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 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 0 million from Oxford (18.7 percent of 2008 New York premiums), 0 million from Empire (2.5 percent) and 4 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 0 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.
