May 5, 2010
By Jennifer Hansen*
High Risk Pools, Medical Loss Ratios And Other Health Law Implementation Issues
May 4, 2010
News outlets report on state high risk pools and other implementation issues for the new health law.
"Eighteen states have said they will not administer a stopgap program to provide insurance coverage to people whose preexisting conditions have left them uninsured, forcing the federal government to do the work," The Washington Post reports. "The states' decisions increase the challenge the government faces as it sets out to translate the far-reaching health-care legislation into action, and they hint at the complexities to come. ....As of Monday, 29 states plus the District of Columbia had said they would do so, and 18 said they would leave the job to HHS." Some governors who decided against administering the program "said they were unwilling to take on the task because it appears that Congress has allocated too little money. Meanwhile, it was unclear how soon coverage will be available." Funding is available as of July 1, "but the earliest enrollment dates will vary, depending on such factors as whether states must first adopt new laws or regulations, said Jay Angoff, director of the HHS Office of Consumer Information and Insurance Oversight"
Politico reports on early haggling over what counts as "a medical expense" for health insurers. "Under health care reform, insurers will be required to maintain certain 'medical loss ratios,' insurance-speak for the percentage of premiums they spend on medical expenses. Defining what a 'medical expense' is, it turns out, is crucial." For example, "Claims for visits to physicians clearly fit the bill; likewise for surgeries and hospital stays. But what about a 24-hour nursing hotline? Does a flier in the mail that encourages subscribers to reduce sodium intake count? Or a new computer system to better manage care for multiple chronic conditions?" (Kliff, 5/4).
NPR: "The new health law leaves it up to the states to control health insurance premiums," but "[s]ome states don't have their own experts to review rates. And they face enormous political pressure from insurers, which have lobbyists in every state." But Sen. Dianne Feinstein, D-Calif., "says there's a role for the federal government here. She wants the U.S. Secretary of Health and Human Services to be able to block increases that are more about profit than about health care" (Silberner, 5/4).
The New York Times reports "[t]he Community Living Assistance Services and Supports Act, or Class Act, the first national plan to help the great majority of Americans who have no insurance for long-term care, became law in March. Even though there was little fanfare—the measure was just one piece of the broader health care overhaul—the idea had been hugely important to Mr. Kennedy and his staff, who had been working on the current version of the plan since 2003." The Times spoke with several experts to parse out who is eligible for the program and how it will work (Span, 5/3).
Meanwhile, The Washington Post asked Gerard Anderson and Bradley Herring of the Johns Hopkins Bloomberg School of Public Health several questions about the health law, including which changes come into effect first (5/4).
Health Law Program May Benefit Early Retirees, Big Firms
May 4, 2010
A health law program that will go into effect next month will steer
$5 billion to buttress employer-sponsored health plans for retirees who are not yet old enough to qualify for Medicare and have no other options for buying coverage, The Associated Press reports. "Older baby boomers working for large companies—and looking to downshift to less-demanding employment—could be the immediate beneficiaries." The plan will pay a big chunk of claims for patients in that category, lowering costs for companies and encouraging them to continue to offer the coverage to retirees until more options become available as the result of the health law in 2014 (Alonso-Zaldivar, 5/4).
Politico:"The federal health care overhaul plan requires that the program be implemented by June 21, but HHS plans to have it up and running by June 1, according to a White House official." Here's how it will work: "Employers—including private companies, local governments, nonprofits, unions or religious entities—can apply for reimbursements of up 80 percent of claims costs for health benefits between $15,000 and $90,000" (Haberkorn, 5/4).
Bloomberg Businessweek: "There is no limit on what size companies can apply for the subsidy, according to the law signed by Obama. The program would remain in place until 2014, when the overhaul law requires a system of exchanges, or marketplaces, for consumers to shop and select health insurance coverage" (Armstrong, 5/4).
Officials' Plan To Enforce Rescission Ban Still Unclear
April 30, 2010
WellPoint, UnitedHealth and other major insurers have said they will end the practice of terminating policies when policyholder become sick except in cases of fraud, earlier than the September deadline the health overhaul set, Reuters reports. But, it may be difficult for government officials to enforce the new prohibition on rescission, as the practice is called.
Previously, in some states an insurer could have canceled a policy by proving someone made a mistake when applying for coverage—even a nonintentional one, a senior health official in the Obama administration told Reuters." The federal health department will have to draft guidelines for enforcing the change, but their approach or timeline are not clear. "HHS's regulations, however, won't tell states how to enforce the ban, the administration official said. Federal officials can also help step in when needed, the official added" (Heavey and Krauskopf, 4/30).
Earlier today, The Washington Post reported that "[a]fter being criticized as obstructionists during the long health-care debate, insurance companies"—including WellPoint—"now are implementing some popular provisions even sooner than the law demands." The decision regarding rescissions is one such example (Hilzenrath, 4/30).
States Move To Require Ultrasounds Before Abortions
April 29, 2010
Various states have passed or are considering bills to tighten abortion regulations.
"Florida's Republican-led Senate pushed through an 11th-hour provision Wednesday that would require women seeking an abortion in their first trimester of pregnancy to pay for ultrasound exams....unless they could prove they were a victim of rape, domestic violence or incest by providing a copy of a restraining order, police report, medical record, or other court order or documentation," The Associated Press/Miami Herald reports. Lawmakers estimated that the cost of the ultrasound averages "between $350 and $400. . . . A second change to the measure approved Wednesday would prevent any tax dollars from being used to pay for elective abortions although it would not pertain to victims of rape or incest" (Kallestad, 4/28).
The Palm Beach Post: "The measure came as a surprise to Democrats; it had not been vetted through any committees this year and Senate Republicans added it as a last-minute amendment to a nursing home reform package Wednesday. ....Florida law already requires ultrasounds for abortions after the first trimester of pregnancy. But more than 90 percent of the procedures take place in the first trimester" (Kam, 4/28).
The Florida Sun Sentinel:"The amendment was tacked on to an otherwise innocuous bill dealing with drug-free workplaces by Sen. Andy Gardiner, R-Orlando. A rookie senator, Gardiner had been under attack from religious conservatives for failing to push through another abortion bill regarding parental notification. The bill, now with the ultrasound mandate, is set for a final vote Thursday in the Senate. After that, if approved, it moves to the House, which is deeply conservative and voted for the ultrasound bill in 2008. . . . The abortion coverage ban would apply to Florida residents and businesses who buy insurance under so-called health exchanges, which will be established as a result of Obama's health care law" (Hafenbrack, 4/28).The Times-Picayune
: Louisiana also is considering a bill that would require women to have an ultrasound before getting an abortion. "The Senate Health & Welfare Committee sent Senate Bill 528 to the floor after removing a section that would have required a 'screen depicting the active ultrasound images' placed within the woman's view during the procedure and for her to receive an explanation of what is on the screen. Under the new language, women would have to be offered a chance to see an image of the fetus and receive a printout, but would have the right to refuse. Even without the language, Louisiana would become one of about 15 states that require ultrasounds before an abortion can be performed if the bill by Sen. Sharon Weston Broome, D-Baton Rouge, becomes law" (Moller, 4/28).
Politico:"On Tuesday, the Oklahoma Senate passed one of the country's most restrictive abortion laws, requiring that women seeking an abortion have a viewable ultrasound and listen to a detailed description of the fetus prior to the procedure. The law came on the heels of a stringent Nebraska measure, passed two weeks earlier, banning abortion at 20 weeks gestation. Taken together, the two new laws represent some of the most aggressive abortion legislation. ....Fourteen other states do require the provision of an ultrasound prior to abortion, but Oklahoma goes further by requiring both the description of the fetus and that the ultrasound monitor be in sight." The Oklahoma law passed over "objections from Gov. Brad Henry (D), who had previously vetoed the bill." Meanwhile, a Nebraska law "bans abortion after 20 weeks gestation on the basis that the fetus could feel pain. When it takes effect in October, the new regulation will likely be challenged as unconstitutional, largely because it bans pre-viability abortions" (Kliff, 4/28).
Tulsa World: The only clinic in the city that performs abortions is following the law while also challenging it. "'We don't like it, but we're following it,' said Linda Meek of Reproductive Services of Tulsa. ....A hearing is scheduled for Monday in Oklahoma County District Court for a temporary restraining order against enforcement of the ultrasound law. The New York-based Center for Reproductive Rights filed suit on behalf of Reproductive Services and the Norman doctor shortly after the Senate's override vote. Opponents of the new law say it is the most extreme measure of its kind in the country" (Krehbiel, 4/29).
*We would like to thank Jennifer Hansen, Esquire Hooper Lundy & Bookman Inc., San Diego, California, for selecting the articles for this week’s compilation.