In 1971, President Nixon proposed a national health insurance plan built on heavily employer private coverage. Senator Ted Kennedy proposed what would today be called a single-payer plan. In 1974, the debate had morphed into Nixon vs. Kennedy-Mills vs. Organized labor. Despite the prediction in the second clip shown, the result was stalemate rather than passage in 1974 or 1975.

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“Should it really be the role of government to require people to purchase a health insurance product they don’t want, raise taxes to give that same product to others who can’t afford it, and commandeer our state government and its resources to carry it out?” Cannon, a Winter Park Republican, told House members after being sworn in two weeks ago.

“Or, should we work to limit government and empower the private sector?”

On numerous fronts, Florida policymakers have already answered that question.

While the fight against President Obama’s health-care reform may be centered in the Beltway, Republican resistance to the sweeping new mandates is also taking shape in Tallahassee. Among the battlefronts:

• Florida led the charge with 19 other states last March by challenging the law in federal court, claiming the mandates that uninsured people buy coverage violated states’ rights. A judge in Pensacola is expected to rule shortly after a Dec. 16 hearing on whether the suit can move forward. More states are expected to join after a new crop of state attorneys general are sworn into office in January.

•Last spring, GOP legislators hastily drafted a constitutional amendment spelling out that Florida businesses and residents couldn’t be forced to buy insurance, but a Tallahassee judge threw it off the November ballot for “misleading” language. Lawmakers have re-filed an altered version and hope to place it before voters in 2012.

•And perhaps most significantly, legislative leaders are poised to block spending and rules necessary to implement the law. Already, state regulators has refused to impose minimum spending mandates that might generate refunds for consumers – but which health insurers say will hurt their profits. And Gov.-elect Rick Scott has also made clear he doesn’t want the state doing anything to help the law along.

The Patient Protection and Affordable Care Act passed last spring anticipated that the states would lead the way on many of its more than 100 changes to the nation’s health care system. With 3.8 million uninsured residents, Florida is one of the states that would be most affected by the law.

The most controversial reforms – including the requirement that individuals buy coverage or pay a penalty — don’t start until 2014, and phase-ins continue until 2018. But the bill requires states to start working now to improve their data-collecting and enforcement mechanisms.

It was hoped states would create their own insurance exchanges, to match individuals with insurance plans; establish “high-risk” pools to insure people now shunned by providers; and police new restrictions on insurance company profits.

But Gov. Charlie Crist opted last spring not to immediately tap into federal grant money to create a Florida high-risk pool to cover people with pre-existing medical conditions, deferring to the federal government. And now Cannon, R-Winter Park, and Senate President Mike Haridopolos, R-Merritt Island, may seek to block any cooperation by the state.

Florida has been awarded million in grants to provide 0 rebates to seniors who fall into the “donut hole” in the Medicare prescription drug program; to help prepare the Office of Insurance Regulation to evaluate out-of-state insurers seeking to sell health coverage in the state; and to plan for creating a health-care marketplace, or “exchange,” and other changes.

But even before he was officially named speaker, Cannon warned Crist that no state agency should take any steps to comply with the law “without clear and comprehensive guidance from the Legislature.” The Oct. 19 letter demanded an itemized accounting of all state agency activities regarding the federal law.

Specifically, the letter singled out the Office of Insurance Regulation for work it has begun – and which legislative budget-writers approved – to study how Florida’s health-care laws should be amended to conform to the federal reform, and to boost the state’s ability to handle new rate-filing data.

“Not only are Florida insurance officials helping the federal government to write rules on these matters, but [OIR] is jumpstarting these new regulatory functions by developing data systems necessary for enforcement,” Cannon complained.

He added: “We intend to develop a clear and statutorily-defined framework for Florida agencies’ activities in regard to the federal health law. Pending such legislative action, state agencies should examine each anticipated action or function in light of their specific statutory authority.”

Laura Goodhue, executive director of Jupiter-based health-care advocacy group Florida CHAIN, said the criticism appeared designed to bully agencies into slowing their efforts to follow the federal law.

“I know transparency is important in implementing laws, but creating a chilling effect is certainly not helpful,” said Goodhue, who attended meetings with OIR over the last year as part of an advisory health insurance board.

In response, most all of Florida’s state agencies produced itemized lists of what they had done — down to how many staff hours Department of Management Services staff spent examining new rules requiring lactation rooms and milk storage for breast-feeding mothers in the workplace.

Cannon spokeswoman Katherine Betta said last week that Cannon’s staff was still reviewing the responses and hadn’t decided “what the next step will be.”

OIR communications director Jack McDermott defended his agency’s work, adding there was no intent to be “an advocate for the implementation of federal healthcare.”

“Virtually all of this information — whether it is actual review of large group rates, or expanding data systems to collect additional data – would require additional statutory authority or administrative rules,” McDermott e-mailed in response to questions.

And recently, OIR decided to slow one of the new law’s reforms – by not imposing new profit limits on health insurers beginning Jan. 1.

A new federal “medical loss ratio” requirement would force insurers to spend 80-to-85 percent of the premiums they collect on medical care, with the remainder set aside for overhead including executive salaries and profit. Nearly half the country’s insured population are covered by providers that spend more than that on overhead and profit.

Florida’s “medical loss ratio” is 65-to-70 percent, and OIR will ask the federal government for a three-year waiver from the tougher standard, said McDermott.

At a recent hearing, most of Florida’s main health insurers complained that the new standard would hurt their bottom lines and restrict the Florida insurance market. Insurance Commissioner Kevin McCarty agreed, saying he feared making the change next year would “destabilize” the market and hurt competition.

The move could have a pocketbook implication for Floridians.

The law requires insurers to provide rebates to customers if they exceed the overhead limits in 2011. The feds estimate the rebates could average 4 for individuals in 2012. But if OIR wins the three-year delay, Florida consumers won’t be eligible for those checks in 2012.

“To me, the delay obviously would be helpful to the insurance companies and HMOs, and not to the patients,” said Senate Minority Leader Nan Rich, D- Weston. “That’s less money for care for patients.”

Legislative conservatives like Rep. Scott Plakon, R-Longwood – who’s re-filed the constitutional amendment that says Floridians could not be compelled “directly or indirectly… to participate in any health-care system” – say they are determined to fight every way they can.

Plakon’s House Joint Resolution 1 has already picked up a prime sponsor in the Senate: its new leader, Haridopolos.

“We have to follow the law. But in the process, we need to put Floridians first,” Plakon said. “So if there is any room there, we would default to the position of putting Floridians first instead of this kind of massive federal takeover.”

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Health insurance quotes

With the emergence of the internet, it is much simpler to find what you’re looking for in health insurance coverage. Just use one of the major search engines and plug in where you live along with the words “health insurance quotes”. With some health insurance plans in Texas, they are connected with certain hospitals, depending on where you live. It’s a excellent thought to have health insurance where you can go to a medical facility that is close to your home.

There will probably be many entries for you to choose from. Look through the ones that you reckon best fit you and go over what they have. Look for those that are affordably priced and have the options that you want. There are some of them that don’t cover certain options, such as testing and related items. You need to know what options are available with the plot you’ve selected. You want your health insurance in Texas to cover the things you need.

You can always consult with the health insurance provider to make sure that you have the right options for your health insurance. Then you may not need extras with your health insurance. It all depends on what you need. Some people with health insurance in Texas need more; on the other hand some people need less. It all depends on the needs of the policyholder and their family. The need to have health insurance in Texas is very crucial; without it you and your family could suffer a fantastic disservice.

If you are looking for dental insurance, that will probably be separate from regular health insurance. In addition to that, vision insurance may be on a separate platform. Question the health insurance provider for quotes before you make your final choice on health insurance in Texas. Also, question the health insurance provider about making arrangements for flexible payment plans. It’s vital for you to know your payment schedule before you start giving them money.

Just like with health insurance anywhere else, you have to make sure that you can afford the payments. You don’t want to skip on a payment and then be cancelled. You should customize your health insurance so that you won’t have distress paying on it each month. Having health insurance in Texas is crucial in order for you to stay healthy.

Even though you may be bogged down with looking for health insurance in Texas, it has still become simpler to get, especially with the internet. the internet has made it possible to research further and get the best deal for you and your family.

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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 ,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 8 million investment is expected to bring about .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 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 billion in state spending on public education and another billion in higher education, plus more than 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 0 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.

Financial Markets (ECON 252) Insurance provides significant risk management to a broad public, and is an essential tool for promoting human welfare. By pooling large numbers of independent or low-correlated risks, insurance providers can minimize overall risk. The risk management is tailored to individual circumstances and reflects centuries of insurance industry experience with real risks and with moral hazard and selection bias issues. Probability theory and statistical tools help to explain how insurance companies use risk pooling to minimize overall risk. Innovation and government regulation have played important roles in the formation and oversight of insurance institutions. Complete course materials are available at the Open Yale Courses website: open.yale.edu This course was recorded in Spring 2008.

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The premium for one insurance plan could rise almost 36 percent.

The insurers cite rising costs of medical care and federal health care reforms.

The question is whether the state will let them.

Under a new state law, health insurers must submit their premiums to the state Insurance Department for approval before they take effect.

The state can reject or modify the increases if regulators feel they are not appropriate or justified.

The law also means insurers must disclose their rate plans much earlier than in past years.

Reaction from consumers and small businesses has been swift.

“There’s no question that there’s frustration and anger,” said Howard N. Silverstein, president and CEO of Choice Employee Benefits Group LLC, an insurance agency. “Everybody I’ve talked to cannot believe that some of the rate increases are as high as they are.”

Joe Milazzo, owner of Milazzo Renovations in Lancaster, already was paying ,200 a month for individual coverage from Independent Health Association when he got a notice of an increase of roughly 15 percent.

“It’s craziness,” he said. “It’s getting to the point where health insurance payments are more than the mortgage payment.”

So he went to the Amherst Chamber of Commerce’s insurance broker and got almost the exact same plan from BlueCross BlueShield of Western New York for ,351.72 — but every three months, because he is now in a group plan.

“We’re talking a lot of money in savings, for virtually the same plan. I still don’t believe it,” he said.

‘Entire industry changing’

In response, employers are expected to cut back on benefits and ratchet up the amount that employees and their families pay to share in the costs — through higher deductibles, co-pays and co-insurance.

“Our clients … have come to expect double digit increases the past few years,” said Colleen C. DiPirro, president and CEO of the Amherst Chamber, which helps small businesses get health insurance. “However, it doesn’t make it any easier for them to absorb the costs.”

“At the end of the day, I think the entire industry is changing and people are going to become more acclimated to paying more out of pocket and utilizing health insurance for major claims to keep them from financial ruin as a result of a health issue,” she said. “That is the only way we can insure the masses.”

The average requested increase across the board for BlueCross Blue-

Shield was 13 percent, according to information filed with the state Insurance Department, but the increases range from 3.9 percent on one HMO to 28 percent.

Increases would range from less than 10 percent for 30 percent of members to 10 percent to 15 percent for 45 percent, and more than 15 percent for more than 22 percent of those covered.

Independent Health’s rates would rise 10 percent overall, but the increases would range from 7.4 percent on an HMO to 35.8 percent for its small-group high-deductible health plan, where the deductible is not changing. For 1 percent of the company’s small group subscribers, increases would exceed 21 percent.

Univera Healthcare wants to raise rates by 5.4 percent for its Transitions, direct-pay HMO and point-of-sale plan, and 11 percent for all of its other products.

The insurers noted that the premiums and estimated ranges apply only to their base policies, before taking into account individual “riders” that modify coverage for group plans. Also, they are not final until approved.

Independent Health submitted a 1,200-page rate filing July 29, one of the first to do so, and responded to questions once with another 600 pages.

“It’s a ridiculous process,” said Dr. Michael Cropp, the insurer’s CEO.

Univera spokesman Peter Kates said the company submitted its information in August but has not heard back from the state.

Comments reveal rage

HealthNow, the parent of BlueCross BlueShield, filed rates Sept. 1 and has talked to state regulators. But “we don’t have any insights” about how the state will rule, said Stephen T. Swift, the insurer’s chief financial officer.

“They’re very, very stretched,” Swift said. “I’m optimistic the state will approve these rates as filed, but I can’t say we have any indication.”

Comments from the public to the state Insurance Department are being posted, with names blacked out, on the department’s Web site.

“This is preposterous!!!!” wrote a woman who co-owns a business with her husband. Independent Health had notified them of an 11.8 percent increase. “Who on earth can afford this? … The cost of health insurance now is an almost unmanageable burden. This new increase would put us out of business.”

“In these economic times to propose an average 14 percent increase in health care is absurd,” wrote another person who appears to be an insurance agent. “I am not looking forward to meeting my clients and trying to explain these incredible increases while their expenses rise and wages fall.”

“I am writing to express my disgust,” wrote another small business owner, who claimed to have received notice of a 37 percent rate increase.

A dental health care professional wrote: “I wish my income increased as much as my health insurance premiums have.”

As they do each year, the insurers defended their increases as necessary to account for the ever-increasing costs of providing care for their members. Companies routinely cite the high costs of and growing consumer demand for new diagnostic technology and hospital treatments, such as colonoscopies, heart surgeries, radiation and chemotherapies, and intensive services for patients during emergency room visits.

They also point to the high cost and use of sophisticated drugs, especially brand-name and specialty prescription drugs or injectable medications for some of the most serious medical conditions.

“Each year, medical inflation and a continuing increase in the use of medical goods and services combine to drive health care costs higher,” Univera wrote in its own letter. “To cover these increasing costs, we must modify premium rates.”

Consolidation among providers also has reduced competition to some degree, allowing prices to creep up. And the local insurers are quick to note that their administrative costs are much lower than the national average and especially for-profit health plans.

“Obviously our push is to drive those rates as low as possible,” HealthNow’s Swift said. “We know our customers’ concerns as far as affordability and access.”

But they also have treaded in waters that even the White House has deemed inappropriate, by blaming the federal health care reforms. Obama administration officials have warned the industry and its national trade group not to justify rate hikes by citing the reforms.

Notices called “deficient’

So far, requirements for full coverage of preventive care with no co-pays on screenings, the elimination of annual and lifetime limits and coverage for young adult dependents up to age 26 are the only reform provisions that have taken effect.

“Independent Health has evaluated the cost of our members’ health services and benefit changes, including those mandated in conjunction with health care reform,” the carrier wrote in a letter to small employer groups. “As such, we have determined that we must adjust our premiums for 2011.”

Late last month, after the due date for the filings, the Insurance Department issued a statement criticizing many of these notices to employers as “deficient, if not misleading, and in violation of the new prior approval law.” That law was designed to allow insured consumers an opportunity to understand any rate increase and to comment or ask questions about it.

“These type of misleading notices have the effect of confusing members and masking the underlying reasons that a rate adjustment is being requested,” the Insurance Department wrote in its letter to insurance companies, directing them to provide consumers and employers with details.

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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 5 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 5 million. A .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 9 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 .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 5 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 0 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 5 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.

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Back in March, Congress passed the Affordable Care Act, which in 2014 will require all Americans to have health insurance or pay a penalty. Although many people would now like to put discussion of employer health insurance behind them, the question of why only some founders of small businesses offer insurance remains an important one. Its answer will influence how much of a role government will play in providing employee health insurance for years to come.

One part of the new law is a set of tax credits and penalties designed to encourage employers to provide insurance.The problem is that for most young small businesses, it won’t work.That’s the conclusion I reached, based on research I conducted with Alicia Robb of the Ewing Marion Kauffman Foundation.We examined the decisions of founders of young companies on whether or not to offer health insurance, using information from the Kauffman Firm Survey, which tracks a cohort of nearly 5,000 new businesses started in 2004.

The data show that very few new businesses offer employee health insurance. Nearly two-thirds of companies with employees did not offer employee health insurance at any time during their first five years of operation. Moreover, only one in five offered insurance to their workers in all of the years.
insurance: no performance benefits

The few young small businesses that offered health insurance differed dramatically from those that didn’t: They tended to be larger and higher-paying, structured as partnerships and corporations, and they offered their employees a wide variety of benefits. Most young businesses don’t fit this profile. The majority are sole proprietorships with few, modestly paid employees. Only a handful of young companies grow dramatically. A minority shift from sole proprietorships to other legal structures. Few ever add a lot of benefits. This means that only a small portion of young small businesses are health-insurance-providing types. Most are not.

One argument that’s often made to justify giving employees health insurance is that doing so helps companies perform better. Those that offer employee health insurance, the argument goes, get better and harder-working employees. We examined whether the provision of employee health insurance provides any performance benefits to young companies. We found that it does not.

Controlling for a variety of other firm and founder characteristics, we saw no significant effect from providing employee health insurance on firm survival, growth in assets, growth in sales, growth in profits, or growth in employment during the first five years of operation. Stated differently, offering employee health insurance doesn’t appear to do anything to improve the performances of young companies, despite what some observers argue. We shouldn’t claim that the new law will benefit small business owners by making their companies more successful.
low-paying, sole proprietorships

The data offer three key takeaways for policymakers. First, only a minority of new businesses offer health insurance to employees, even by age five. Fewer still move from not offering insurance to providing it. When thinking about how to manage small business health insurance, policymakers need to keep in mind that offering insurance isn’t something that young companies naturally evolve to do as they mature. Consequently, most of the employees at new businesses that don’t offer health insurance will need to be covered by government programs and state exchanges.

Second, new companies that don’t offer insurance tend to be smaller, lower-paying, sole proprietorships with a large share of part-time workers. These offer employees limited benefits. Policy makers need to recognize that offering employee health insurance is something that fits certain kinds of new companies and not others. Small business owners who don’t offer employee health insurance aren’t being heartless. They are responding to the economics of the industries they are in and the business models they are pursuing.

Third, offering employee health insurance doesn’t improve the financial performance of new companies. Policymakers need to understand that despite the many reasons why they want the founders of all businesses to offer health insurance to employees, requiring that entrepreneurs provide such insurance won’t benefit many of the business owners.

Hundreds of thousands of new businesses with employees are founded in the U.S. every year. Few of these companies are large enough, pay enough, or are structured in a way that would lead them to offer employee health insurance. Moreover, few will turn into businesses that provide health care coverage to their workers. As a consequence, most of the several million workers hired by young businesses annually will be getting their insurance from government programs and state exchanges for years to come.

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Health insurance is often provided for people as an employment benefit. State and federal government also are responsible in giving out health insurance to individuals who are: over sixty-five years of age, those receiving public assistance and those with certain disabilities like blindness and end-stage renal disease. Usually, employers and government programs are the ones who provide most health insurance coverage to individuals. However, 5% of the American population acquires individual health insurance plans. Individual health insurance plans have many advantages.

1. If you are a policyholder then you don’t have to worry about where to get the money to pay for the hospitalization, doctor’s fees and other medical expenses because the health insurance company will cover all the expenses. The costs of medical care and treatment have been increasing lately that many people are now realizing the importance of having the right health insurance coverage to protect them in the years to come.

2. Those people who have individual health insurance plans have an easier access to proper treatment and care compared to those people who are uninsured. This is also the reason why many Americans who are not qualified for voluntary public insurance want to have individual health insurance plans for their own purpose. Aside from that, their dependents or other members of their family can also benefit from the health insurance. These are just some of the many advantages of having individual health insurance plans.

At present, there are about 47 million individuals in the United States who are uninsured. According to a recent National Survey, most of these people do not have health insurance because of the very high cost of health insurance coverage. But, if you do not have any health insurance coverage, it will cause some problems not only to you but to your families as well because you’re going to have to pay for the medical expenses out of your own pockets.

Uninsured individuals are mostly the ones who do not receive the proper medical care and treatment. Usually, uninsured individuals suffer a lot because their illnesses or diseases are taken for granted and they cannot afford to get the proper medical care and treatment that they deserve.

The secret in finding the right individual health insurance plans is to know how to find what you are looking for. We all know that finding individual health insurance plans isn’t an easy thing to do. There are a lot of health insurance companies nowadays that it’s very confusing what health insurance policies are right for you and for your budget. You should look at exactly what sort of coverage do you need.

Take time to sit down and list out carefully what medical services suit your needs in times of accidents or unexpected illness. And when you have decided what you need then you need to look for individual health insurance plans that you can afford. You can find a lot of health insurance companies online that offers affordable individual health insurance plans for you and your family so that you will have peace of mind knowing that you’re covered when you or any member of your family gets sick or involved in accidents.

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Acquiring Health Insurance Quotes through Phone Calls

Calling an insurance company for health insurance quotes may sometimes be full of hassle. First, it will really take time especially if you want to understand more about the details and you want to ask a number of questions. Secondly, when you call these insurance companies, it is a trend that your call will be put on hold. It would really be frustrating especially if you need the health insurance quotes already and you are made to deal with all these hassles when you make that phone call. But, there are positive points when you inquire for health insurance quotes over the phone.

The first good thing about getting health insurance quotes over the phone is that you get to talk to a human being who is well knowledgeable about the health insurance quotes. While the person is explaining to you the different details of the health insurance quotes, you have the choice of asking follow up questions.

When you talk to an insurance consultant through the phone, you can also inquire on other offers on that same policy you are interested on. Usually, insurance companies do adjustments on health insurance quotes to suit your needs better.

If you already like the health insurance quote presented to you by the insurance consultant, you can directly buy the policy. These transactions are usually made through credit cards.

Another option: Online Health Insurance Quotes

Given this modern day, there is another option you can explore if you want to get health insurance quotes –online. This is another simple and fast way of getting your health insurance quotes and purchasing your insurance policy.

Insurance companies now have their websites where you can check the policies they offer and ask for free online health insurance quotes. It is also an easy way for you to check on different insurance companies and to choose among the companies and the policies would suit your needs.

When you get the quotes online, it will save you more time because you receive the health insurance quotes faster and from multiple insurance companies as well. So this means you will be saving more time than you calling different insurance companies one after the other. This is also an easier way of comparing the health insurance quotes that you receive from the numerous insurance companies.

Purchasing policies online is also easy. After choosing which health insurance quote you want best, you can then acquire that health insurance policy fast and simple. You just need your credit card for this transaction –don’t worry, transactions are secured for this.

You can also choose to hire an independent agent to find you the best health insurance quotes. Some independent agents get discounts from some companies so you will get better health insurance quotes from them. Just make sure that even though you are presented with health insurance quotes that are light on your budget, they must cover your needs well too.  Independent agents can be really big help especially of you do not have time for the phone calls or you do not really know how to compare and contrast health insurance quotes.

A person looking for affordable health insurance quotes can also simply apply for various health insurance quotes. Getting your hand on such diverse quotes as well as comparing all of their estimates will definitely provide you with a very sensible idea about which plans in reality can provide you with affordable health insurance.

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As the reform bill was passed policy rates were climbing. A report revealed that members of the middle class were losing health insurance faster than any other income group. Those who missed the Government provided safety net because of their income were thrown on the mercies of the individual market. Here, insurers have been denied coverage based on preexisting conditions and are vulnerable to charges of high and ever increasing premiums.

The limits insurers placed on who gets coverage is one of the three major problems that needed to be addressed in the individual market. The other two are the affordability and whether the policy would pay for what is needed when the insured gets sick. A study found that excluded conditions varied by insurer. In a 2001 study by the Georgetown Health Policy Institute, researchers 37 percent of applications were rejected. There were insurers who would turn you down if you had hay fever. The public thus was a victim of a roulette insurance market. How easy is it for individuals to wade their way through the market to insurers who would cover them is a question. Although federal law requires insurers to sell policies to certain people who lose group coverage, including those who lost their jobs due to lay offs; but places no limits on what an insurer can charge. In February 2010, Connecticut announced that health premiums for individual medical plans rose in price by 20 percent over in 2009. In this void have stepped some states in varying degrees. Maine, Massachusetts, New Jersey, New York and Vermont required insurers to sell individual policies to everyone, irrespective of their health. Washington state required insurers to take individuals with some health problems. While, Iowa required insurers to cover preexisting conditions in new applicants, if they had insurance previously for those conditions and did not let the insurance lapse.

Of those who do buy their own insurance the health insurance market works well for some; but, not for others. In the individual market prior to the reform bill, in order to lower their risks insurers preferred the healthiest applicants. In most states, insurers may consider the health history of the applicant in deciding coverage and its cost. Unlike group plans offered by employers which provide coverage to everyone, there is no guarantee in most states individuals can obtain insurance. It has been realized that solving problems in the individual market would improve the health care crisis. In California, Connecticut and several other states regulators have taken actions against insurers who revoked individual coverage after policyholders fell ill. Before the President won the election Senators Ron Wyden, a Democrat from Oregon, and Bob Bennett, a Republican from Utah were supporting a bill that would shift workers getting coverage through employers to purchase their own insurance. The intention of their proposal was to break the link between employment and insurance. The two supporters of the bill believed this would let people keep their coverage even when they lost or switched their job. The proposal would have required everyone to have coverage and insurers to sell insurance to all applicants. The health reform bill has addressed these failings. Both presidential candidates had expressed the desire to improve options for people who buy their own coverage. Candidate Obama wanted to allow individuals and small firms to have the bargaining leverage and purchasing power of latge firms by creating ways for individuals to buy insurance in groups. Advisors to candidate McCain had acknowledged the current system was broken. Douglas Holtz Eakin, who was a senior policy adviser noted that he did not want to give the impression the individual or small group market is a good place to be, as it was not

The public hospitals have been at the vanguard of the victims of inadequate and absent coverage. They have provided for the uninsured and those under insured by Medicaid, that reimburses them at below cost. They are also unable to compete with private and nonprofit hospitals for patents with private health insurance coverage. Yet, the cost of providing care to the uninsured and under insured has climbed and taxpayer support remained static.

Currently employers are looking to shift more burdens to their employees due to rise in the cost of health insurance. A Reuters research team in analyzing claim data has discovered that smaller employers saw costs rise the most. According to a report released in March 2010, the cost for an employer to offer individual plans to workers increased by 43 percent over a eight-year period. The amount employees paid for the single plans increased over 64 percent.

Large corporate employees have enjoyed the most secure and highest quality coverage in the nation during their employment. They have not been victimized during their employment with revocation or denial due to preexisting conditions. Nevertheless, a recently released annual survey by the National Business Group on Health has indicated that the impact of rising costs means this island of safety is about to be buffeted. This surveyed large employers indicated they were considering shifting more of the cost on their employees.

Harvard researchers looking into what portion of bankruptcy filers filed for medical reasons found some enlightening information. They found that illness caused the majority of filings. The study looked at a year that preceded the housing bust; but reveals what is the general scenario absenting this reason. The larger segment of filers were covered by insurance they lost or proved to be inadequate. Majority of these were middle class homeowners who had college degrees. The study revealed the vulnerability of Americans who were literally one major illness from bankruptcy. There are big Obama effects on individual health insurance coverage. Certainly there are due to be major Obama effects on individual health insurance.

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