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This Week in Health Care Reform : EasyToInsureME Health Insurance

This Week in Health Reform

Republican Scott Brown’s victory over Massachusetts Attorney General Martha Coakley (D) in the January 19 special election to fill the seat of the late Senator Edward Kennedy (D) might prove to be a game-changer for the health care reform debate. The loss of the 60th Democratic vote now robs Senate Democrats of a filibuster-proof majority. Last week, Democrats were rushing to wrap up a House/Senate agreement on the bill, likely due to reports that Coakley’s lead had diminished.

Congressional leaders are still aiming to have the controversial points in the health care reform bill settled as soon as possible, so they can send the compromised bill to the Congressional Budget Office (CBO) for scoring. The CBO will then need 12 days to analyze the legislation.

In addition to Senate Majority Leader Harry Reid (D-NV) and Speaker of the House, Nancy Pelosi (D-CA), lawmakers participating in the White House meetings include: House Majority Leader Steny Hoyer (D-MD), House Majority Whip James Clyburn (D-SC), House Energy and Commerce Committee Chairman Henry Waxman (D-CA), House Ways and Means Committee Chairman Charlie Rangel (D-NY), House Education and Labor Committee Chairman George Miller (D-CA), Assistant Senate Majority Leader Richard Durbin (D-IL), Senate Finance Committee Chairman Max Baucus (D-MT), Senate HELP Committee Chairman Tom Harkin (D-IA), and Senate Banking Committee Chairman Christopher Dodd (D-CT).

A main point of contention between the two houses of Congress pertained to the
40 percent excise tax on high-cost health insurance plans passed by the Senate. Since many labor union members would be affected by the tax on high-cost health insurance plans, the House of Representatives was not supportive of this provision in the Senate bill. Union leaders have also been included in key negotiations on this provision, and on January 14, signaled that they are ready to support the merged legislation with the compromised provision.

The main revenue source for the Senate’s health care reform bill (H.R. 3590) would be from an excise tax – beginning in 2013 – on employer-provided, high-cost health insurance plans costing more than ,500 for individuals and ,000 for a family. The reported compromise on the legislation now makes the tax kick-in on policies costing ,900 for individuals and ,000 for families. The tax threshold would still rise at inflation plus one percentage point, as is currently written in the Senate bill. Additionally, dental and vision benefits would be removed from the calculation of threshold costs, and plans offered by state and local governments, as well as plans covered by collective bargaining agreements, would be exempted from the excise tax until 2018. This would allow current agreements to expire and allow for negotiation of new contracts.

In an effort to make up the lack of revenue from the modification of the excise tax provision, leadership will have to come up with new funding to finance the merged bill. Some reports have mentioned that the pharmaceutical industry has agreed to provide more money than the billion they have already negotiated with the White House. Medical device companies could also face additional fees. Portions of the main revenue source in the House bill – a Medicare payroll tax on wealthy U.S. residents – could be added as well.

On January 14, Richard Trumpka, president of the AFL-CIO, said, “Union leaders approached negotiations with the White House and congressional leaders with one overriding goal in mind – getting a bill signed into law.” Gerald McEntee, president of the American Federation of State, County and Municipal Employees (AFSCME), said, “We do like the way it’s shaping up, but it’s still not finished. We’ve got to see a final product.”

There also has been significant discussion – but no resolution so far – about the question of whether to establish a single national health insurance exchange or allow each state to operate its own exchange. Blue Cross and Blue Shield of Texas continues to support a state-based approach to exchanges.

President Obama tells the crowd in St. Louis, MO that the time is now to pass health insurance reform and announces new plans to rein in waste and abuse in Medicare, Medicaid and other government health programs.

Health Insurance Reform Easytoinsureme February 5 2010

FEBRUARY 5, 2010

This Week in Health Care Reform EasyToInsureME FEBRUARY 5 2010   

Despite proclaiming to focus on other issues, such as the economy and jobs, President Barack Obama injected new energy into the health care reform debate this week.

On Monday, President Obama held a Q&A session via YouTube in which he responded to questions submitted during his State of the Union address. He commented that “it is my greatest hope” to have health care reform legislation “not just a year from now, but soon.” He also responded to criticisms regarding the lack of transparency around the reform negotiations.

On Tuesday, at a town-hall-style meeting in New Hampshire, President Obama rejected the notion that health care reform was dead, saying “we’ve got to punch it through.” Further, on Wednesday, he met with Senate Democrats reiterating his commitment to reform and encouraging lawmakers to press forward. He also suggested that Republicans play at least some role in negotiating a final bill.

Health Care Reform Negotiations

Democrats Look for Path Forward: Recent statements made by Rep. Charles Rangel (D-NY) are the first concrete signs that Democrats have started working to revive comprehensive health care reform legislation. Rep. Rangel indicated to the media that lawmakers have begun writing a compromise bill based on the legislation passed by the Senate last December. The bill will incorporate changes agreed upon last month by White House negotiators and members of the House and Senate.

Senate Majority Leader Harry Reid (D-NV) did not commit to a timeline for reform, but hopes that Democrats can agree to a path forward by next week. So far, he has been unable to identify compromise language that will win the needed 51 Senate votes.

At the same time, Speaker of the House Nancy Pelosi (D-CA) indicated that the House would vote on a small piece of the overall health care reform package next week. The proposed bill would overturn the insurance industry’s exemption from federal antitrust laws. The Senate version of health care reform did not include this measure because Sen. Reid could not secure the 60 votes needed to include it; however, Sen. Reid indicated the Senate would reconsider the measure.

Additional Activities

President Obama’s Budget Assumes Health Care Reform: On Monday, White House officials released a proposed .8 trillion 2011 budget including several measures aimed at improving health care:

·        Hiring more fraud detectives to root out waste in Medicare and Medicaid

·        Providing .5 billion to help state Medicaid programs swelling with enrollment due to unemployment

·        Eliminating Congressional earmarks for building hospitals and other facilities, including million for Alaska and million for Mississippi

·        Initiating or increasing funds for the following research projects:

o       quality improvements for seniors with chronic conditions

o       effective medical treatments for the costliest conditions

o       expeditious ways to adopt electronic medical records

o       medical fields such as genetic medicine that may provide breakthrough treatments.

Further, the budget assumes that some form of health care reform legislation will pass Congress. It includes a “reserve fund for health care reform” totaling 4 billion as a “down payment” for the legislation and also assumes that the reform effort will generate 0 billion in savings over 10 years.

States Begin Initiatives to Expand Coverage: With the fate of national health care reform in question, state legislators are pushing their own bills to expand coverage. Last Thursday, California’s State Senate passed a measure to create a government-run health care system, ignoring a veto threat from Gov. Arnold Schwarzenegger. The measure is now with the State Assembly. Missouri legislators have introduced a similar bill to create a government-run plan whereas lawmakers in other states, including Virginia and New Jersey, are working to tweak existing state programs to expand coverage. Tight budgets in all of those states may hinder these efforts.

Virginia Senate Says No to Individual Mandates: On Monday, Virginia’s Democratic-controlled State Senate passed measures that would make it illegal to enforce an individual health care mandate. This decision comes in direct conflict with the House and the Senate health care reform bills, both of which require all individuals to purchase health insurance.

Public Opinion

Majority of Americans Doubt Passage of Health Care Reform, but Growing Optimism: A survey released by the Pew Research Center on Wednesday shows growing optimism around the passage of health care reform. While the poll indicates that the majority of Americans (60 percent) do not believe health care reform legislation will pass this year, the figure is down from the 67 percent who said – just after a special Senate election was held last month in Massachusetts – that such legislation would not pass.

Poll Indicates Damage Done On Health Care Reform: A poll released Tuesday by Public Policy Polling shows that Republicans currently have the advantage over Democrats in the ballot races for Congress, regardless of the final outcome of health care reform. In general, the poll shows that 43 percent of voters surveyed would vote for a Republican, whereas 40 percent would vote for a Democrat. When asked about the implications of the health care overhaul.

* If health care reform passes, 45 percent would likely vote Republican and 40 percent would likely vote Democrat.
* If health care reform does not pass, 43 percent would likely vote Republican and 38 percent would likely vote Democrat.

The poll also shows that 36 percent of respondents support the President’s health care reform effort, while 51 percent oppose it.

Looking Ahead

Currently there is no timeline for the development of a comprehensive health care reform package. However, Speaker Pelosi is moving forward with smaller pieces of the bill, starting next week with the repeal of the antitrust exemption for insurance companies.

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JANUARY 29, 2010

This Week in Health Care Reform

Following the election of Republican Scott Brown to the Massachusetts State Senate last week and the resulting loss of Senate Democrats’ supermajority, lawmakers continue to pave the way for health care reform – with limited progress. In addition, polls indicate that the public would rather lawmakers focus more on the economy than on health care.

State of the Union Address

President Obama Gives State of the Union Address: On Wednesday evening, President Barack Obama delivered his first State of the Union address before a joint session of Congress. Having hoped to have a health care reform bill on his desk prior to his address, the President instead used his speech to encourage Congress to push forward on health care reform. Yet, he did not give specific guidance as to how to proceed with the legislation. Instead, he made it clear that his primary focus would be on jobs and the economy.

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Health Care Reform Negotiations

Democrats Still Seek Way Forward: While vowing not to give up, Democratic Senate leaders indicated Tuesday that they no longer felt pressure to move quickly on health care reform; and, in the wake of the Massachusetts election and in reaction to public opinion, they shifted focus to jobs and the economy. Senate Majority Leader Harry Reid (D-NV) commented that there is “no rush” on health care and said that he and Speaker of the House Nancy Pelosi (D-CA) were working to map out a way to complete health care reform in the coming months. On Wednesday, Sen. Pelosi floated a two-pronged strategy to pass incremental changes now and pursue comprehensive reform later.

Some lawmakers have considered breaking up the legislation into smaller pieces that have bipartisan support. However, this option will prove challenging given the complexities and interdependencies of the measures. For example, lawmakers would like to include a measure that requires all insurance companies to insure those with pre-existing conditions; however, premiums will most likely increase unless there is an individual mandate.

Earlier this week, Democrats appeared to be coalescing around a different strategy through which Senate lawmakers would make changes to their bill to appease members of the House. The Senate would then pass the revised bill via reconciliation, which only requires 51 votes. Following that, the House would approve the revised bill, giving it to President Obama for his review. However, movement on this strategy stalled Tuesday when two centrist Senators, Sens. Evan Bayh (D-IN) and Blanche Lincoln (D-AK), indicated that they would oppose using reconciliation to bypass Republican support. Others, including Sen. Joe Lieberman (I-CT) and Sen. Dianne Feinstein (D-CA), have suggested a “time out” on health care reform until there is a clear path forward.

In the GOP response to President Obama’s State of the Union address, Virginia Governor Robert McDonnell said that Republicans share the Democrats’ desire for health care reform, but do not agree with their proposed solutions. Republicans suggest that Democrats scrap the current proposals and start over with more Republican input on issues such as medical malpractice reform and selling insurance policies across state lines.

Republicans Call for Transparency: On Wednesday, the House Energy and Commerce Committee marked up a resolution presented by Rep. Michael Burgess (R-TX) which requested that the administration divulge documentation regarding the health care reform deals made with trade associations and a labor union. Committee Chairman Henry Waxman (D-CA) said that while details remained to be worked out, he would support a narrowed version of the Republican request for White House records.

President Obama to Speak with House Republicans: President Obama will meet with House Republicans on Friday in response to an invitation to speak at their annual retreat in Baltimore that begins Thursday and ends Saturday. The meeting comes just after the President’s State of the Union address, and members of the news media speculate that the meeting may spur more bipartisanship or potentially lead to even more tension between the two parties.

Interest Groups Call for Reform: With health care reform’s fate in jeopardy, interest groups have voiced their support, encouraging Democrats to push forward with legislation. The AARP, American Cancer Society Cancer Action Network, Consumers Union, Families USA and Service employees International Union sent a joint letter last Thursday urging Congress not to abandon comprehensive health care reform. Further, the United States Conference of Catholic Bishops also sent a letter to Congress urging a push for reform.

Public Opinion

Polls Show Concern with Health Care Reform; More Focus on Jobs and Economy: Several polls were released this week that highlight the public’s disenchantment with health care reform and anxiety around the struggling economy.

A new CNN/Opinion Research poll released Tuesday shows that only three in ten Americans say they want Congress to pass legislation similar to the bills currently being discussed in Congress. Forty-eight percent of Americans would like lawmakers to start again on a new bill, and 21 percent believe Congress should not work on bills that would change the current health care system. Further, a Wall Street Journal/NBC poll released Wednesday found that 51 percent of Americans believe President Obama has paid “too little attention” to the economy and that 44 percent feel he has paid “too much attention” to his proposed health care overall.

In addition, a new USA Today/Gallup poll released late last week finds that most Americans call for a more bipartisan effort in health reform. A 55 percent majority of Americans say that President Obama and Congressional Democrats should suspend movement on health care reform and consider alternatives that would increase Republican support.

A poll released last weekend by the Washington Post , Henry J. Kaiser Family Foundation and Harvard University’s School of Public Health indicated that dissatisfaction with the direction of the country, including the Democrats’ health care reform proposals, drove the outcome of the Massachusetts election. The post-election survey of Massachusetts state voters showed that overall 43 percent say they support the health care reform proposals advanced by President Obama and Congressional Democrats, while 48 percent oppose them.

A new poll released Monday from the Robert Wood Johnson Foundation found that fears regarding the health care reform package increased significantly in December as members of the Senate finalized their bill. Thirty-three percent of respondents said they believed their access to care would worsen if the legislation passed, up from 25 percent in November. Forty-two percent said the country’s finances would suffer under reform, compared with 34.6 percent in November.

Looking Ahead

Next week, the President will present his Budget to Congress (which includes health programs), after which Congressional hearings will commence. We expect health reform to be discussed in these sessions. While there remains no clear path forward for health care reform, Congressional leaders will continue to work to find a solution.

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MARCH 26, 2010

This Week in Health Care Reform     

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

Health Care Reform Negotiations

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

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

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

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

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

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

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

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

Additional Activities

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

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

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

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

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

Public Opinion

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

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

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

Looking Ahead

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

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Federal

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

States

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

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

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

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

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

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

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

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

NEW JERSEY: Last week Governor Chris Christie declared a fiscal state of emergency calling a special session of the legislature to lay out his plan for dealing with state’s current .2 billion budget shortfall. His plan calls for significant cuts or eliminations across 375 state programs and withholding 0 million of state education aid. Of note on the program side is a .6 million reduction in Charity Care funding to hospitals, which pays for care to uninsured residents. In legislative action, the Assembly Financial Institutions and Insurance Committee held a three-hour public hearing on out-of-network reimbursement. Much of the hearing focused on the markedly higher billing practices of ambulatory surgery centers and one non-par hospital. Aetna presented testimony regarding its experience with the non-par hospital, citing their disparate year-over-year increase in charges compared to other similarly situated hospitals. Chairman Schaer indicated the committee will work over the next several months to craft a solution.

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

Political analyst Craig Crawford on the flawed logic of the health-care penalty for not having insurance.

President Obama addresses the House Democratic Caucus and says that the time is now to vote for health care reform for America.

President Obama tells the crowd in St. Louis, MO that the time is now to pass health insurance reform and announces new plans to rein in waste and abuse in Medicare, Medicaid and other government health programs.

President Obama shares the story of Natoma Canfield, a cancer survivor who had to drop her health insurance due to excessive rate hikes only to be diagnosed with leukemia, and tells the crowd in Strongsville, Ohio that cases like Natomas make it clear that the time is now for health insurance reform. March 15, 2010.

First Lady Michelle Obama speaks about the difficulties senior women face in today’s health insurance market and the importance of reform. November 13, 2009. (Public Domain)