Health Insurance Reform Issues Student Health Insurance

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

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

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

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

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

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

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

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

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

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

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

Source: ArticlesBase.com

May Health Insurance Reform Weekly Easy To Insure ME

A weekly compilation from Aetna of health care-related developments in Washington, D.C. and state legislatures across the country. EasyToInsureME has the answers.

Week of April 25, 2011

The U.S. Supreme Court announced Monday that it had rejected a request from the state of Virginia to fast-track its challenge of the Affordable Care Act (ACA), which was signed into law in March 2010. The Court did not disclose the reasons behind its decision.  Since the 4th and 11th Circuits will be hearing arguments in the next two months on the constitutionality of the individual mandate, it is much more likely that once these two Circuits have spoken the Supreme Court will be more inclined to resolve the matter with some finality.

While the lawsuits filed by a number of states march on through the normal appeals process, some of the states are taking the unusual step of turning down money available to help fund implementation of the law. Oklahoma, for one, has turned down .6 million in demonstration grants to distance itself from the law. But Idaho Governor C.L. “Butch” Otter upped the ante last week when he issued an executive order prohibiting state agencies from implementing any aspect of the health reform law and from accepting federal funds tied to implementation of the law. While some question whether such outright defiance of the law would hold up as constitutional, the situation underscores the bitterness felt by some state leaders toward the law. In some cases, implementation can be expected to move at a snail’s pace, if at all, until the U.S. Supreme Court weighs in on the issue.

Federal

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

States

ARIZONA:  The legislature adjourned last week after a contentious and partisan session. Governor Jan Brewer has until May 2, to sign or veto legislation, but the final status on several bills affecting health insurers and their customers is already known:

A bill that would have established the Arizona Health Exchange, governed by a board of directors that included insurer representation, was voted out of committee but did not make it out of the House. The legislation was based on the NAIC model.
A bill that would have required health insurers to provide a written claims information report within 30 days of receiving a request from a plan, plan sponsor, or plan administrator was passed in both chambers but died when a required conference committee failed to consider the matter prior to adjournment.
A bill that would have established the procedural mechanisms for an interstate compact to work with other states to avoid implementing provisions of the ACA was passed by both chambers but was vetoed by Governor Jan Brewer.
A bill that would have prohibited contracts from requiring providers to assume the cost of acquiring vaccines and would have mandated reimbursement of providers for vaccine acquisition costs and administration was scrapped. Health insurers committed to meeting with the Arizona Academy of Pediatrics to reach a resolution without legislation.

In other matters, the Department of Insurance announced that it will hold a series of community meetings around the state to provide information about health insurance premiums in the individual and small group markets.

CALIFORNIA:  Governor Jerry Brown signed a bill into law last week that eases administrative and cost burdens on employers and individuals, come tax time, by conforming to federal rules relating to the taxation of dependent coverage. As a result, employers and their employees will not have to deal with the complications of complying with differing tax rules.  Aetna joined a diverse coalition of business, labor, and other groups in helping to focus attention on the need for this legislation. Also, the California Health Benefits Exchange board met for the first time last week, a step toward implementing the first reform-prompted insurance exchange in the nation. The Board spent most of it time on administrative decisions and announced the appointment of interim administrative director, Pat Powers, who is now president of the nonprofit Center for Health Improvement.

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In other news, Aetna is seeking amendments to a bill that would direct state regulators to develop a single prior authorization form to be used by providers and plans in seeking authorization for prescriptions.  The bill already has been amended to reflect some the industries’ concerns. But other issues remain to be resolved, including the timeframe that plans would be allotted to approve prior authorization requests.  Aetna and others are seeking more flexibility on that issue and want to ensure the legislation does not conflict with what CMS or other national workgroups are developing. The bill passed the Senate Health committee last week.

CONNECTICUT:  The Governor and legislative leadership announced a budget deal last week that does not include a proposed premium tax increase. A premium tax increase (from 1.75 percent to 1.95 percent) was designed to raise million for the state but would have triggered retaliatory taxes for Connecticut-domiciled insurers, including Aetna, sending approximately million to other states. A coalition that included Aetna, the state trade association, property/casualty insurers and life insurers was able to convince state leaders that lowering tax credits (until 2013) to drive about million in new revenue was a better id.

The administration and Democratic legislative leaders also announced an agreement on the proposed SustiNet state-run health plan. This agreement combines aspects of the SustiNet bill with the Connecticut Healthcare Partnership bill.  The new deal calls for opening the state employee health plan to municipalities and some non-profits but not to the public. The agreement also would establish a “SustiNet cabinet” advisory panel within the lieutenant governor’s office to oversee health reform efforts in the state. The agreement does not call for the state to combine the Medicaid and state employee and retiree health plans into a large pool (as the current SustiNet proposal would).  Legislative language for the new proposal is still being developed, but it is clear the bill will not include the SustiNet quasi-public authority or a public option.

In the next fiscal year, municipalities would be allowed to buy coverage through the state employee and retiree plan, under the new agreement. Non-profits that have contracts with the state could buy in beginning the following fiscal year. The agreement does not include allowing small businesses to buy coverage through the state employee plan. Whether the state health plan is ultimately expanded further will depend how the initial round of pooling goes and whether expansion is considered necessary once federal health reform rolls out. As part of health reform, the state plans to establish an insurance exchange by 2014.

GEORGIA: America’s Health Insurance Plans (AHIP) will be submitting a letter to Governor Nathan Deal urging him to veto prompt-pay legislation that would apply insurer claims-payment standards to self-funded plans.  Also passed and awaiting the Governor’s signature is a bill that would allow for sale of coverage across state lines.

MAINE: A revised state supplemental budget that covers a million gap between revenues and spending is now law. Last week Gov. Paul LePage signed the bill, which had unanimous, bipartisan support. Most of the million gap resulted from cost overruns in the state Department of Health and Human Services. The supplemental budget appropriated unspent funds from various state agencies to fill the gap. The budget addresses spending in fiscal 2011, which ends June 30. A two-year budget starting July 1 is still being deliberated.

NEW YORK: Less than one week after the Cuomo administration held a meeting to gather input on a health insurance exchange, Senate Republicans will hold their own open Roundtable on Exchanges this week to gather similar input. The roundtable discussion will be chaired by Senate Insurance Committee Chair Jim Seward and Senate Health Committee Chair Kemp Hannon. Although only trade associations were invited to participate, the meeting will be open to observers. At the administration’s first exchange meeting, the consumer lobby made it clear that they support an exchange that is either a government agency or public authority that is an active purchaser. The NYS Association of Health Underwriters advocated for a merger of the individual and small group markets combined with an expanded definition of small groups up to 100. Some small businesses, however, spoke against such a merger. The Business Council of NYS made the point that an exchange with all of New York’s mandated benefits, aggressive purchasing and extensive consumer components may not be sustainable.  There was no discussion of financing. It is anticipated that future meetings and public hearings will be scheduled by the Cuomo administration to solicit public input.

Citizen Action of New York is pushing for a health insurance exchange that is exactly opposite of the market-based model advocated earlier this month by the Manhattan Institute. The consumer group said in a statement last week that some of the recommendations of the pro-business Manhattan Institute “would undermine the rights of consumers.” Citizen Action’s research and education affiliate, Public Policy and Education Fund of New York, recommends one statewide exchange that functions as an independent authority and coordinates its enforcement efforts with the state Insurance Department and the attorney general. Citizen Action also wants heavy consumer representation on the governing board and a significant increase in penalties for violations of the new federal law.

TEXAS: The House passed a bill  that would allow the state to enter into a health care “compact” with like-minded states. The bill, passed on a party line 102-46 vote, is a grab for some of the control over health care currently held by the federal government. Lawmakers in several other states are considering similar initiatives. The bill would require at least one state partner and approval from Congress before it could go into effect. Proponents say the bill would help Texas stretch its health dollars further and better deal with spiraling costs. Critics say it would remove a key federal safety net and cut back on already strapped programs for the the poor and elderly. The legislation faces a final procedural vote before moving to the Senate.

WASHINGTON: The Governor is expected to sign legislation establishing a state health insurance exchange as a non-profit, public private partnership with a governing board consisting of nine members.  The bipartisan legislation directs the board, in consultation with the Washington State Health Care Authority, to develop a range of recommendations for establishing/implementing the exchange using stakeholder input and recognizing the need for a private market outside of the exchange. The board’s recommendations would need to be ratified by the legislature during the 2012 legislative session.

Source: ArticlesBase.com