Ctamlouis Health

President Obama’s Health Insurance Bill

President Obama Releases New Health Care Proposal in Time for Health Summit: On Monday February 22, 2010, White House officials unveiled a new health insurance reform overhaul that builds on the Senate version passed last Christmas Eve, with some changes aimed at pleasing House Democrats who had concerns with the Senate bill. The President’s proposal does not include the public option, despite the hopes of Senate Democrats, due to White House concerns that the provision will hinder passage in the Senate. President Obama ignored requests by Republicans to scratch the Democratic plan and start over. As such, Republican leaders questioned Democratic motives and labeled the bill as a massive government takeover of America’s health care system.

Republicans Insist House Democrats Don’t Have the Votes to Pass Legislation: Minority Whip Eric Cantor (R-VA) announced on Wednesday that Democrats don’t have the necessary votes to pass the President’s proposal in the House because of three new House vacancies and lagging support among some moderate Democrats. At issue for some Democrats are weaker abortion provisions in the President’s proposal as well as the ongoing controversy over passing a bill by a simple majority, a process known as reconciliation.

Health Care Summit Preview

On Thursday, the President’s Health Care Summit began at 10:00 a. m. with opening comments from the President, followed by remarks from both Republicans and Democrats. The discussion centered on four themes: controlling health care costs, overhauling the insurance market, reducing the deficit and expanding insurance coverage. Prior to Thursday, several top Republicans and some Democrats stated that expectations were extremely low for the Summit’s success.

House Republicans arrived armed with their own version of a health care bill that encourages small businesses to join together to buy insurance, gives federal money to states to run high-risk pools for those unable to obtain private insurance and limits damages in medical malpractice lawsuits. The Republican plan would cost $61 billion and cover three million people over ten years. In contrast, President Obama contends his plan would cost $950 billion and cover 30 million people over the same time period. However, officials at the Congressional Budget Office (CBO) indicated they would not be able to officially score the President’s proposal with just a summary – that legislative language is needed.

Note: A full summary of the results from the Health Care Summit will be included in next week’s newsletter

Additional Activities

WellPoint Executives Defend Premium Increases: On Wednesday, the House Energy and Commerce Subcommittee on Oversight and Investigations held a hearing to examine the proposed health insurance premium increases by Anthem Blue Cross in California. Anthem, a WellPoint subsidiary, recently informed subscribers in California that premiums for individual insurance policies would be raised an average of 25 percent, with some rates going up as much as 39 percent. Angela Braly, president of WellPoint , said the premium increases were justified by soaring medical costs, and that pending legislation could make the problem worse, driving up costs further for young, healthy people.

“Raising our premiums was not something we wanted to do,” Ms. Braly said . “But we believe this was the most prudent choice, given the rising cost of care and the problems caused by many younger and healthier policyholders dropping or reducing their coverage during tough economic times. By law, premiums must be reasonable in relationship to benefits provided, which means they need to reflect the known and anticipated costs they will cover. “

In Sacramento , Leslie Margolin, president of Anthem Blue Cross in California, also testified before lawmakers, joined by vice president and general manager James Oatman. The focus of that hearing was also the proposed premium increase for California members in the individual market, with company executives pointing to the current economic climate and rising health care costs as reasons for the rate hikes.

U. S. House of Representatives Repeals Antitrust Exemption from Health Insurance Companies: On Wednesday, the House of Representatives voted 406-19 in favor of repealing a 65-year-old antitrust exemption from health insurance companies. Democrats said the repeal would lead to increased scrutiny of the industry. Yet, the non-partisan Congressional Budget Office said last year that repealing the exemption would not significantly reduce premiums because states already investigate health insurance companies.

In addition, industry executives pointed out that legislation could further hinder competition and the ability to share information to improve health care quality. “Health insurance is one of the most regulated industries in America at both the federal and the state levels,” said Karen Ignani, president and chief executive of America’s Health Insurance Plans (AHIP). “The real focus should be on addressing the rising cost of medical care, which is putting an unsustainable burden on families, employers and the federal budget,” she said.

Public Opinion

Polling Suggest Health Care Reform is Still Key to Economic Recovery: Recent polling on health care reform shows mixed reaction among the public over the proposed legislation. According to a recent CNN poll, 48 percent of those questioned said lawmakers should work on an entirely new bill and 25 percent felt that Congress should stop work on health care reform altogether.

According to the monthly poll from the nonpartisan Robert Wood Johnson Foundation, 75 percent of Americans still think it’s important that Obama include health care reform in addressing the nation’s economic crisis, while many still harbor doubts about the legislation.

When asked how health care legislation relates to their economic situation:

* Nearly 31 percent said they thought the Democratic bills would make their personal financial situation worse, compared with 10 percent who said it would improve their family budgets.
* Forty-two percent said the nation’s fiscal condition would suffer because of the legislation, compared with 26 percent who said it would get better.
* Americans were divided on whether the Democrats’ approach would improve overall access to health care around the country, with 35 percent saying it would and nearly that many disagreeing.

Health Insurance Coverage Varies Widely Based on Age: Coming just before the President’s Summit on Health Care Reform, a newly released Gallup Poll reinforces the wide degree of variability in health insurance coverage across U. S. population segments, especially when it comes to age. Eighty-four percent of 18-year-olds have health insurance, most likely because they are still covered under their parents’ policies. By age 22, health insurance coverage reaches its lowest point, with just 66 percent maintaining coverage. From age 22 on, the percentage of Americans with health insurance begins to climb, albeit slowly, reaching the 95 percent level at age 65 when Medicare becomes an option.

Looking Ahead

Legislators need to determine next steps for health care legislation coming out of the President’s Health Care Reform Summit. On Wednesday, Department of Health and Human Services Secretary Kathleen Sebelius invited executives from the top five insurance companies to meet at HHS to discuss their companies’ insurance premiums.

MARCH 26, 2010

This Week in Health Care Reform     

Health care reform legislation passed the House this week on a party-line vote. Late Sunday night, House Democrats approved the Senate health care reform package, sending the legislation to President Obama for his signature. On Tuesday, President Obama signed the underlying bill into law, yet the House has yet to finalize the package of “fixes” that will alter the final implications of the legislation.

Health Care Reform Negotiations

House Democrats Pass Health Care Reform Package: The House of Representatives approved the Senate health care reform bill Sunday night by a vote of 219 to 212. The vote marks the climactic finale to a year-long debate over health care reform. In the final vote, 34 Democrats joined all House Republicans in voting against the measure. Shortly thereafter, the House also passed a package of “fixes,” by a vote of 220-211, that was sent directly to the Senate for its approval through reconciliation. On Tuesday, President Obama signed into law the Senate health care reform bill, called the “Patient Protection and Affordable Care Act. “

Republicans Force Senate to Send the Reconciliation Bill Back to the House: Shortly after the President signed the Senate bill into law, Senators began deliberations on the reconciliation bill. Reconciliation protocol restricts Senators to 20 hours of debate on the measure, but it does not limit the number of amendments that can be filed. In an expression of opposition to the bill, Republicans filed 29 amendments to the reconciliation package.

After 10 hours of continuous debate, Republicans were successful in eliminating two provisions related to college financial aid in the non-health care portion of the bill. The Senate parliamentarian ruled early Thursday morning that those two provisions violated the chamber’s rules, sending the legislation back to the House for a new vote. As a result, on Thursday afternoon, the Senate voted on the reconciliation bill without those two provisions and sent the bill  back to the House for a vote on final passage. The House vote will likely come Thursday evening.

What Does This Health Care Reform Legislation Mean: While the health care reform bill extends insurance coverage to 32 million more Americans by 2019, the legislation has other far-reaching implications that will be phased in sooner, during a multi-year implementation period.

Several features of the new health care overhaul bill that would take effect in 2010 under the measure passed Sunday include:

* New product requirements beginning 6 months after enactment, including:
o Coverage for dependents up to age 26
o No lifetime maximum benefit limits
o And no cost sharing on preventive care for certain policyholders
* Temporary federal high risk pools;
* Tax credits for small employers; and
* Prohibition on pre-existing condition exclusions for children (beginning 6 months after enactment).

Most Americans will have until 2014 to purchase insurance or pay a penalty. Other elements of the bill that will not take effect until at least 2014 include insurance marketplaces called “exchanges”; rules requiring insurers to accept all applicants regardless of pre-existing conditions, and an expansion of state Medicaid programs.

A number of experts question whether health care reform will really drive down insurance premiums. America’s Health Insurance Plans ( AHIP), the trade group representing health insurers, outlines a series of concerns related to the legislation including a lack of provisions that address underlying health care costs, improve quality of care or ensure a stable risk pool. In addition, AHIP expressed concerns regarding new taxes on health coverage, which will likely increase premiums.

Additional Activities

Obama’s Executive Order on Abortion Funding: On Sunday afternoon, prior to the final House vote on health care reform, President Obama agreed to issue an Executive Order that would uphold the ban on federal funding for abortion . In so doing, he secured about a half-dozen votes from anti-abortion Democrats, led by Rep. Bart Stupak (D-MI), who previously opposed the legislation. On Wednesday, President Obama signed the Executive Order banning the government from spending federal money to pay for abortions through plans offered on the insurance exchanges created under the measure.

States Filing Lawsuit to Fight Provision of Health Care Reform Bill: In response to the new health care reform legislation, states across the country have filed lawsuits asking the courts to declare the law unconstitutional and to bar its enforcement. On Monday,Attorneys General in 13 states, led by Florida, filed a joint lawsuit claiming that the new health care reforms violate state government rights in the U. S. Constitution and will force massive new spending on hard-pressed state governments. Joining Florida in the suit are Alabama, Colorado, Idaho, Louisiana, Michigan, Nebraska, Pennsylvania, South Carolina, South Dakota, Texas, Utah and Washington.

At the same time, the Attorney General in Virginia filed a separate suit contending that Congress has exceeded its power in mandating that people buy health insurance. Virginia Attorney General Ken Cuccinelli argues that the new law’s requirement clashes with Virginia law that exempts citizens from federal fines imposed for not having health insurance.

Senate Voting to Extend COBRA Until May 5:  Senate Democrats plan another short-term extension of unemployment aid this week, setting up a face-off with Republicans, who are vowing to fight the extension if the $10 billion cost isn’t offset with spending cuts. The bill, currently set to expire on April 5, would extend a series of emergency programs – including funding for unemployment insurance benefits and COBRA health coverage for the jobless  – and would hold off a deep cut in reimbursement rates for doctors who serve Medicare patients. The long-term extension has already passed in both the House and Senate, but the two measures are not expected to be reconciled and sent to the President’s desk until after the Easter recess.

President Obama Heads to Iowa to Speak on Health Care: President Obama headed to Iowa on Thursday to increase support for his health care legislation. This was President Obama’sfirst trip out ofWashington since signing health care reform legislation earlier this week. He spoke at the University of Iowa, in the city where he first announced his health care proposal during the Presidential campaign.

Public Opinion

Most Americans Want Republicans to Fight Health Care Reform Bill: In a recent CBS News poll, 62 percent of Americans said they want congressional Republicans to continue challenging the bill, while 33 percent said they should not. Disapproval of the bill has remained steady, with 46 percent saying they disapprove, including 32 percent who “strongly” disapprove. A majority of Americans continue to say that they find the bill to be confusing and do not understand what it means for them or their family.

American’s Split on Health Care Reform Passage: In a recent USA Today/Gallup poll, 42 percent of Americans said they were angry or disappointed with the recent passage of health care reform legislation. When asked to reveal party affiliation, 79 percent identified themselves as Republicans.

Polling Shows Support for State Lawsuits Against Government: National polling reveals significant opposition to the individual mandate. In a newly released Rasmussen report , 53 percent of those polled oppose the new mandate requiring every American to buy or obtain health insurance. Further, 49 percent of voters are in favor of their state suing the federal government to fight the mandate. Fifty-one percent say individual states should have the right to opt out of the health care plan entirely.

Looking Ahead

After this week’s final health care reform vote, President Obama plans to travel the country in the next few months to discuss the new law. Republicans have begun their own discussions of the law, with an eye towards the November elections.

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

As you review the different health care options available in Georgia, you’ll note that there are options from several major national providers. In reviewing pros and cons, you’ll want to make sure your choice is financially sound, ranks well, and provides access to the health care professionals or organizations that you prefer. Another method for choosing well is to review ratings from third parties. US News and World Report recently ran rankings of some of the health insurance providers who operate in Georgia; they evaluated responses from consumers, physicians, and their own reviewers to come up with ratings and scores

United Health Plan performed fairly well, just two-tenths of a point behind their competition, Aetna, on the ratings report, with an overall score on a 100 point scale of 82. 3. Like the national competition in Gerogia, United Health has NCQA accreditation; this means that they’ve gone through a rigorous screening process to meet 60 separate standards checks and must annually renew and prove that they are meeting increasing tough standards of quality in order to retain this prestigious distinction. Think of the NCQA as the “Good Housekeeping” seal of approval, for insurance plans. For more information on NCQA, an independent not-for-profit group, visit their site—ncqa. org.

United Health Care performed particularly well with regard to treatment options—specifically, for asthma medication and treatment. They have strong support for other treatment needs as well (mental and behavioral health, alcohol and/or drug awareness, and testing for children and adolescents). The balance of their scores were average or above average, in most categories.

One of United Health Care’s biggest initiatives on a national level—especially relevant for Georgians who live in rural areas or who may not have access to every specialty, within their local area, is a new partnership with Cisco to present “Connected Care”. Connected Care takes advantage of technology to offer access to health care providers and resources online, in a one-on-one format, with secure conversations possible between patient and doctor (minus the office visit). There is an accompanying mobile access clinic (again, to increase access in rural communities) and the initiative, just launched, is gaining momentum. Imagine—being at work, and being able to spend  5 minutes one-on-one chatting with your doctor about a problem or question—without taking 90 minutes from your day to drive to the doctor, wait, meet with him/her, drive back…online access means quick answers, less worry, and better communication. And access to specialists in faraway places is that much easier.

Facts On Alabama Health Insurance

When it comes to health insurance, Alabama doesn’t really come to mind. The more popular association to Alabama, perhaps, is a Hollywood movie or two with the word Alabama in the title (and it does sound sweet). But heres one thing you should know about Alabama: its one state that is very particular about the healthcare of its citizens. In fact, the state governor even proposed to legislate tax breaks to small-time businesses that offer healthcare benefits to employees.

But Alabama is not really that much different from all the other states in the United States, and there are some facts that may be or less true for others.

* Prices are the same, always

It doesnt matter if youre getting your healthcare plan from the healthcare provider head office or from your insurance agent. Prices across health insurance plans (specific to healthcare providers) remain the same. Under certain law, insurance providers are not allowed to sell programs at prices much than the price offered by agents.

* Dont take it personally if your pre-existing condition is not covered

Like anywhere in the United States, health care insurance providers are not prohibited from excluding pre-existing conditions from their coverage. But of course, you can always qualify for guaranteed issue health insurance if you meet certain criteria.

* Employment at bigger companies is better

If you want to save on health insurance costs, then choose to be employed at a company with 25 or more employees. Under the Health Maintenance Organization Act of 1973, companies with 25 or more people on their payroll are required to offer healthcare benefits to their employees.

* More options for dental healthcare plans

For dental healthcare, there are actually three kinds of plans that you can choose from: the traditional dental HMO plans, dental PPO plans, and dental discount plans. These are available throughout Alabama.

HMO and PPO plans are the real insurance plans: you pay the premiums and then the insurance company pays for the dental healthcare provider. Dental discount plans are not insurance plans, you pay an annual fee so you can benefit from dental services at discounted rates (typically 50% to 60% of professional fees). The rest of the billed amount you will have to pay from out of your own pocket.

* There are many healthcare providers

When it comes to healthcare plans, keep in mind that there are many healthcare providers and that the Internet has made it all possible for practically anyone and everyone to get health insurance quotes in minutes. When choosing a healthcare plan, it’s best to keep these things in mind:

- Your Actual Real-life Needs (Are you single or trying to raise a family? Do you need to go to a doctor often?)

- What You Want (Will any doctor do for you? Do you prefer to keep your doctor?)

- Your Budget (How much can you set aside to pay for monthly premiums?)

The state of Alabama health insurance is most likely true elsewhere in the United States. So if youre reading this article from New Jersey, you can very well take those truths stated above like they were some pieces of good advice.

Week of March 15, 2010

The White House last week continued to rail against rising health insurance premiums to help build popular support for his health care reform package. But the effort to focus the blame for rising costs on insurers was questioned, in particular, by state insurance experts and economists quoted in a New York Times story last week. Insurance commissioners said that trying to hold down premiums before costs were under control would be very risky. This approach could mean solvency issues in some cases, they told the Times. To help educate Americans about the true drivers of rising health care costs, America’s Health Insurance Plans, the industry trade association, last week launched a new national ad campaign. The ad demonstrates that health insurance company costs represent a small slice of the overall health care cost pie.

Federal

With a cadre of staff operatives searching for the right health insurance reform provisions among those previously discarded from the House, Senate and the President’s proposals, Democratic leadership has been relentlessly pursuing every possible pathway to pass a final bill. The expected process would have: 1) the House pass the Senate-adopted reform bill (which most House members hate), 2) the House passing a bill to “fix” all the things it hates using a reconciliation legislative vehicle, followed by 3) the Senate passing the very same reconciliation bill — requiring only 51 votes in the Senate. The House Budget and Rules Committees are expected to start the review, hearing and mark-up process of the reconciliation bill this week. The Senate commitment to using reconciliation was made official in a scathing letter from Leader Harry Reid to the Minority Leader. Along the way the two Chambers will need to see the latest CBO “scores” on the bill before voting, and 216 House Democrats will have to resolve policy disagreements over abortion, federal health insurance rate review and authority, and other substantive issues. Additionally, the House will have to trust that the Senate can pass the reconciliation measure without changing one comma. Partisanship has blossomed into open hostility over health reform. Whether Congress can overcome these policy, process and political mine fields remains as murky as ever, but Democrats have chosen to try and will push for resolution by the Easter recess.

The Senate has passed Jobs Bill II and shipped it off to the House, where passage is not certain. Within the bill are two health-related items of note. First, the COBRA eligibility and subsidy program will be extended to the end of 2010. (These provisions are set to expire at the end of March. ) Second, the bill contains a suspension until September 30, 2010 of the cut to physician Medicare reimbursements for the current calendar year. (This provision is also set to expire at the end of March. ) Aetna urged Congress to apply the “doc fix” to next year’s reimbursement as well, since insurers’ Medicare rates are based on what doctors are paid, but in the end Congress failed to make this change. Aetna and the industry will continue to find ways both to establish a more lasting, if not permanent, doc fix and to devise a legislative solution to the disconnect between doctor reimbursement and Medicare Advantage rates for 2011 and beyond.

States

ARIZONA: Budget issues remain front and center as the governor and Republican leadership proposed a plan they hope will close the $700 million deficit this year and reduce the anticipated $2. 6 billion deficit in 2011. Righting the state’s fiscal ship has become a very partisan exercise, with the Republicans supporting reductions in Medicaid and KidsCare, and the elimination of full-day kindergarten. As the special session on the budget is running concurrently with the regular session, no other bill hearings were held. The oral chemotherapy parity bill may be dead for this year as proponents did not meet the deadline for submitting amendatory language.

CALIFORNIA: The Assembly Accountability and Administrative Review Committee chaired by Assemblyman Hector De La Torre held a hearing last week to examine how the Department of Managed Health Care (DMHC) and the Department of Insurance (CDI) has handled issues surrounding the rescission of policies in the individual market. According to a report prepared for the committee by Bryan Liang, director of the Institute of Health Law Studies at the California Western School of Law, fewer than 300 of 6,000 former policyholders are participating in health insurers’ agreements to settle such cases. Republican committee members were highly critical of this witness, while De La Torre was critical of the Departments. The DMHC reported that since their settlements were completed there have only been nine rescissions over the past two years, proof that the DMHC and the health plans have revamped their processes for rescission and have worked to address the problem.

COLORADO: A bill mandating maternity and contraceptive coverage in individual policies continues to receive significant attention in the Senate. The most recent amendment proposes requiring maternity coverage in at least three of the plans marketed by an insurer. It would also allow a current member of a plan without maternity coverage to switch to a plan with maternity coverage from the same carrier during the first trimester. The other major bill would require that second level appeals be performed by physicians who are actively involved in clinical practice. This measure is counterintuitive in the current economy, since it would result in outsourcing appeals and drive up costs for plan sponsors and their employees.

CONNECTICUT: A proposal that would require health insurance plans to cover oral chemotherapy in the same way that intravenous chemotherapy is covered made it through the legislature’s Insurance and Real Estate Committee last week. Currently, many health plans treat the two kinds of cancer treatments differently. Chemotherapy treatments that come in pill form are often categorized as prescription drug benefits that can require patients to pay a larger share of the cost. Cancer patients, doctors and patient advocates spoke in favor of the bill, while insurers and the Connecticut Business and Industry Association opposed it, arguing that it would put a mandate on health plans that could raise costs and make it more difficult for employers to afford insurance.

GEORGIA: A bill restricting the use of rescissions in individual health insurance policies passed a Senate committee last week. Aetna continues to work with its trade organizations to educate legislators about the adverse effect of this type of legislation. Discussions also continue regarding legislation affecting the use of rental networks.

KANSAS: Roughly half way through the legislative session, several health care bills are still moving through the process. On the regulatory front, the Insurance Department has proposed a regulation that would mandate coverage of routine patient care costs while the insured is enrolled in a cancer clinical trial – a mandate that was rejected by the legislature in 2008. A hearing will be held on April 20, and Aetna will have an opportunity to present testimony on this issue. Bills still alive include mandates for autism and orally administered chemotherapy, legislation prohibiting dental contracts that require the dentist to follow a fee schedule for non-covered services, and a ban on “most favored nation” clauses by some insurers. Another bill would allow small employers to create individual HRAs to fund premium payments on individual policies, require administering insurers to offer employees the option of receiving health insurance coverage through a high-deductible health plan with an HSA, and requiring insurers who offer small group health plans to offer high-deductible health plans with HSAs, while authorizing tax deductions for health insurance premiums for individual insurance policies. Separate legislation would amend the definition of “eligible employee” to include part-time workers (currently less than 30 hours per week). Pending legislation concerning hospital charges would prohibit charging private-pay patients more than 25 percent of what the hospital’s highest volume private payer would pay for the same goods or services. Legislation that died includes a telemedicine mandate and creation of a health care insurance database for employers.

KENTUCKY: Health issues that are being hotly debated by the legislature right now include an autism mandate, a dental bill that would not allow insurers to hold dentists, optometrists or ophthalmologists to a fee schedule for non-covered services, and a bill setting a reimbursement floor for chiropractic services. The chiropractic services proposal would allow chiropractors to bill, and would require insurers to reimburse, an evaluation and management (E&M) CPT code on each and every visit. In addition to billing for follow-up services for manipulations and other therapies, the chiropractor would be allowed to submit, and the insurer required to pay, for another E&M code on each and every visit. The legislation would also add a new mandated benefit to the Kentucky statutes. Currently, reimbursement for chiropractor visits is required only if the chiropractor performs a service already covered by the health benefit plan. Under the proposal, any service within the scope of practice of a chiropractor that is billed would become a mandated benefit. Finally, the bill would require health benefit plans to provide reimbursement without the chiropractor having to provide any documentation that the services were medically necessary. Each of these bills has, or is expected to, pass at least one chamber.

SOUTH DAKOTA: Several important legislative deadlines are approaching, resulting in a flurry of activity. Bills or resolutions not passed by the second chamber by March 9 died. But the Governor has already signed a bill that amends the premium rate-setting procedure for the high-risk pool so that rates for a given classification are 150 percent of the average actively marketed premium. The pool will have to offer three or more plan designs, remove coverage requirements for the plans (such as disease management) and remove set cost-sharing values. The bill was signed by the Governor on March 1 and will become effective on July 1, 2010. The Governor has also signed a bill prohibiting rating based on injuries caused by domestic violence and legislation requiring refunds of premiums for partial months, in the case of mid-month cancellations. Both chambers have passed legislation prohibiting contract language requiring dentists to accept a fee schedule for non-covered services, and the bill awaits the Governor’s signature. Finally, the legislature passed a resolution opposing the federal health care reform proposals passed in the U. S. Senate and House.

Republican governors are not alone in being concerned about what the proposed health care legislation might mean for their already overstrained budgets: Democrats share the same worries.          “We’ve got concerns,” Gov. Jack Markell of Delaware said in an interview Wednesday, hours before getting elected as the chairman of the Democratic Governors Association. “And we’re doing our best to communicate them. We understand the need to get something done, and we’re supportive of getting something done. But we want to make sure it’s done in a way that state budgets are not negatively impacted. ”

From the start, Republican governors have been more outspokenly critical about the health care legislation – in particular, the bill proposed by Harry Reid of Nevada, the Senate majority leader – which they said would saddle them with millions of dollars in additional Medicaid costs as insurance coverage is expanded. At their own meeting two weeks ago in Texas, Republican governors declared Democrats felt the same way as they did, but were less apt to say it out of loyalty to President Obama.

Asked about that, Mr. Markell responded: “Perhaps we’ve expressed some of our concerns less publicly. But I believe all governors are certainly concerned about what the potential impact is of some of these bills. ”

Mr. Markell said that there was no division between governors and the administration on the need to get some sort of health care bill through; he said that he was reminded of the need in conversations with small businesses struggling with health care costs and constituents who have been unable to get health care coverage. He said his concern was some of the bills being considered would do that by shifting some of the costs to the state – but said he remained confident, after conversations with the White House, that would not be the case.

Whatever the outcome of the health care deliberations, Mr. Markell said he did not believe it would affect the electoral outcome for governors in 2010, a year in which 19 gubernatorial seats currently held by Democrats are on the ballot. The key issues, the governor said, were jobs and the economy.

And to that regard, Mr. Markell said that he was hopeful that the White House and Congress would dispose of the health care deliberations and move on to discussing some sort of jobs creation legislation.

“Right now I believe we need to be focused really significantly on the state level on jobs and on the economic climate overall,” he said. Asked if Mr. Markell thought Mr. Obama and Congress were spending too much time on health care at the expense of the economy, he responded: “Well I feel it would be terrific if they could finish health care and move on. ”

Most people don’t give serious consideration to health insurance until they realize how much medical care actually does cost. Many young individuals, in particular, feel they can slide by without health insurance because presently they feel great. The problem with this line of thinking is that an illness can strike with little warning, and even though the likelihood of developing a serious disease increases as a person ages, there is still a chance that you can become ill while young. For this reason it’s important to start looking for affordable health insurance while you are still in your twenties or thirties.

In Indiana, if you are single and make under $1,149 a month, you will qualify for state assistance with your health care premiums. If you make more than that you’ll need to find affordable health insurance on your own. The best place to start this search is with your employer. Ask about any group plans that you may be eligible for now or in the future. Quite often these types of plans offer very extensive benefits at a cost that is fractional to what you’d pay in a private plan. Even if you feel that you don’t need all the coverage, with the low cost it comes at, you can certainly afford to have it.

When you are shopping for health insurance from a private company it may seem a bit overwhelming. There are many choices in health care plans and it’s important to pick one that offers the benefits you feel you need now. You can always adjust your coverage in the future if your health care needs change. This typically occurs after you marry or have children. Until then, pick a plan that offers the basics. This will ensure you have coverage when you need it at a price you can afford.

As the owner of an independent health insurance agency and the founder of a website for comparing health insurance providers I often get asked, “What type of health insurance do YOU have?” Of course, no one health insurance company or health insurance plan is right for everyone because everyone has different needs, lives in a different area, etc… but I can certainly feel comfortable telling people that I personally have a Health Savings Account (HSA) and I absolutely love it!
Here are 7 reasons why I love my HSA:
#1 All Contributions to my HSA are Tax Deductible

Every single dollar that I contribute into my HSA http://www. easytoinsureme. com/united-health-one. html every year is deductible on the front of my personal 1040 tax return (up to certain annual limits imposed by the IRS – for 2010 the maximum deductible HSA contribution is $3,050 for singles and $6,150 for families with those age 55 or over getting an extra $1,000 allotted maximum contribution amount).   This HSA contribution deduction is great because it is an “above the line” deduction meaning that it is deducted before arriving at your Adjusted Gross Income (AGI) number.   To make this deduction even better there are absolutely no income phaseouts for the HSA contribution deduction so you could be Bill Gates or Warren Buffet and still take the full HSA contribution deduction.   The more money you make the more attractive this deduction is to you.
#2 The Money in my HSA Grows Tax Free

All of the money in my Health Savings Account grows tax free as long as I use the money in the account for qualified medical expenses or wait until I am age 65 or older and use it for my retirement.   Yes, you heard me right “Tax Free” not just “Tax Deferred” as you may be accustomed to hearing about with a 401K or other similar tax deferred account.
#3 I Can Choose any Health Insurance Company I Want

Another reason I love my HSA is that the HSA itself is simply a savings account with some special paperwork so that it receives special treatment from the IRS.   The HSA itself is NOT health insurance but is simply the second component of what is commonly thought of as a HSA health insurance plan with the first component being a high deductible health insurance plan (according to the IRS a high deductible health insurance plan is any health plan with a deductible of at least $1,200 for singles and $2,400 for families – so still pretty low minimums).   What this means is that many different banks offer Health Savings Accounts and you can choose the bank that you prefer to set up your HSA and then buy your high deductible health insurance plan from any insurance company that you like.   You can even purchase a plan from United Healthcare one year and then shop around in year two and switch to a potentially cheaper plan with Humana and then in year three switch to Blue Cross Blue Shield, etc.   This ability to constantly comparison shop and not be tied to one particular insurance provider is a great benefit to an HSA (as your actual savings account component of the plan still stays with your original bank).
#4 I Pay Very Low Monthly Premiums

The higher the deductible is on your health insurance plan then the lower your monthly premium payments will be.   Since a high deductible health insurance plan is a requirement for opening a Health Savings Account then one of the nice things about the plans is that the monthly premiums are comparatively very low!  I would much rather save a large sum of money every month by paying less in premiums each month than paying extra for a very low deductible and co-pays.
#5 I Am Firmly In Control of My Health Care Dollars

The beautiful thing about an Health Savings Account as compared to a Flexible Spending Account is that while Flex Spending Accounts require you to use up the money in the account every year all of the money that you contribute to an HSA rolls over from year to year.   In fact, as mentioned above, even if you don’t end up using the money in your HSA for medical expenses (a good thing!) then when you reach age 65 you can withdraw the money tax free for your retirement.   Most HSA custodians will give you an option to place your HSA money into a savings account, investment account, etc. as the decision is up to you as to where you place your HSA account money.
#6 I Can Rest Easy

Admittedly some people simply sleep better at night knowing that they have a very low deductible and low co-pays for things like doctor’s visits and prescriptions and I understand that but I like to think of it like this -  After your first year of contributing the maximum to your HSA then unless you use up all of the money with a large unforeseen medical bill then you will have enough money in your HSA for years two and on that even if you have to meet your deductible then as long as your HSA health insurance plan covers all expenses 100% once the deductible is met then you effectively have zero out of pocket costs because you already have the money in your HSA account!  Sure, if you start an HSA tomorrow and you have only contributed a couple hundred dollars into the account so far and you get hit with a big medical bill then you will have to come out of pocket for your deductible amount but once you have maxed out your HSA contribution for a year or two then you are essentially home free with potentially no additional out of pocket costs even for large medical bills!
#7 HSA Setup is Very Easy

If you can open a savings account then you can open a Health Savings Account just as easily.   If you can apply for a regular health insurance plan then you can apply for a high deductible health insurance plan just as easily.   Almost every bank has HSA’s available and almost every health insurance company has high deductible health insurance plans available.   Setting up an HSA is so easy that I probably took twice as long to write this article as it would take you to apply for both a Health Savings Account at your bank and a high deductible health insurance plan at your health insurance company.

Public health advocates are warning about the consequences of a plan to eliminate funding for Arizona’s KidsCare, the state health program covering 47,000 children of the working poor. Gov. Jan Brewer proposed the move to deal with Arizona’s $5-billion budget deficit. Critics argue uninsured low-income families would then have only two options: take their children to overwhelmed community clinics or to hospital emergency rooms.

Among the other programs facing cuts is Arizona Health Care Cost Containment System (AHCCCS) Administration, Arizona’s Medicaid agency. Tara Plese, director of government and media relations for the Arizona Association of Community Health Care Centers, says that means several clinics around the state may have to close for lack of revenue.

“It wouldn’t be in all communities, and it may just be that some of the services that some of these clinics now provide like dentistry or pharmacy, would be the first cut. “

If parents have no other health care option for their children except emergency rooms, Plese says everyone who does have insurance will pick up the tab as costs are passed on through higher prices.

Like community health centers, emergency rooms are required by federal law to treat everyone regardless of ability to pay. But, she says the costs must still be covered somehow.

“With the hospitals, when you get all the uncompensated care coming through your ER, then you are going to have to find some way to make up for that cost, and it’s going to go back on the commercial insurers. “

The public’s health will also suffer if thousands of kids, especially six-to-nine year-olds, are left without coverage, she adds.

“That’s an age where they’re getting another set of immunizations, they’re more prone to being sick because they’re in school, they’re getting sick, other children are getting sick, and it’s a time when they probably visit doctors with more frequency. “

Arizona’s KidsCare program began in 1998, at a time when many employers were either dropping employee health coverage or sharply boosting premiums. State dollars for Kidscare are matched three-to-one by the federal government.

Federal

Owing to multiple blizzards in Washington, Congress started its President’s Day recess a full week early and conducted no official business last week. However, there was some legislative drama as Senate Majority Leader Harry Reid pulled the rug out from under Finance Committee Chairman Max Baucus by scrapping the Baucus jobs bill (without warning), which contained many health insurance items, and replacing it with a stripped down, narrow jobs bill. Whether the health items Baucus originally inserted with Republican help will make it back to the table remains fuzzy. Among the health items that have been dropped are: the COBRA eligibility extension (to May 31); the “doc fix” (to October, 2010) of Medicare reimbursement rates; and the favorable statutory direction to CMS to calculate the 2011 Medicare Advantage rates “as if” the doc fix were in place.

States

California health insurance The Office of Patient Advocacy released a report card on the state’s HMOs last week. Aetna received 3 out of 4 stars. The goal of the report card is to allow consumers to compare how well health plans use personal medical records and help address conditions such as asthma, arthritis and diabetes.

COLORADO: Governor Bill Ritter held a press conference to announce what he calls “the next round of reforms that represent common sense. ” His legislative package includes bills to preclude insurance companies from charging different rates due to a person’s gender, ensure that women have access to breast cancer screening, assure plain language is used in insurance forms, standardize insurance applications and explanations of benefits, and encourage greater use of online tools to enroll people in public programs. Apart from the Governor’s proposals, a bill that would establish a public option was also introduced.

CONNECTICUT: In a short legislative session of only three months, the Insurance & Real Estate Committee wasted no time in putting forth an agenda that includes many concept drafts for repeat legislation from previous sessions. These include prohibiting health insurance copayments for preventive care, limiting prescription drug copayments, prohibiting Social Security disability payment offsets, and exempting the Municipal Employees Health Insurance Plans from the premium tax on small group premiums. In addition, the committee reintroduced legislation that includes nearly a dozen new health benefit mandates. The Council for Affordable Health Insurance, an independent think-tank, says that health insurance mandates could increase premiums in Connecticut by more than 50 percent overall.

GEORGIA: A bill was proposed last week that would impose significant restrictions on insurers’ ability to rescind health insurance policies. Aetna, through the Georgia Association of Health Plans and AHIP, met with the legislator sponsoring the bill to express concerns with the bill.

INDIANA: The legislative session is at halftime, and the insurance agenda is now limited. Most insurance issue bills are officially dead, including a bill that would have prohibited health plan provisions requiring a contracted provider to accept more than a certain number of patients; coverage for dialysis treatment regardless of whether the facility is contracted or not and without certain benefit restrictions; and a bill that would have allowed out-of-network assignment of benefits. However, Aetna is expecting that a bill requiring insurer and HMO annual reporting of premium cost composition, including administrative costs, may be resurrected. A bill that restricts dental insurers and HMOs from establishing fee schedules for non-covered services passed the Senate, with our amendment to accommodate most of the key concerns expressed by opponents of the bill. As the bill stands, dental insurance plans may impose fee schedules for covered services, regardless of whether the plan actually pays for the services rendered.

KANSAS: An amended version of S. B. 389 related to dental services passed the Senate Financial Institutions and Insurance Committee on February 11. The amended bill prohibits any contract between a health insurer that offers a health benefit plan and a dentist from containing a provision that requires the dentist to accept a fee schedule for services unless the service is a covered service. Committee amendments added to the definition of a “health benefit plan” the following: any subscription agreement issued by a non-profit dental service corporation; any policy of health insurance purchased by an individual; the state children’s health insurance plan; and the state medical assistance program under Medicaid. We will continue to update you as this bill progresses and hope to make favorable changes as the bill moves through the House.

MASSACHUSETTS: Governor Deval Patrick filed a 40-page bill that proposes giving the insurance commissioner the power to hold public hearings on rate adjustments and essentially cap health care price increases. Rate increases for individuals would be held to the rate of medical inflation; those sold to employers with 50 or fewer workers could not exceed one and a half times the level of medical inflation. The legislation would also impose a two-year moratorium on any new health benefit mandates. Legislative leaders praised the intent of the governor’s plan but declined to promise support. Strong opposition is expected from medical provider groups. The Governor simultaneously announced emergency regulations to take immediate effect that will require health insurers to submit proposed small business rate increases for review by the state 30 days before they take effect. Several other proposed provisions include a requirement that insurers offer at least one coverage plan with a limited network of health care providers costing at least 10 percent less than health plans with access to more physicians. The Massachusetts Association of Health plans is lobbying in support of a bill introduced by Senate Insurance Chair Richard Moore that would create a cheaper health insurance product for small employers by capping payments to providers at just 10 percent above Medicare rates. The Massachusetts Medical Society is against that proposal.

MISSOURI: An autism coverage mandate bill was amended and “perfected” by the Senate and then sent to the Government Accountability and Fiscal Oversight Committee from which it must emerge before returning to the floor of the Senate. In addition to two mandate-related amendments, a third amendment to the bill allowing for limited cross border sales of health insurance also passed. In its current form, the bill contains a mandated offering of the coverage in the individual market. Coverage is limited to treatment ordered by a licensed physician or psychologist whose treatment plan the carrier is entitled to review every six months. Coverage for applied behavior analysis (ABA) is limited to $52,000 annually (down from the $72,000 as introduced) for persons under age 21. Meanwhile in the House, a bill containing significant language relating to the credentialing of autism service providers also passed. The bill also contains a mandate to offer coverage in the individual market and to groups of fewer than 25. Groups of 25 to 50 would be entitled to an exemption from the mandate if they could demonstrate an increase in premiums tied to the mandate. The bill limits annual coverage of ABA ($36,000 for children ages 3-9; $20,000 for children ages 9-21). Aetna will continue to monitor the status of these mandates, but it appears fairly clear at this point that something will pass on the issue of autism.

NEW JERSEY: Last week Governor Chris Christie declared a fiscal state of emergency calling a special session of the legislature to lay out his plan for dealing with state’s current $2. 2 billion budget shortfall. His plan calls for significant cuts or eliminations across 375 state programs and withholding $500 million of state education aid. Of note on the program side is a $12. 6 million reduction in Charity Care funding to hospitals, which pays for care to uninsured residents. In legislative action, the Assembly Financial Institutions and Insurance Committee held a three-hour public hearing on out-of-network reimbursement. Much of the hearing focused on the markedly higher billing practices of ambulatory surgery centers and one non-par hospital. Aetna presented testimony regarding its experience with the non-par hospital, citing their disparate year-over-year increase in charges compared to other similarly situated hospitals. Chairman Schaer indicated the committee will work over the next several months to craft a solution.

NEW YORK: With Democratic Senator Hiram Monserrate officially expelled from the Senate, the Democratic majority (31-30) now faces an uphill battle getting the 32 votes needed to pass legislation. However, both the Senate and the Assembly moved forward with a public hearing on the Executive Budget proposal for health, including the section mandating the prior approval of rate adjustments. The Health Plan Association testified on behalf of the industry. If enacted, Governor Paterson’s proposal for an 85 percent medical loss ratio and a prior approval hearing process for all rate adjustments would essentially amount to government control of health insurance, undermining the private health insurance market in New York. Price controls would weaken health plan solvency, hurt providers and virtually eliminate innovation and efficiency. At the same time, the proposal ignores the underlying cause of the increasing cost of health insurance — the increase in the actual costs of health care services.

OKLAHOMA: The second session of the 52nd Oklahoma Legislature convened in Oklahoma City on February 1. Legislators quickly turned to the state’s $1. 3 billion budget deficit described by Governor Brad Henry (D) in his eighth and final state of the state address and FY 2011 executive budget. During his address, the Governor focused on his plans for resolving the $1. 3 billion budget deficit through precise budget cuts. His only reference to health insurance was to encourage the expansion of Insure Oklahoma, a program developed by the state in partnership with small employers to provide affordable health coverage. The legislature is scheduled to adjourn on May 28 but only after addressing a range of legislation including several bills of interest to Aetna.

SOUTH DAKOTA: A dental fee schedule bill (S. B. 108) unanimously passed the Senate Commerce Committee and is expected to be taken up by the full Senate early this week. The bill prohibits any contract between a health insurer that offers a health benefit plan and a dentist from containing a provision that requires the dentist to accept a fee schedule for services unless the service is a covered service. Aetna will continue to follow the bill’s progress as it progresses.

TENNESSEE: Several bills have been proposed that would make changes to the state’s external review law. Aetna and other industry representatives will be meeting with the Tennessee Department of Commerce and Insurance regarding its proposed changes to the external review law. The bill proposed by the TDCI most closely mirrors the model legislation proposed by the National Association of Insurance Commissioners.

UTAH: The Speaker of the House has introduced a health reform bill addressing health information technology, individual and small group market reforms and transparency. The overarching theme of the reforms is micromanagement of rates and rating factors, and a broadening of the Insurance Commissioner’s authority. The transparency provisions apply plan designs and benefit descriptions submitted by carriers, and would require providers to make available, upon request, a price list for services on both an inpatient and outpatient basis.