Steve Patterson

Texas Health Insurance: Availing Of The Medicare Supplement

Recently, there has been a growing awareness in Texas regarding health care programs. Insurance agencies in Texas extend their services to the public based on this trend. To avail of Texas Health Insurance, there are various considerations and this is what this article is all about.

Availing of Medicare Supplement Insurance in Texas isn\’t as hard as it seems. In fact, it is much simpler if you use a much more sensible approach — weighing the pros and cons. Statistics show that Texas Medicare Supplements can be easily availed of in the state, because there are hundreds of options provided for those who need health care.

Before applying for those health benefits, first you must choose a Texas Medicare Supplement program that suits your current situation. As soon as you complete the necessary paperwork and start paying the monthly premiums, you can begin enjoying the advantages of health care.

Other Advantages of Texas Medicare

One of the advantages of Medicare in Texas is that you can choose to be treated by any doctor, in any hospital, in the entire nation — as long as that particular hospital accepts Medicare. Therefore, when you use a Texas Medicare Supplement, rest assured that it is not limited to local hospitals only, but you can gain access for treatment in prestigious medical institutions as well.

Medicare Supplement Insurance in Texas comes in various categories and from different providers. But one unique aspect of Texas Medicare Supplements is that it remains the same regardless of what company you get it from. This allows you the flexibility to look around for the best affordable prices available in your state.

There are situational determinants that you should consider when trying to avail of Texas Medicare Supplements. The simplest process available is called ‘Guaranteed Issue’ when you are primarily interested with price and flexibility of monthly coverage.

Some health care providers offer an introductory price for the first two years and dramatically raise the price of the premiums afterward. It is important to do your research and do not be blinded by the ‘cheap’ introductory price of the premium.

If you\’re looking for expanded health insurance coverage but fail to get approved for guaranteed issue, you need to review the basic guidelines of Texas Medicare providers. You will notice that different health care providers have varying standards for Medicare approval. Some are strict, but others are more lenient.

It is best to consult Texas Medicare Supplement insurance agent to help you choose which program and company fits your situation, preferences, and health needs. Therefore, it is imperative that you contact a professional health insurance agent to better weigh your options for availing a Texas Health Insurance program.

Article Source: http://www.articlesbase.com/insurance-articles/texas-health-insurance-availing-of-the-medicare-supplement-1653886.html

About the Author

Steve – Weight Loss Diet Forum & South Beach Acai Supplement Trials http://WeightLossDietForum.com

Health Insurance

The federal health care reform legislation, known as the Patient Protection and Affordable Care Act, signed by the President on March 23, 2010, and the Health Care and Education Reconciliation Act approved by Congress, signed by the President today, will expand the availability of health care coverage to millions of Americans. While some of the measures will be implemented this year, many do not take effect until 2014 and some extend out to 2020.

Below is a high-level overview of the timeline.  It is important to note that many of these reforms and their effective dates are subject to the rules and regulations process both at the state and federal levels – which could alter the intended timing of implementation.

2010

New Programs:
* Temporary retiree reinsurance program is established
* National risk pool is created, small business tax credit is established
* $250 rebate for Medicare members who reach the ‘doughnut hole’

Insurance Reforms:
* Prohibits lifetime benefit limits – based on dollar amounts
* Allows restricted annual limits on the dollar value of certain benefits
* Coverage rescissions/cancellations are prohibited (except for fraud or intentional misrepresentation)
* Cost-sharing obligations for preventive services are prohibited
* Dependent coverage up to age 26 is mandated
* Internal and external appeal processes must be established
* Pre-existing condition exclusions for dependent children (under 19 years of age) are prohibited
* New health plan disclosure and transparency requirements are created

2011

Insurance Reforms:
* Uniform coverage documents and standard definitions are developed
* Minimum medical loss ratios are mandated

Medicare Reforms:
* Medicare Advantage cost sharing limits effective
* Medicare beneficiaries who reach the doughnut hole will receive a 50discount on brand name drugs
* A 10Medicare bonus will be provided to primary care physicians and general surgeons practicing in underserved areas, such as inner cities and rural communities.
* Medicare Advantage plans would begin to have their payments frozen.

Other:
* Employers are required to report the value of health care benefits on employees\’ W2 tax statements.
* Annual industry fee for pharmaceutical manufacturers of brand name drugs.
* Voluntary long term care insurance program would be made available to provide cash benefit for assisting disabled individuals to stay in their homes or cover nursing home costs. Benefits would start five years after people begin paying a fee for coverage.
* Funding for community health centers would be increased to provide care for many low income and uninsured people.

2012

* Hospitals, physicians, and payers would be encouraged to band together in ‘accountable care organizations.’
* Hospitals with high rates of preventable readmissions would face reduced Medicare payments.

2013

* Individuals making $200,000 a year or couples making $250,000 would have a higher Medicare payroll tax of 2.35on earned income —up from the current 1.45 A new tax of 3.8on unearned income, such as dividends and interest, is also added.
* Medical expense contributions to flexible spending accounts (FSAs) limited to $2,500 a year—indexed for inflation. In addition, the thresholds for claiming itemized tax deduction for medical expenses rise from 7.5to 10of income.
* Medical device manufacturers would have a 2.9sales tax on medical devices; devices such as eyeglasses, contact lenses, and hearing aids would be exempt.
* Eliminates deduction for expenses allocable to Medicare Part D subsidy for employers who maintain prescription drug plans for their Medicare Part D eligible retirees.

2014

Coverage Mandates & Subsidies:
* Individual and employer coverage responsibilities are effective.
* Individual affordability tax credits are created and small business tax credits are expanded.

Health Insurance Exchange & Insurance Reforms:
* State individual and small group health insurance exchanges operational.
* Guaranteed issue, guaranteed renewability, modified community rating and minimum benefit standards (‘essential benefits’ plan) effective.
* Lifetime and annual dollar limits are prohibited for essential benefits.
* Pre-existing condition exclusions are prohibited.

Taxes & Fees:
* Addition of new taxes on health insurers

Medicaid and Medicare Reform:
* Medicaid expanded to cover low income individuals under age 65 up to 133of the federal poverty level—about $28,300 for a family of four.
* Minimum medical loss ratio of 85required for Medicare Advantage plans

2018

Taxes & Fees:
* Tax (‘Cadillac tax’) imposed on employer sponsored health insurance plans that offer policies with generous levels of coverage.

2020

Medicare Reform:
* Doughnut hole coverage gap in Medicare prescription benefit is fully phased out. Seniors continue to pay the standard 25of their drug costs until they reach the threshold for Medicare catastrophic coverage.

Author  Resource: Easy To Insure ME http://www.easytoinsureme.com/

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<a href=’http://www.easytoinsureme.com/’>health insurance</a>

<a href=’http://www.easytoinsureme.com/’>health insurance quotes</a>

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Medicare Supplemental Health Insurance

What is Medicare Supplemental Health Insurance and why you need it.

Also called “Medigap” Insurance it is sold by Private Insurance Companies and covers gaps in Medicare Coverage.

The Medicare program provides healthcare coverage to approximately 44 million Americans, making it America\’s largest government-sponsored healthcare program in which qualifying consumers can enroll. However, even though it provides coverage for many health-related issues, Medicare often does not cover the full cost of healthcare for participants. Participants, therefore, need to be aware of what is and is not covered by their particular plan in order to ensure that they purchase necessary Medicare Supplement insurance or enroll in additional coverage plans, if needed.

Medicare coverage has deductibles that increase every year, and many gaps that could leave you with unlimited out-of-pocket expenses. A Medicare Supplement plan can help protect against these expenses.

Medicare Supplemental Health Insurance helps you pay for co-pays, coinsurance, deductibles and excess charges not normally covered by Medicare.

In addition, Medicare Supplemental Health Insurance also provides some Benefits not provided by Medicare. It’s only for original Medicare. It doesn’t provide insurance for other types of health coverage, including:

Medicare Advantage Plan

Stand-alone Prescription Drug Plans

Employer/Union Group Health Coverage

Medicaid

Veterans Administration (VA) Benefits

TRICARE

There are two reasons you need Medicare Supplemental Health Insurance:

1. Cover Gaps in Original Medicare

2. Receive Benefits not Covered by Original Medicare

In short, Medicare Supplemental Health Insurance Plans help you reduce out of pocket expenses not covered by original Medicare.

As the nation’s leading independent agency specializing in Medicare Supplemental Health Insurance Plans, MediGap Advisors can show you how you can save money with the best Medicare Supplemental Health Insurance plans that fit your needs and your situation.

Our professional advisors will take a look at your biggest health care expenses and show you the best Medicare Supplemental Health Insurance plans to protect you from charges that Medicare doesn’t cover. Call 866-681-7712 to speak with a professional advisor.

Article Source: http://www.articlesbase.com/health-articles/medicare-supplemental-health-insurance-3712302.html

About the Author
Wiley Long has served in the health insurance industry since 1988 and is currently president of MediGap Advisors, the nation\’s leading online Medicare supplemental insurance agency. Living in Fort Collins, Colorado, Wiley is a music lover, skier and dedicated father as well as an industry leader, providing solutions for thousands of clients seeking assistance with their Medicare supplemental insurance needs.

For a comprehensive and easy-to-understand guide on ‘How to use Medicare Supplements to complete your Medicare Coverage’, visit http://www.MyMedigapReport.com or call 866-681-7712 or you can watch the video at http://www.dailymotion.com/video/xfiwsw_best-medicare-supplement-best-medicare-supplemental-plan_people

Health Insurance

A McKinsey Quarterly report that found 30 percent of employers were likely or highly likely to stop offering health insurance after 2014 as a result of the health care reform law has continued to generate much follow-up discussion in the past three weeks.  The debate over the results included sharply worded criticism from the White House, which led McKinsey to publish on its website follow-up information about the methodology of the survey. The McKinsey report, however, is just one of many that have examined the potential impact of the Affordable Care Act (ACA), with differing results, The Robert Wood Johnson Foundation last week released studies that show employer coverage has eroded significantly in the past decade, from 69 percent in 2000 to 61 percent in 2009, but that the ACA is expected to help reverse the trend among small employers. An Urban Institute brief released last week anticipates that the ACA will have a similarly positive impact on small businesses and their workers.

Federal

Vice President Biden\’s bipartisan group of negotiators, which has been trying to work out an agreement to raise the debt ceiling, hit a roadblock last week when key Republicans withdrew from the negotiations.  House Majority Leader Eric Cantor (R-VA) announced that he would not participate in Thursday\’s session and called for President Obama to resolve an apparent standoff over Democrats\’ demands to raise revenue as part of the agreement and Republicans\’ opposition to tax increases. As a result, talks have been elevated to President Obama, who has scheduled separate meetings at the White House with Senate Majority Leader Harry Reid (D-NV) and Senate Minority Leader Mitch McConnell (R-KY). Negotiations also are expected between the President and Speaker of the House John Boehner (R-OH). Prior to Thursday, Biden\’s group reportedly had agreed to about $1 trillion in savings, potentially impacting health care programs such as Medicare and Medicaid. It is unlikely that the President will negotiate an agreement with Republicans by the July 1 deadline that Biden\’s group had set for themselves. Separately, Sen. Mark Warner (D-VA) said last week that the Senate Group of Five would aim to release a deficit reduction proposal in a week or so.

Article Source: http://www.articlesbase.com/insurance-articles/health-insurance-reform-weekly-july-5th-2011-4988708.html

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Health Insurance

While the majority of health insurance reform provisions go into effect in 2014, there are a number of provisions that take effect in 2010. Here\’s an overview of the provisions that become effective this year: Read more at http://www.easytoinsureme.com/

Health insurance quotes

Immediately at enactment

• Grandfathering – Plans and individuals that ‘renew’ their coverage are exempt from any provisions of the law. These ‘grandfathered plans’ must comply, however, with the following provisions of the law: extend dependent coverage through age 26, prohibit rescissions, eliminate waiting periods greater than 90 days, and eliminate pre-existing condition exclusions for children

• Small employer tax credits – provides premium subsidies for small groups with 25 or fewer employees and average salaries of $40K or less

Less than six months

• High-risk pool program – establish a temporary national high-risk pool for individuals with pre-existing medical conditions. (effective 90 days post enactment through January 1, 2014)

• Temporary reinsurance for employer retirees – Creates a temporary reinsurance for employers providing health insurance coverage to retirees over 55 who are not eligible for Medicare (effective 90 days post enactment through January 1, 2014)

Six months plus

• No lifetime limits – Eliminates all lifetime limits on the dollar value of coverage (effective six months post enactment)

• Restrictions on rescissions – Prohibits insurers from rescinding coverage except in the cases of fraud (effective six months post enactment)

• No pre-existing conditions for children – Eliminate pre-existing condition exclusions for children under 19 (effective six months post enactment)

• Dependent age 26 – Extends dependent coverage to age 26 (effective six months post enactment)

• Preventive care with no cost sharing – Eliminates cost-sharing for certain preventive services (effective January 1, 2011)

• Appeals process – Individuals  have access to an  internal and external appeals process to appeal decisions by their health insurance plan.

Article Source: http://www.articlesbase.com/insurance-articles/health-insurance-reform-immediate-actions-3054752.html

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Easy To Insure ME

Health Insurance

Federal

Although the House vote to repeal health care reform is symbolic only (given the Democratic Senate and White House), it is a necessary first step leading to committee by committee action over the coming months on discrete provisions of health care. One such item, medical malpractice liability reform, got a hearing last week before the House Judiciary Committee as Republicans paraded several witnesses before the committee to showcase the need for legislation from the physicians\’ perspective. Since it is very unlikely that the American Medical Association\’s wish list would ever become law, the best result from the committee process would be a bill that skirts the more controversial items (e.g., cap on damages) and focuses on attainable and meaningful reforms, such as health courts, stronger pre-trial evaluation and settlement pathways.  This would be a path Aetna would strongly support.

States

ARIZONA: Governor Jan Brewer has announced that she will request a waiver from the federal Centers for Medicare and Medicaid Services so that the state can set Arizona Health Care Cost Containment System (AHCCCS) eligibility below levels mandated by the PPACA. In March 2010, Governor Brewer signed a fiscal year 2011 budget that stripped funding for the state\’s Children\’s Health Insurance program (KidsCare) and cut $385 million from AHCCCS, effectively repealing an expansion of AHCCCS to childless adults approved by voters in 2000. However, following enactment of the PPACA, the state rescinded the scheduled cuts to comply with the law\’s ‘maintenance of efforts’ (MOE) requirement. The MOE requirement prohibits a state from having eligibility standards, methodologies, or procedures for adults that are more restrictive than those in effect on March 23, 2010, until a health insurance exchange in the state is fully operational, and for all children in Medicaid and CHIP through September 30, 2019. The MOE requirement provides an exception for non-pregnant, non-disabled adults earning more than 133 percent of the federal poverty level if a state is projected to have a budget deficit. Arizona faces a mid-year budget deficit estimated at $825 million. A $1.4 billion shortfall is projected for the 2012 fiscal year.

CALIFORNIA: The U.S. Supreme Court has agreed to review whether health care providers and patients have the right to sue California over budget reductions made to Medi-Cal reimbursements. The high court will review three legal challenges to California\’s proposed and adopted reimbursement cuts. The Supreme Court\’s ruling on the case could have major implications for efforts to address California\’s budget deficit. Last week, Gov. Jerry Brown (D) released a budget proposal that would reduce Medi-Cal payments to health care providers by 10 percent to cut program spending by about $719 million in fiscal year 2011-2012. In addition, the case could have implications for other states seeking to address budget deficits by cutting Medicaid payments. With federal courts in California blocking the cuts, 22 states have joined California in appealing the issue to the Supreme Court.  The court is expected to hear oral arguments in the case next fall. A decision is expected in late 2011 or early 2012.

CONNECTICUT: Speaker Chris Donovan, members of the Public Health and Insurance Committees and a variety of advocates held a press conference last week to announce the Public Health Committee has raised the SustiNet bill based on the recent recommendations of the SustiNet Board. Few details were provided, but the original report recommends that SustiNet become a licensed insurance plan. ’We don\’t need health insurance anymore, we need to move towards health assurance — health care that will be there for us, and the SustiNet plan will do that,’ Donovan said. Lawmakers will face a $3.7 billion budget deficit by July 1. Rep. Betsy Ritter, D-Waterford, co-chairwoman of the Public Health Committee, said the plan will have to go before multiple legislative committees, with the actual bill some weeks away. A financial analysis on upfront costs is not yet available. Aetna is working with the Connecticut Association of Health Plans (CTAHP) and AHIP to secure an objective fiscal analysis of SustiNet\’s, as a public option, true cost to the state, and of the strong, positive impact health insurers have on the state\’s economy.

DELAWARE: In his State of the State speech, Governor Jack Markell emphasized the need for state government to spend more efficiently.  He specifically noted that the demands state employee health insurance and pensions are putting on the state budget are unsustainable. The Governor specifically stated he is open to any and all good ideas for addressing this budget issue. In other news, a joint meeting of the Senate Health Committee and the House Economic Development, Banking, Insurance, and Commerce  Committee was convened for an update on the state\’s effort to implement health care reform. Rita Landgraf, Secretary of Health and Social Services, along with Bettina Riveros, Health Care Commission Chair, advised legislators the commission will spend the next six to eight weeks holding stakeholder meetings across the state seeking input on establishing a state health insurance exchange.

GEORGIA: The Exchange Workgroup formed by former Governor Sonny Perdue had its final meeting last week and will submit a list of issues for Governor Deal\’s administration to review before deciding how to proceed on the issue of instituting an exchange in Georgia. As the head of this workgroup for Governor Perdue is continuing under Governor Deal\’s administration, it is likely that there will be some enabling legislation during the 2011 session, though it is unclear what that will be. The legislative session began January 11, 2011 and continues for 40 legislative days.

IOWA: The General Assembly convened in Des Moines on January 10 and is expected to adjourn on April 29, 2011  In the November elections, Republicans took control of the House and gained a few seats in the Senate, narrowing the Democrats\’ majority there. Republican Terry Branstad was sworn in as governor for the second time. Having served in the post from 1983 to 1999, Branstad is the longest-serving governor in Iowa\’s history. The state\’s budget deficit is projected to be more than $785 million for fiscal year 2012 and will dominate legislative discussions. House Speaker Kraig Paulsen has vowed to remedy the deficit through spending cuts rather than tax increases. The Governor\’s proposal to revise the state\’s annual budget to a two-year cycle will also be debated. Bills of interest so far include several challenging PPACA\’s individual mandate, a prohibition on abortion coverage, creation of mandate-lite policies, a mandate for coverage of smoking cessation programs, a rate review bill that would require a public hearing for any increase over 10 percent in the individual market, and a bill establishing $100 as the minimum required payment for state employees.

INDIANA: Governor Mitch Daniels has issued an executive order  establishing the Indiana Health Benefit Exchange. In his order he directs the Indiana Family and Social Services Administration (IFSSA) to cooperate with appropriate state agencies, including the Department of Insurance (IDOI), to establish and operate the exchange. The IFSSA Secretary or the secretary\’s designee will serve as the incorporator of the Exchange. If, after careful analysis, the state deems it appropriate to proceed with creation of the exchange, a board of directors will be selected. The board will include representatives of state agencies and the Indiana General Assembly. Standing Committees will be appointed that have stakeholder representation. In addition, Governor Daniels submitted a letter to HHS Secretary Kathleen Sebelius requesting approval of a state plan amendment to extend the Healthy Indiana Program (HIP) beyond its expiration date. HIP, the state\’s consumer-directed program for covering the uninsured population, is scheduled to expire in 2012. Daniels notes he has received communication from HHS staff indicating the state plan amendment will be rejected due to HIP\’s required level of contribution from participants.  The Governor said the state intends to utilize the program for the newly eligible Medicaid population pursuant to PPACA. Daniels cautioned that Indiana does not have the time and financial resources necessary to complete new rigorous requirements for applying for a waiver extension if the amendment is rejected. The current 45,000 enrollees in the program would have to be transitioned into traditional Medicaid.

MISSOURI: The 96th General Assembly convened on January 5 and is expected to adjourn on May 30, 2011. With 106 members to the Democrats\’ 57, the GOP has the largest number of seats it has ever held in the House and is just three members short of being veto-proof.  Given the large Republican majorities in the General Assembly and 70 percent voter support for Proposition C – an effort to turn back health care reform, the legislature will be under pressure to do nothing to move Missouri closer to enactment of federal health reform.

Significant health care bills filed this session include a resolution calling on the Attorney General to file a lawsuit challenging the constitutionality of the PPACA, a bill requiring statutory authorization by the General Assembly to implement PPACA, a bill expanding the autism mandate, an MLR bill for large carriers requiring a 90 percent MLR for Missouri-associated revenues and 85 percent for smaller carriers, a bill requiring the state employee health plan to offer a minimum of three high-deductible options with differing annual deductibles and annual out-of-pocket expenses, a bill prohibiting ‘Most Favored Nation’ clauses, legislation creating transparency and publication of carriers\’ fee schedules and requiring carriers to contract with providers willing to meet certain provider participation terms and conditions, and creation of a uniform group application for insurance.

NEBRASKA: The 102nd unicameral legislature has convened in Lincoln where it is expected to spend much of the session grappling with a budget deficit approaching $985 million for the 2011-2013 biennium. Implementation of the PPACA is expected to receive serious attention as well, with six bills relating to implementation or rejection of PPACA introduced to date. Bills of interest include legislation creating an Exchange Task Force, an interim committee for PPACA study, and several bills challenging the individual mandate, prohibition of abortion coverage, and a cochlear implant mandate. In addition, a bill banning discretionary clauses in health and disability income insurance contracts has been introduced.  The legislature began its work on January 6 and is tentatively scheduled to adjourn on May 26, 2011.

NEW HAMPSHIRE: The legislature convened on January 5, 2011, and is scheduled to adjourn on June 30, 2011. Governor John Lynch will continue as the state Executive; however, Republicans have gained control of both chambers in the legislature. In addition to the state\’s budget deficit, implementation of federal health care reform will continue to be a priority for the governor and the legislature. Given the Republican majority and anticipated revenue shortfalls, there will be limited, if any, activity on health insurance issues. The legislature will, however, be paying close attention to federal health reform implementation issues and activities. In addition, there have been discussions about eliminating certain state mandates if they are not included in the essential benefits required under the PPACA. In 2010, the state enacted legislation granting certain powers to the commissioner with respect to implementation of PPACA.  This legislation also created a legislative oversight committee, to which the Department of Insurance (DOI) must report monthly. This month the DOI submitted a request for a waiver of the 80 percent minimum loss ratio (MLR) requirement for individual health insurance market policies until 2014.

NEW YORK: In a new report, the United Hospital Fund (UHF) looks at how New York might set up health insurance exchanges. One option is to let HHS run the state\’s exchange, While that could save money, it would also mean ceding key operational and regulatory issues to the feds. It might also jeopardize existing consumer protections in Medicaid that are unique to New York. If the state sets up its own exchange, it must decide whether to join a multi-state exchange, a statewide entity, or small local ones. UHF noted that New York might consider following the leads of Massachusetts and California by creating an independent public authority to run an exchange. Former Governor David Paterson created a 35-member Exchange Committee that met only twice and did not make any recommendations. Governor Andrew Cuomo has not indicated his plans for establishing an insurance exchange in New York.

PENNSYLVANIA: Governor Tom Corbett has announced his intention to nominate Michael Consedine as the next Insurance Commissioner. Consedine is a partner at the law firm of Saul Ewing, where he serves as Vice Chair of its Insurance Practice Group.  Prior to joining Saul Ewing 12 years ago, Consedine served as state Insurance Department Counsel.

The Corbett transition team has announced that adultBasic, Pennsylvania\’s health insurance program for low-income adults, is expected to expire on February 28 due to lack of funding.  The announcement, unusual in that it comes from an incoming  administration, was necessitated by the need to provide advance notice to enrollees and to inform them of alternative coverage options. Originally started by former Governor Tom Ridge and funded through the state\’s allocation of Tobacco Settlement dollars, the program was later funded through the 2005 Community Health Reinvestment Agreement (CHRA).  While that agreement between the Rendell Administration and the state\’s four Blue Cross plans expired on Dec. 31, 2010, additional funding was later provided by the plans pursuant to the CHRA\’s formula.  It now appears those additional funds will be exhausted by the end of next month.

TENNESSEE:  A new Commissioner of Insurance appointed by Governor Bill Haslam took office last week. Julie McPeak is an attorney at the Nashville firm of Burr and Forman and the former Commissioner of Insurance in Kentucky.  Aetna is scheduling a meeting with the new Commissioner within the next several weeks.

Article Source: http://www.articlesbase.com/politics-articles/health-insurance-quotes-reform-weekly-january-4132269.html

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individual health insurance / Golden Rule insurance // Aetna health insurance

Health Insurance

States with Republican governors kept up the pressure last week on Washington to give the states greater control over health care under the Patient Protection and Affordable Care Act (PPACA). Twenty-one Republican governors sent a letter to Health and Human Services (HHS) Secretary Kathleen Sebelius asking for greater authority over some provisions of health reform, including the ability to define ‘essential’ health benefits and set minimum criteria for participating in insurance exchanges. They threatened not to run their own state-based exchanges if HHS does not act on their requests. Sebelius quickly responded with her own letter in which she reviewed the various options states have to reduce costs in their Medicaid programs, and she indicated she is continuing to review what authority she may have to ‘waive the maintenance of effort under current law.’ Senate bills have already been introduced to address the role of the states in health care reform, which is sure to keep the issue on the front burner. Visit Easy To Insure ME for more info

Federal

The House Committee on Ways & Means held a hearing last week on ‘The Health Care Law\’s Impact on Medicare and Its Beneficiaries,’ featuring testimony from CMS Administrator Donald Berwick, M.D., and CMS Chief Actuary Richard Foster. Berwick testified that the PPACA has had a positive impact on Medicare beneficiaries, noting that beneficiaries now have first-dollar coverage of key preventive benefits, additional assistance with prescription drug costs, and an annual wellness visit with the physician of their choice. In response to concerns noted by several committee members about the impact of funding cuts on Medicare Advantage, Berwick indicated that Medicare Advantage enrollment increased by 6 percent from 2010 to 2011. He suggested that the program is healthy and offers robust choices. Foster\’s testimony reiterated his prior projection that the PPACA will cause Medicare Advantage enrollment to decline by about 50 percent by 2017 — from a projected 14.5 million under the pre-PPACA law to 7.3 million under the new law.  His testimony further explained that Medicare Advantage enrollees will experience ‘a large increase in out-of-pocket costs’ and ‘less generous benefit packages’ because PPACA will reduce rebates to Medicare Advantage plans, with the reduction in rebates reaching $1,500 per beneficiary by 2019.

The Administration last week issued favorable guidance with respect to student health coverage that will result in little disruption, if any, to this business until at least the 2012-2013 academic year. This guidance was announced in a Notice of Proposed Rule Making (rather than as an interim final regulation), which fortunately means that the rule is not effective immediately as has been the case with most regulations relating to PPACA reforms. The proposed student health rule would create a special class of individual coverage for student health pursuant to a set of factors, e.g., written contract between school and insurer, coverage only for students and dependents, health status may not be used as a condition of eligibility.  As Aetna has advocated, the impact would be delayed, as the rule (whenever finalized) would not be effective until policy years beginning on or after January 2012. Until then, student health is not subject to PPACA reforms.  And, when effective, student health would be excepted from the current guaranteed issue and renewability provisions of PPACA.  While it will be unclear for a while whether and how student health will be subject to the medical loss ratio (MLR) provisions of PPACA, we are encouraged by the fact that the proposed rule invites comments on whether student health should receive some sort of special accommodation (akin to the special rule for limited benefit plans) with respect to MLR, owing to the unique characteristics of the student health market.

States

ARIZONA:  The industry-supported exchange bill was introduced last week under the sponsorship of the House Health Committee Chairman and the respective chairmen of the House and Senate Banking and Insurance Committees. The bill provides for a market-based mechanism; governance by a board with insurer representation; no dual regulation; and a conditional repeal provision. The first hearing will be held this week. In other news, Governor Jan Brewer appointed Don Hughes, former AHIP retained counsel, as Special Advisor for Health Care Innovation. Hughes will help direct state efforts to improve the cost-effectiveness and accessibility of health care. He will engage in strategic planning with a focus encompassing both public health care and Arizona\’s large private health insurance industry.

CONNECTICUT:  A jointly held public hearing of the Public Health and Insurance and Real Estate Committees was scheduled for this week on two new health care bills. The first bill would establish the SustiNet Plan Authority, a quasi-public agency empowered to implement a public health care option. The SustiNet Plan is a health insurance program that consists of coordinated individual health insurance plans that provide health insurance products to state employees, Medicaid enrollees, HUSKY Plan, Part A and Part B enrollees, HUSKY Plus enrollees, municipalities, municipal-related employers, nonprofit employers, small employers, other employers, and individuals in Connecticut. The Authority is authorized, but not required, to begin offering SustiNet coverage to employees and retirees of non-state public employers, municipal-related employers, small employers, and nonprofit employers after January 1, 2012.  Beginning on January 1, 2014, SustiNet will offer coverage to individuals and employers.  Among other things, the bill directs the Authority to implement primary care case management and patient-centered medical homes for all SustiNet Plan members, establish a pay-for-performance system, and establish procedures to prevent adverse selection.

The Committees also will hear testimony on a bill to establish the Connecticut Health Insurance Exchange pursuant to PPACA.  The exchange would be a quasi-public agency offering qualified health plans to individuals and qualified employers by January 1, 2014.  The bill would establish a 13-member board of directors to manage the exchange. The exchange would have the authority to review the rate of premium growth within and outside the exchange in order to develop recommendations on whether to continue limiting qualified employer status to small employers. It also would have the authority to charge assessments or user fees to health carriers to generate funding necessary to support the operations of the exchange. The bill directs the exchange board to report to the legislature by January 1, 2012 on whether to establish two separate exchanges, one for the individual market and one for the small employer market, or to establish a single exchange; whether to merge the individual and small employer health insurance markets; whether to revise the definition of ‘small employer’ from not more than 50 employees to not more than 100; and whether to allow large employers to participate in the exchange beginning in 2017.

Aetna will submit comments on both bills through the Connecticut Association of Health Plans.

IDAHO: Draft legislation is circulating that would prohibit insurance companies and managed care organizations from refusing to contract with qualified providers solely because the provider: is not a member of a group, network or any other organization of providers contracting with the insurance company; or does not offer all of the services obtained through the group, network or organization of providers contracting with the insurance company. However, the provider may be required to comply with the practice standards and quality requirements of the contract specific to the services contracted. The bill generally is intended to impact insurers and managed care organizations. It does not contain an exclusion or exception for HIPAA-excepted benefits. As yet, the bill has not found a sponsor and has not been ‘introduced.’  While there remains a possibility that the bill could be introduced before the deadline for committee bill introductions, it is considered unlikely.

MINNESOTA: When the legislature convened the first half of its 2011-2012 biennium last month, Republicans controlled both legislative chambers for the first time since 1972. And, Republican lawmakers wasted little time introducing bills to repeal measures passed by the 2010 legislature to fund state medical assistance, general assistance medical care, and MinnesotaCare. In his first official act as Governor, Mark Dayton signed an executive order implementing early Medicaid expansion (to 133 percent of the federal poverty level) for Minnesota, which is expected to make 95,000 more state residents eligible. Minnesota\’s $188 million investment is expected to bring about $1.2 billion in matching federal funds. Governor Dayton also signed an executive order removing the ban on applications for federal PPACA-related grants. Minnesota is expected to receive an exchange planning grant soon. While Governor Dayton cleared the way for the state to seek grants for implementing federal health reform, it is unlikely that state legislators will be passing bills to implement the federal health reform law unless absolutely necessary. Other pending bills of interest include anti-PPACA legislation, a bill requiring guaranteed issue in the individual market, creation of a defined contribution program for childless adults with incomes at or above 133 percent of FPL (reduction from current level of 250 percent), the prohibition of dental plan fee schedules for non-covered services, and an autism coverage mandate. In addition, Governor Dayton named a new Commissioner of the Department of Commerce, Minneapolis attorney Michael Rothman.

NEVADA: The legislature convened on February 7 with a scheduled adjournment date of June 6. Governor Brian Sandoval will sponsor an exchange bill, although he opposes federal health care reform. His reasons include not wanting the federal government to take action in the state and the fact that the legislature will not meet in 2012. The Division of Insurance (DOI) has indicated that it will pursue federal reform measures, including external review. Other legislation of interest includes the establishment of a statewide health information exchange system and amending the requirements for reimbursement of out-of network services to comply with the PPACA.

TEXAS: Governor Rick Perry delivered his State of the State speech last week, which included plans to suspend the State Historical Commission and the Commission on the Arts in addressing the state\’s $27 billion budget deficit. Speaking to a joint session of the legislature, Perry said the time has finally come to streamline state government. Perry\’s speech focused heavily on how strong the state\’s economy is, despite the deficit. According to Perry, Texas added more jobs in 2010 than any other state in the nation. That state-wide job growth occurred in the sectors of business, health care, manufacturing, hospitality, construction and energy. Perry\’s speech was highly critical of national politics, and he threatened to push back when Washington encroaches on states\’ rights. His budget proposal calls for cutting more than $2 billion in state spending on public education and another $2 billion in higher education, plus more than $2 billion in health and human services programs. Those cuts would come with much larger reductions in federal dollars, because states draw federal funding for programs such as Medicaid by spending state money.

VERMONT: Newly-elected Governor Peter Shumlin\’s focus has been on reducing the state\’s projected $100 million budget deficit. Proposals to deal with the deficit include changes to the administration of the state\’s Catamount program, changes to Catamount reimbursement, imposing an assessment on managed care organizations, increasing the provider tax on hospitals, and imposing an assessment on dentists. The legislature is also considering a number of bills that would create a single-payer, government-run health care plan and require rate reviews. The bills include:

Supported by the governor, H.B. 202 would establish Green Mountain Care and the Vermont Health Benefit Exchange, through which all state residents would be eligible for health benefits. After implementation of the Green Mountain single-payer system, private insurance companies would be prohibited from selling health insurance policies in that cover services also covered by Green Mountain Care.

H.B. 80 would create a single-payer health care system called Ethan Allen Health. If the secretary of Human Services obtains a waiver from the exchange requirement, private insurance companies will be prohibited from selling insurance policies in the state for coverage of services covered by Ethan Allen Health. But it would not prohibit individuals from purchasing supplemental health insurance covering services not already covered by Ethan Allen Health.

S.B. 57 would establish Green Mountain Care as a single-payer health care system, which will include coverage provided under a health benefit exchange, Medicaid, and Medicare.

H.B. 146 would establish a public health care coverage option called Green Mountain Care that would require Vermont residents to have health care coverage at least equivalent to the actuarial value of Green Mountain Care and would assess a financial penalty against those who fail to maintain such coverage. The bill would institute a candy and soft drink tax as well as a 10 percent payroll tax on all employers with more than four employees to fund Green Mountain Care.

S.B. 56 and H.B. 165 would amend current rate review procedures to require written approval from the commissioner before a health insurance policy can be issued and to require that all rate and form filings be filed electronically.  Rate changes would require approval by the commissioner prior to implementation and notice to plan members of rate changes and a 30-day comment period.

H.B. 82 would require health insurers to disclose to the Department of Banking, Insurance, Securities, and Health Care Administration the fee schedules they negotiate with providers, and directs the department to post the information on its website.

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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 $5.7 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 $54 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 $9.5 billion in 2009 — that could rise to $32 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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Health Insurance

PricewaterhouseCoopers and Medco Health Solutions released two new views of cost trends in health care during the past week, building on the release of the Milliman Medical Index.   PwC Health Research Institute\’s ‘Behind the numbers: Medical cost trends for 2012,’ examines the medical cost trends for employers in 2012.  This new report found ‘Medical cost trend is expected to increase from 8 percent in 2011 to 8.5 percent in 2012.’  And two main drivers identified by PwC are provider consolidation and cost-shifting to the private sector.

Providing a view of prescription drug utilization and pricing trends, Medco\’s Annual Drug Trend Report showed this week that while the overall growth of prescription drug prices is at an historic low (as a result of increased use of generic drugs), the cost of specialty treatments is still increasing at an alarming rate.  According to Medco\’s report ‘Specialty drug trend was 17.4 percent in 2010, fueled by unit cost growth of 11.5 percent.’

Federal

There is no Federal report for this week.

States

ARIZONA: The Department of Insurance (DOI) held a public hearing on rate review as part of its Health and Human Services (HHS) grant activities. The DOI has retained Mercer Consulting to assist in performing a gap analysis to identify areas that need to be addressed in order to comply with the requirements of the Affordable Care Act (ACA). During the hearing, it was noted that the state\’s current statutory scheme does not authorize the DOI to review a health insurer\’s medical loss ratio, potentially not allowing the state to meet the HHS requirement of having ‘an effective rate review process.’

The Director of Insurance and the Governor\’s office also hosted their first workgroup on the implementation of an exchange. Despite the legislature\’s refusal to pass an exchange bill, there is concern at the executive level about a lack of preparedness in the event the ACA is not repealed or found unconstitutional. This week\’s topic was the qualified health plan certification, and participants focused on not adding requirements beyond the ACA minimum benefit requirements.

CALIFORNIA: The Appropriations committees of both houses are wading through many bills that would have varying impacts on state finances.  Bills meeting certain dollar thresholds are sent to ‘suspense’ filing for consideration at later hearings.  Most of the legislation that Aetna and other allies have opposed has been sent to the ‘suspense’ filing, including a bill on rate regulation and all bills on benefit mandates, because of the fiscal impact of each bill and potential conflicts with federal guidance on essential benefits. These bills may be revived at a later date, or they may be held by the committees.  We expect the majority of the bills to be voted off the suspense file by the end of the month, including.

Rate regulation – According to Appropriations, there would be an annual fee-supported special fund cost of at least $30 million to DMHC and CDI.
Rate regulation – According to Appropriations, there would be an annual fee-supported special fund cost of at least $30 million to DMHC and CDI.
Autism mandate – According to the committee analysis, this bill would result in annual costs to the following state entities:
CalPERS: $9 million
Medi-Cal, for enrollees in managed care plans: $114 million
MRMIB plans (Healthy Families, AIM, MRMIP): $37 million

In state budget news, the governor will release his May revision to the state budget next week, taking into account new revenue figures that show the state taking in more than $2 billion in unanticipated new tax dollars. The governor still believes that asking voters to extend the higher tax rates set to expire this summer is the right thing to do because the higher revenue forecasts would not close the entire budget shortfall.  Republicans, however, have been quick to argue that higher revenue forecasts mean that extending tax rates is not needed at this time.

CONNECTICUT: The legislative session adjourns June 8, but the legislature has yet to reach a conclusion on several major issues, including an exchange bill, a rate review bill and the SustiNet bill.  Although the SustiNet compromise bill language is not public, the Administration and press reports have said that the bill does not include a public option but would create an advisory board on health reform implementation and examination of future state reforms. In addition, an anti-most favored nation clause bill has passed the House and now goes to the Senate for its consideration. Aetna supported the bill with amendments. The bill is expected to pass. Additionally, the recently released HHS rate review rule may push legislators to advocate for adoption of the federal 10 percent trigger for rate review in Connecticut, just in case the federal law is repealed.

DELAWARE: The Department of Insurance (DOI) submitted a medical loss ratio (MLR) waiver application to HHS for its individual health insurance market. The DOI-requested adjustment proposes a three-year phase-in of the MLR as follows: 65 percent for 2011, 70 percent for 2012, and 75 percent for 2013.

GEORGIA:  Governor Deal has signed legislation that applies state prompt-pay standards to self-funded plans.  Aetna will be working with self-funded customers who have questions about the validity of the new law and its application to their plans, which are generally covered by ERISA.

INDIANA: Insurance Commissioner Stephen Robertson submitted an MLR waiver request to HHS seeking relief from the MLR regulation for the individual market and for consumer-directed health plans in both the individual and small group markets.  Specifically, for the individual market, Indiana is requesting that the MLR be waived for the individual market through 2014, or, as an alternative, that it be phased in as follows: 65 percent in 2011, 68.75 percent in 2012, 72.5 percent in 2013, 76.25 percent in 2014, and 80 percent in 2015, with an exemption from the MLR requirement until 2014 for new market entrants (defined as those that have not previously sold individual major medical health insurance products in Indiana for the previous 10-year period). For consumer-directed health plans in the individual and small group markets, Indiana is requesting a permanent waiver from the federal MLR requirements.

MAINE: Governor LePage has signed into law an Act to Modify Rating Practices for Individual and Small Group Health Plans. The new law is designed to open up Maine\’s individual and small-group insurance market to competition. It also is supposed to:

help lower health insurance premiums by broadening Maine\’s community rating system and allowing insurance companies to base their premiums on a more flexible set of criteria.
allow Maine residents to purchase insurance in four New England states beginning in 2014.
set up a reinsurance pool to cover individuals with serious illnesses. The pool would be subsidized by a covered lives assessment capped at $4 per member per month.

The Maine People\’s Alliance (a progressive advocacy group), the Maine Democratic Party, and others are looking into the feasibility of initiating a referendum on the new law. In order to get a referendum on the November ballot, opponents would have to file approximately 60,000 signatures with the secretary of state no later than 90 days after the enactment of the bill on May 17, 2011.

MONTANA: Governor Brian Schweitzer has decided to reconsider his amendatory veto of legislation that prohibits the state from enforcing the individual responsibility requirement contained in the ACA.  Noting the critical role that the individual mandate plays in lowering the cost of coverage, the Governor\’s amendatory veto argued that the prohibition against enforcing the mandate in Montana should be contingent on whether residents have access to affordable coverage.  However, on May 13, the Governor reversed his position and signed the bill into law, as permitted under Montana\’s statutory procedural guidelines.  The provisions of the law include legislative findings stating that the ACA individual coverage requirement will cause unnecessary expense and inconvenience to individuals and employers, and therefore the legislature prohibits any agency of the state from enforcing the provisions of the ACA and subsequent federal regulations that relate to the individual coverage requirement. The law specifies that the prohibition extends to requiring public employees to purchase or maintain coverage and state officials or employees from participating in boards, commissions, or entities of the NAIC that are assigned to recommend provisions that implement the individual mandate.

NEVADA: HHS informed the Nevada Division of Insurance that the state\’s application for a transitional waiver from the MLR provisions contained in the ACA has been denied and amended.

In its response letter, HHS admits that application of the ACA MLR standard could in fact lead to destabilization of the state\’s individual market but argues that the transitional waiver requested by the state (72 percent) exceeds the amount necessary to prevent destabilization and would ‘deny consumers an excessive amount of benefit.\’  For this reason, HHS determined that Nevada should be granted a one-year transitional waiver under which the MLR for the state\’s individual market will be 75 percent in 2011.

SB 440, which would create the Silver State Exchange, had its first hearing on March 18 in the Finance Committee, but no action to advance the measure was taken.

NEW JERSEY: Last week the Department of Banking and Insurance (DOBI) announced that Horizon Blue Cross Blue Shield of New Jersey has officially withdrawn its application to convert to a for-profit entity.

In the final round of public budget hearings, the non-partisan Office of Legislative Services (OLS) and State Treasurer, Andrew Sidamon-Eristoff, testified that state revenue is now expected to exceed forecast by $600 to $900 million due to higher income tax collection. This was welcome news as the legislature and the Christie Administration wrestle with various program cuts under the current budget proposal. Leadership in the legislature has called for restoration of property tax rebates and reconsideration of the proposed changes to the Medicaid program.  It has been reported the Administration is seeking to change Medicaid eligibility to 33 percent of the federal poverty level. Democratic legislators have come out en masse opposing this change.

NEW YORK:  James Wrynn will be the deputy superintendent for Insurance under the Department of Financial Services (DFS) after the consolidation of the New York State Insurance Department, of which he is currently superintendent, with the Banking Department. Benjamin Lawsky was nominated to be the superintendent of the DFS. At packed confirmation hearings, Lawsky appeared before the Senate Insurance Committee and then the Senate Banking Committee. Lawsky said he understands that prior approval has become ‘overly politicized.’  He said he would make addressing this his ‘number one priority.’ He also said he planned to meet with all stakeholders on this issue in the coming months. He was unanimously approved by both Insurance and Banking Committees but must still appear before the Senate Finance Committee for its approval.

The NYS Department of Insurance held public hearings on exchanges that reports say were not well attended. The New York Health Plan Association testified that the success of any health insurance exchange boils down to the affordability of coverage it can offer.  The HPA said the best way to preserve affordability is through an independent authority, which could be created by passing very limited exchange legislation before the end of the legislative session. Such legislation could establish the governance and infrastructure of the exchange and charge it with conducting research to make recommendations regarding the policy issues that need to be addressed by 2014. A key issue to address is how to ensure that the exchange is financially sustainable by 2015, as the law requires.

NORTH CAROLINA: Legislation implementing an Exchange Advisory Board met with some consumer opposition last week.  Opposition centered mostly on the way in which the exchange will be funded.

OKLAHOMA:  In the final week of the legislative session, leadership in both chambers announced the formation of a special joint legislative committee to study how the new federal health care law affects Oklahoma. Senate Pro Tem Brian Bingman and House Speaker Kris Steele ordered the formation of the joint committee and announced that ‘studying this issue in more depth makes for healthy legislative process. The scope of this law is vast, so we need to make sure we are prepared to address this law in a conservative way that is best for Oklahoma.’ The committee will have bipartisan membership. The joint committee will hold a series of public meetings over the legislative interim focusing on how the ACA affects Oklahoma. The committee will also explore how to best approach the law as the state awaits the outcome of its lawsuit challenging the law\’s constitutionality. The committee will then make recommendations on how the state should address the federal health care law.

As a result, legislation that would create an Oklahoma health insurance exchange will not be heard this year.

TEXAS: The health care collaboratives that would be set up by pending legislation (Senate Bill authored by Senate Health and Human Services Chair Jane Nelson are intended to promote higher quality of care at lower cost. The collaboratives would allow groups of providers, such as hospitals and doctors, to bargain collectively with the people who pay them. The goal is to give providers more leverage in price negotiations with an eye to cutting overall health care costs. But staff at the Federal Trade Commission (FTC) say giving these collaboratives antitrust protection could have the opposite effect and could harm consumers. Staffers have flagged this key provision of the Lieutenant Governor\’s health care agenda for the session, indicating that a tool intended to improve the efficiency and quality of care in Texas might in actuality ‘lead to dramatically increased costs and decreased access to health care for Texas consumers.’ To get around any antitrust issues, SB 8 specifically gives collaboratives exemption from antitrust laws. The bill is in the final stages of passage and could be headed to the House floor at some point in the last 10 days of the legislative session.

Meanwhile, uncertainty hung over the Texas Capitol at the end of last week as budget negotiators worked to bridge the gulf between the House and Senate spending plans and avert a special legislative session. What had been a $5 billion difference Wednesday was narrowed to a few hundred million dollars as the House agreed to the Senate\’s proposal on public education. To help pay for the $3 billion added into the budget, the House relies on the $1.2 billion of additional state revenue announced by Comptroller Susan Combs this week. Lt. Gov. David Dewhurst said he was optimistic that a deal was in the offing. Negotiators are taking it down to the wire trying to complete their work by the end of the legislative session on May 30.

WISCONSIN: The Wisconsin Office of Free Market Health Care\’s (OFMHC) survey to gather stakeholder input on the design of a potential Wisconsin Health Insurance Exchange closed last week.  Now, the OFMHC will develop its plan for the exchange.  OFMHC has been tasked to design and implement a Wisconsin Health Insurance Exchange that utilizes a free-market, consumer driven approach.

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Health Insurance

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