250,000, and that much of the final bill - hundreds of billions of dollars over the next 10 years - can be achieved from savings within the current system. Coming up with the rest remains a key legislative obstacle.

Obama put his support behind the idea of taxing employers that offer high-cost insurance plans.

"I do think that giving a disincentive to insurance companies to offer Cadillac plans that don't make people healthier is part of the way that we're going to bring down health care costs for everybody over the long term," Obama said on NBC's "Meet the Press."

Obama's network interviews were taped Friday at the White House. He became the first president to appear on five Sunday network shows in the same morning, an extraordinary effort to build public support for his top domestic priority.

The goal is expand and improve health insurance coverage and rein in long-term costs.

Yet despite so many weeks of speeches, town halls and interviews, Obama said he has found it difficult at times to make a complex topic clear and relevant.

"I've tried to keep it digestible," Obama said. "It's very hard for people to get their arms around it. And that's been a case where I have been humbled and I just keep on trying harder."

Obama told Univision's "Al Punto" ("To the Point") that the strong opposition to his plan is part of a political strategy.

"Well, part of it is ... that the opposition has made a decision," he said. "They are just not going to support anything, for political reasons."

By BEN FELLER, Associated Press Writer Ben Feller, Associated Press Writer

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Obama: Time for 'bickering' is over on health care

AP - President Barack Obama addresses a joint session of Congress on healthcare at the U.S. Capitol in Washington, …

By DAVID ESPO, AP Special Correspondent David Espo, Ap Special Correspondent

WASHINGTON - Shaking off a summer of setbacks, President Barack Obama summoned Congress to enact sweeping health care legislation Wednesday night, declaring the "time for bickering is over" and the moment has arrived to protect millions who have unreliable insurance or no coverage at all.

Obama said the changes he wants would cost about $900 billion over decade, "less than we have spent on the Iraq and Afghanistan wars, and less than the tax cuts for the wealthiest few Americans" passed during the Bush administration.

In a televised speech to a joint session of Congress, Obama spoke in favor of a provision for the federal government to sell insurance in competition with private industry. But in a remark certain to displease liberals, he did not insist on it, and said he was open to other alternatives that create choices for consumers.

Obama said he remains ready to listen to all ideas but added in a clear reference to Republicans, "I will not waste time with those who have made the calculation that it's better politics to kill this plan than to improve it."

In an unusual outburst from the Republican side of the House chamber, Rep. Joe Wilson, R-S.C., shouted out "You lie" when the president said illegal immigrants would not benefit from his proposals. The president paused briefly and smiled, but from her seat in the visitor's gallery, first lady Michelle Obama shook her head from side to side in disapproval of the interruption.

In general, the president shied away from providing lawmakers with a list of particulars he wants to see included in the legislation, and there was nothing in the speech to invite comparisons with Bill Clinton's pen-waving veto threat more than a decade ago on health care.

Obama's speech came as the president and his allies in Congress readied an autumn campaign to enact his top domestic priority. Republican opposition, contentious town hall meetings and drooping polls have contributed to their woes. An AP-GfK survey hours before the speech showed public disapproval of Obama's handling of health care has jumped to 52 percent, an increase of 9 percentage points since July.

While Democrats command strong majorities in both the House and Senate, neither chamber has acted on Obama's top domestic priority, missing numerous deadlines leaders had set for themselves.

In a fresh sign of urgency, Sen. Max Baucus, D-Mont., announced that his Senate Finance Committee would meet in two weeks to begin drafting legislation, whether or not a handful of Democrats and Republicans have come to an agreement. The panel is the last of five to act in Congress, and while the outcome is uncertain, it is the only one where bipartisanship has been given a chance to flourish.

Obama said there is widespread agreement on about 80 percent of what must be included in legislation. Any yet, criticizing Republicans without saying so, he added: "Instead of honest debate, we have seen scare tactics" and ideological warfare that offers no hope for compromise.

"Well, the time for bickering is over," he said. "The time for games has passed. Now is the season for action."

"I am not the first president to take up this cause, but I am determined to be the last," he added.

The president was alternately bipartisan and tough on his Republican critics. He singled out Sen. John McCain, R-Ariz., for praise at one point. Yet, moments later, in a line apparently aimed at McCain's former running mate, Sarah Palin, Obama accused Republicans of spreading the "cynical and irresponsible" charge that the legislation would include "death panels" with the power to hasten the death of senior citizens.

In one gesture to Republicans, Obama said his administration would authorize a series of test programs in some states to check the impact of medical malpractice changes on health insurance costs.

Responding on behalf of Republicans, Rep. Charles Boustany, R-La., said the country wants Obama to instruct Democratic congressional leaders that "it's time to start over on a common-sense, bipartisan plan focused on lowering the cost of health care while improving quality."

"Replacing your family's current health care with government-run health care is not the answer," said Boustany, a heart surgeon.

In a reflection of the stakes, White House aides mustered all the traditional pomp they could for a president who took office vowing to change Washington. The setting was a State of the Union-like joint session of Congress, attended by lawmakers, members of the Cabinet and diplomats.

The House was packed, and loud applause greeted the president when he walked down the center aisle of the House chamber.

Additionally, the White House invited as guests men and women who have suffered from high costs and insurance practices, seating them near first lady Michelle Obama. Vicki Kennedy, the widow of Sen. Edward M. Kennedy, D-Mass., was also on the guest list. Kennedy, who died last month, had made health care a career-long cause, and Obama spoke movingly of his efforts.

Obama intends to follow up the speech with an appearance Saturday in Minneapolis, the White House announced.

Despite deep-seated differences among lawmakers, Obama drew a standing ovation when he recounted stories of Americans whose coverage was denied or delayed by their insurers with catastrophic results.

"That is heartbreaking, it is wrong, and no one should me treated that way in the United States of America."

The president sought to cast his own plan as being in the comfortable political middle, rejecting both the government-run system that some liberals favor and the Republican-backed approach under which all consumers buy health insurance on their own.

Obama said the legislation he seeks would guarantee insurance to consumers, regardless of pre-existing medical conditions, as well as other protections. "As soon as I sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick or water it down when you need it most," he added.

The president assured those with insurance that "nothing in this plan will require you or your employer to change the coverage or the doctor you have."

Obama also said the legislation he seeks would help those who lack insurance to afford it. "These are not primarily people on welfare," he said in a line that appeared aimed at easing concerns among working-class voters. "These are middle-class Americans."

The president also said he wants legislation that "will slow the growth of health care costs for our families."

Obama said a collective failure to meet the challenge of overhauling health care for decades has "led us to a breaking point."

The so-called government option that Obama mentioned has emerged as one of the most contentious issues in the monthslong debate over health care, with liberal Democrats supporting it and many moderates inside the party opposed. An early draft of Baucus' plan calls for an alternative consisting of nonprofit co-ops. Sen. Olympia Snowe of Maine, the Republican who seems most inclined to cross party lines on the issue, favors a different approach, consisting of a standby in which the government could sell insurance if competition fails to emerge in individual states.

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Don't Leave Home Without This!

Subjects to Address with Your Undergrad-To-Be

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The college fall semester is right around the corner and for most incoming freshmen it will serve as a maiden voyage for living away from mom and dad. If you're a parent who's facing this situation, here are five topics that are a must to discuss with your undergrad-to-be.

The pre-college to-do list is daunting to say the least. From setting up financial aid to securing a place for your child to live, getting ready for college is a process that takes many months to execute. As a result, there are several very important topics that many parents never get around to discussing with their child. We suggest using the next few weeks to catch up on these conversations, establishing a line of communication that will benefit all concerned.

Study Habits and Grades
Most sources state between 20 and 25 percent of all college freshmen will drop out before their sophomore year. Furthermore, it is estimated that 50 percent of college freshmen will never make it to graduation.

There are many reasons why students drop out of college, but at the top of the list is poor grades, or an inability to adapt to the demands of an advanced curriculum. One can only wonder how many of these students would have benefited from the proper intervention early on in their college careers. We suggest that you get the ball rolling NOW.

Start by clearly establishing with your child that college will be a much different experience from high school, especially considering how far away you as the primary support system may be. An effective method for accomplishing this is allowing a peer to reaffirm the message. If you have friends or extended family with a child already attending college, arrange for your child to talk to them about their experience.

You'll also want to be clear with your child about what you expect and that he or she is still accountable to you for the grades received. Let your child know you'll want to see report cards, and that you'll be asking for updates on grades throughout the semesters.

It is so important for you as the parent to make the communication process an inviting one. Think of it this way. If your child ends up having an issue with a certain class, you'll want to know about it as soon as possible. Having open channels of communication will help facilitate this.

Lastly, we suggest that you take a proactive approach by contacting your child's college, inquiring about any available study programs and student mentors. Many universities have programs like these in place, which help incoming freshmen adapt to their new academic curriculum.

Money
Addressing the subject of money with your college freshman is something that will benefit you for the next four years, and your child forever. Once again, the key is to be clear and direct regarding the money received from you, and how you expect it be spent.

Whatever your arrangement, do not send your child to college without establishing a written budget. Show your child the fixed expenses in relation to the money you're providing. Explain that the money left over is what's allocated for fun and entertainment. Not doing so can result in endless requests for more money, not to mention a poor foundation for your child's future budgeting skills.

In terms of getting your child a credit card, we suggest proceeding with extreme caution, as credit card debt among college students has become almost epidemic. According to Sallie Mae, a college financing company, the average credit card debt for college undergrads in 2009 is over $3,000, a thousand dollars more than it was in 2004. What's worse is that average balances are even higher for students in their third and fourth years of college.

Don't forget to warn your child about the high-interest cards that may be solicited to them while on campus. Talk about the responsibility that comes along with having a credit card, as well as the potential dangers. Let your child know that starting out in life with high interest debt is not the recipe for success.

Dating and Friendships
Discussing a child's personal life is different within every family. There are a couple of points, however, that we think are good for everyone to address.

Events in college students' personal lives have the potential to be a huge distraction to their education. Remind your child about the importance of good decisions, as well as maintaining a focus on education. After all, it is the primary reason for attending college.

Let your child know you wish to be kept in the loop regarding friends new and old. This is not only for your peace of mind, but also for your child's safety. Be sure to make it less about the details of the relationships than about maintaining a connection to you and the rest of your child's support system.

You may also want to use the subject of your child's personal life to address your expectations for vacations and breaks. Are you okay with your child spending the holidays with a friend, or do you expect your child to come home? How do you feel about friends or significant others coming to your home on breaks? This is a good time to let your child know how you feel.

Drugs and Alcohol
Do not kid yourself. Drugs and alcohol are readily available on and around most every college campus in America. Regardless of how your child behaved while in high school, your supervision will not be present while your child's away at college. Hopefully you've already addressed the subjects of drugs and alcohol with your child. If not, now is the time to do so.

It's one thing to set up rules while your child is living under your roof. It's a whole other story when your child is living hundreds if not thousands of miles away. Considering there is no immediate accountability to you, the parent, we suggest sharing a few statistics.

According to an Associated Press analysis of federal records, 157 college-age people (18-23) died due to alcohol poisoning over a 6-year span between 1999 and 2005. Eighty-three of these victims were under the age of 21.

What's most important to understand is the numbers quoted only reflect deaths due to alcohol poisoning, giving no consideration to traffic fatalities, homicides, injuries, or sexual assaults. Further analysis by the Associated Press revealed that college freshmen were at the greatest risk, with three quarters of the deaths occurring within the students' first semester in college.

Take the next few weeks to reemphasize the lessons you've already taught your child and to remind your child that his or her life is just beginning.

Personal Responsibility
Considering the aforementioned topics, as well as many others, the idea of personal responsibility is what ties everything together. For the first time, your child will officially reach adulthood and be held accountable for everything he or she does from this point forward. The tricky part is your child won't be living under your roof while this is happening.

Explain to your child that the idea of a "permanent record" is now in effect. How people handle themselves from this point forward will either positively or negatively affect the rest of their lives.

College can be a wonderful experience with infinite possibilities. Talk about these possibilities with your child, explaining the benefits that come with embracing them. Most importantly, let your child know that the next four years will contain some of the more memorable experiences of his or her life.

Here's to some positive memories for both you and your child.

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