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Posted by Friday, Sep. 3rd 2010President 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.
Posted by Wednesday, Sep. 1st 2010All people want to be healthy and no one wants to be sick. Being healthy is fun and to make your body healthier is very easy because you only need to eat healthy food and consume fruits. You also need to do some exercise to train your body and improve your health. The exercises that you can do to make your body healthy are very various. You can simply join a gym and do the exercise there under the trainer’s supervision.
One of the best exercise types that you can do is pilates la. This type of exercise is the most popular exercise that people often do to make their body healthier and to shape it. This innovative exercise is able to make greater strength and muscle tone. It can also improve the posture and flexibility. The pilates classes will also make you have flatter stomach and trimmer waist and there are many more advantages that you can get if you do the pilantes exercise.
Today, there are many reformer pilates that has modified the exercise. The modification is resulted in better application of the exercise styles and better results. Join any gym that has implemented this exercise to ensure that you get healthier body.
Posted by Sunday, Aug. 29th 2010As 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.
Posted by Tuesday, Aug. 24th 2010SAVAGE, MN-Well-known dentist in Savage, Prior Lake and the surrounding areas, Dr. Melissa Zettler, is pleased to announce the newest addition to her practice website- online appointment requesting. The new feature will enable patients to make an appointment with ease, giving them the flexibility to request an appointment at their convenience from the comfort of their home computers.
Cherrywood Dental Care is a full-service dental practice located in Savage, MN, serving patients in the surrounding communities, including Prior Lake, Shakopee, Burnsville and Lakeville. With a focus on patient education, comfort and quality care, Cherrywood Dental Care offers an array of services in many phases of dentistry, including cosmetic dentistry, sedation dentistry, family dentistry and more. Repeatedly chosen as one of Minnesota’s Top dentists, Dr. Zettler delivers professional, gentle dental care to patients of all ages.
“Cherrywood Dental Care is excited to be able to offer our patients the option to request an appointment online from our website,” said Dr. Zettler. “From ordering food and paying bills to finding doctors and getting directions, people everywhere are using the Internet for virtually everything. It only made sense that we design our site with the important information and essential tools for our tech-savvy patients.”
To request an appointment at Cherrywood Dental Care, patients can simply visit Dr. Zettler’s site and complete the appointment request information, including name, preferred time, date and the nature of the appointment. After submitting the form, a staff person from Cherrywood Dental Care will reply shortly with a confirmed time and date.
Dr. Zettler strives to deliver convenient and quality dental care to every patient she serves in Savage, Prior Lake, Shakopee, Burnsville and Lakeville. Having already built an educational website with easy-to-access dental resources and new online patient forms, the newly added appointment requesting feature was designed to further streamline dental care for both the practice and the patients. Additionally, the comprehensive website for Cherrywood Dental Care includes an educational dental library, office details, service descriptions and an engaging blog.
“If you’re looking for an experienced dentist in Savage you can trust, we welcome you to visit us at Cherrywood Dental Care,” said Dr. Zettler. “Stop in, give us a call or request an appointment online, and let us help you achieve your healthiest, most beautiful smile.”
About Cherrywood Dental Care: Dr. Melissa S. Zettler has been serving patients in Savage, Prior Lake, Shakopee, Burnsville, Lakeville and surrounding communities of Minnesota since she founded Cherrywood Dental Care 14 years ago. Repeatedly chosen as one of Minnesota’s Top Dentists, Dr. Zettler specializes in cosmetic and family dental care, including dental implants, lumineers, sedation dentistry and Invisalign. Year after year, Dr. Zettler and her team of dental professionals maintain the highest levels of accreditation and pursue ongoing education to stay abreast of the latest trends and technologies that dentistry has to offer.
Posted by Tuesday, Aug. 24th 2010The Week in Health Reform—Federal Legislative Overview
The White House
On March 3, President Obama continued his push for Members of Congress to complete health insurance reform legislation within the upcoming weeks. He delivered a statement to a group of medical professionals in the East Room of the White House, in which he said that he has asked Senate and House leaders to finish work on health reform and schedule final votes in the next few weeks. The President went on to say that the issues have been debated thoroughly and that now is the time to make a decision. Although he did not specifically mention the budget reconciliation process, the President said that the American people deserve an “up or down” vote on health reform in the same way that welfare reform and tax cuts were approved by Congress in the past under reconciliation rules.
The President said that health insurance reform would change three things:
* End the “worst practices” of health insurance companies
* Give individuals and small businesses the same kind of choices members of Congress have
* Bring down health care costs for families, businesses and the government
The President made numerous references to the health insurance industry and stated that there is a fundamental disagreement between Republicans and Democrats about whether there should be more or less regulation of health insurance companies. The President concluded by emphasizing that he will do everything in his power to make the case for health reform in the coming weeks, and he also urged the American people to make their voices heard.
In addition, the President said he is open to exploring policy priorities identified by Republicans at the bipartisan summit such as:
* Conducting undercover investigations of health care providers that receive reimbursement from federal programs.
* Appropriating funds for state-based demonstration programs to test alternative approaches, including health courts, to resolving medical malpractice suits.
* Linking Medicaid eligibility expansions to higher Medicaid reimbursement for physicians.
* Clarifying that Health Savings Accounts (HSAs) may be offered through the proposed health insurance exchanges.
On March 4, Health Care Service Corporation President and CEO Pat Hemingway Hall attended a meeting at the White House, along with CEOs from other leading health insurance companies and officials from the National Association of Insurance Commissioners. The group met with Health and Human Services Secretary Kathleen Sebelius and President Obama to discuss premium issues in the individual market.
House and Senate
Congressional leaders are now focused intensely on developing legislative language that could be supported by a majority of members in both chambers. The President’s comments last week send a strong signal that such legislation, once finalized, would move through Congress under budget reconciliation procedures.
Under reconciliation rules, the House first would have to pass the Senate version of the health care reform bill, H.R. 3590, which passed on Christmas Eve last year. After that, the House would then be required to pass a separate “corrections” bill incorporating specific changes to that bill that will likely be negotiated among White House officials and House and Senate leaders. After the House passes the “corrections” bill, under budget reconciliation procedures, the Senate would need at least 50 senators to vote for the “corrections” bill. Under reconciliation rules, only a simple-majority vote of 51 votes are needed for passage (Vice President Joe Biden would be the 51st vote if only 50 senators vote for the bill) and filibusters are banned.
In order to meet the goal of sending a final health reform bill to the President’s desk before the Easter recess (which is scheduled to begin on March 29), congressional leaders would need to send legislative language to the Congressional Budget Office (CBO) for cost analysis in the very near future. On March 4, White House Press Secretary Robert Gibbs said that President Obama hopes the House of Representatives will pass the health reform bill by March 18, so the rest of the process can move swiftly.
Speaker Nancy Pelosi (D-CA) is now tasked with trying to corral votes in the House, while trying to assure those who are wary that the Senate will be willing to support the same measures. Some House members are worried about being left “holding the bag,” if the Senate decides it will not support some of the same legislative language.
In order to ensure the Democrats have enough votes, President Obama invited two groups of the Democratic Caucus to the White House on March 4 to continue to push for health reform passage. Members from the Congressional Progressive Caucus were:
Caucus Chairs Raúl Grijalva (AZ) and Lynn Woolsey (CA), Congressional Asian Pacific American Caucus Chairman Mike Honda (CA), Congressional Black Caucus Chairwoman Barbara Lee (CA), Congressional Hispanic Caucus Chairwoman Nydia Velázquez (NY), Reps. Dennis Kucinich (OH), Lucille Roybal-Allard (CA) and Jan Schakowsky (IL), as well as delegates Madeleine Bordallo (Guam) and Donna Christensen (Virgin Islands).
Afterward, Obama met with key members of the New Democrat Coalition. The New Democrats, like the Blue Dogs, are a group of fiscally conservative Democrats. Attendees of this meeting included: Reps. Jason Altmire (PA), Melissa Bean (IL), Lois Capps (CA), Joe Crowley (NY), Ron Kind (WI), Allyson Schwartz (PA) and Adam Smith (WA).
Overview: Extension of Physician Payment “Fix” and COBRA Provisions
On March 2, the Senate passed H.R. 4691, the “Temporary Extensions Act of 2010″ and President Obama signed it into law. This legislation includes a one-month extension of the Medicare physician payment “fix,” premium assistance for unemployed workers with COBRA and state continuation coverage, unemployment insurance and several other legislative provisions that expired on February 28. Before voting on passage of the bill, the Senate first voted on an amendment by Senator Jim Bunning (R-KY) that would have offset the $10 billion cost of the “extenders” package. This amendment was defeated and therefore no further legislative action was needed. The bill was later signed by the President.
Overview: The “Health Insurance Industry Fair Competition Act” – H.R. 4626
In a letter dated March 3, 22 Democratic Senators wrote to Majority Leader Harry Reid (D-NV) urging him to bring H.R. 4626, the “Health Insurance Industry Fair Competition Act, to the Senate floor at its earliest opportunity. In the letter they state that “[this legislation] is an important step toward bringing competition to the health insurance market, and would ensure that anticompetitive abuses such as price fixing and monopolization are policed in the health insurance industry.” America’s Health Insurance Plans (AHIP) CEO Karen Ignagni maintains the position on the legislation saying, “The rhetoric surrounding repeal [anti-trust exemptions] does not match the reality of the situation. Health insurance is one of the most regulated industries in America at both the federal and the state levels. The Act is extremely limited in scope and has nothing to do with competition within the health insurance industry. In fact, a wide range of insurer activities, including mergers and many types of business practices, are and always have been subject to federal antitrust laws and to enforcement by the Department of Justice.”
Author Reference http://www.easytoinsureme.com
Posted by Saturday, Aug. 21st 2010Bodybuilding supplements help you build muscle density and lose unwanted fat. Some bodybuilding supplements can help in building your body to a higher level of perfection and peak performance, without spending unproductive hours in the gym.
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There are many bodybuilding supplements available in the market. 4-Androstenediol, HGH Booster, Testosterone Booster, AAKG (Nitric Oxide) and L-Glutamine are the five most effective bodybuilding supplements. HGH (Human Growth Hormone) booster has HGH releasing formula that can increase your natural HGH production and decrease your body fat. Testosterone Booster increases the production of testosterone to dramatically improve protein synthesis and nitrogen retention. L-Glutamine enhances recovery ability from intense exercise and increases HGH production. It significantly increases protein synthesis and prevents muscle breakdown. 4-Androstenediol will convert into testosterone after entering your body. 4-ANDROSTENEDIOL will convert into testosterone after entering your body. Most of the bodybuilding packages are specifically formulated to simultaneously increase your Testosterone and HGH Levels. So that the synergistic effect created by the combination will force your body for muscular growth. These two hormones work together to increase lean muscle mass and decrease body fat.
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Posted by Thursday, Aug. 19th 2010Week 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.
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