Health Insurance

Week of November 15, 2010

State budget problems are so dire and rising health care costs so worrisome that some states are considering what may have been unthinkable just a year or two ago — opting out of the federal Medicaid program. The New York Times reported last week that Texas (see below) and a handful of other states are considering doing exactly that, especially given that federal health care reform will expand (as of 2014) the number of residents who are eligible for the state-administered health care program. In South Carolina, state officials there are considering not paying Medicaid claims as of March 2011 unless they can secure permission to run at a deficit. Some state leaders concede dropping Medicaid could have a devastating effect on their local economies, making such a course unlikely. The fact that it\’s on the table, however, speaks volumes about the growing problem of runaway health care costs, and the need to develop systematic solutions in the way that the Patient Protection and Affordable Care Act (PPACA) addressed access issues. Easy To Insure ME has the answers

Health Care Reform Implementation
For more detail about the ongoing implementation of the new health care reform law and its potential impact on you, read a new edition of our Eye on Implementation feature.

Federal

With Congress on recess last week, there is no Federal summary for this week.

States

ALASKA: A state health commission created by the legislature this year has begun reviewing rapidly rising medical costs and patterns of health care pricing among providers. Alaska\’s health care costs are rising faster than the national average. The commission held its first meeting in Anchorage October 14 and 15 after its members were appointed by Gov. Sean Parnell. Most members of the panel were on an earlier health care task force, but this panel has five new members, including two state legislators. In an effort to provide the Commission with relevant cost and quality data, Aetna has forwarded several relevant studies and documents produced by its Public Policy Department.

CALIFORNIA: The state is yet again facing a massive budget deficit — $25.4 billion projected for 2011, according to the nonpartisan Legislative Analyst Office (LAO). Governor Arnold Schwarzenegger will call a budget special session starting December 6 to resolve the current-year $6.1 billion deficit. Next year\’s budget process will be impacted by two propositions passed during the November election. Voters approved Proposition 22, which limits the state\’s ability to borrow money from local governments, and they also approved Proposition 26, which makes it harder to raise fees. It also rolls back fees that were passed by less than a two-thirds vote this year. The LAO estimates these two propositions will create a $1 billion hole in the budget. Democrat Governor-elect Jerry Brown, who campaigned on a pledge of no new taxes, will release his budget proposal in early January.

NEW JERSEY: Last week the Assembly Financial Institutions & Insurance Committee took up legislation that clarifies out-of-network payment responsibilities under health benefits plans, requires certain coverage and procedure disclosures to consumers, and revises procedures for changes to managed care plan contracts. After more than two hours of testimony, Chairman Schaer used his discretion to withhold formal action on the bill. In his comments the chairman noted, ‘The rising cost of health coverage is crowding out other socially important efforts for government and resulting in economic stress for employers.’  Led by the New Jersey Hospital Association and Medical Society, the provider community was virtually unified in its opposition to the legislation. The business community, NJ Association of Health Underwriters, and a large contingent of trade unions expressed their support for the bill.  Aetna, along with other commercial plans, remains concerned about provisions in the bill concerning non-participating, hospital-based physicians and the ability of out-of-network providers to waive member copayment, coinsurance, or deductibles. Aetna will continue to closely monitor the legislation.

TENNESSEE: The Tennessee Insurance Exchange Planning Initiative has announced the members of two newly created Technical Advisory Groups (TAGs). Members of these groups will provide expertise on specific analytical questions to help in the state\’s insurance exchange planning process. The state is in the process of deciding whether it will operate a health insurance exchange. Mark Schmidt, Aetna Market President, Southeast, has been appointed to the Governor\’s TAG for State Insurance Exchange Planning. The members of the Actuarial/Underwriting TAG and the Agent/Broker TAGs will provide expertise on specific analytical questions to help in the state\’s insurance exchange planning process. The volunteer members of each TAG will meet in Nashville this fall and winter. Members of the Agent/Broker TAG will provide a detailed inventory of options for state decision-makers and then post any resulting discussion papers. Once additional information is received from the federal government, the state also intends to convene TAGs of health care providers, consumer representatives, and marketing and outreach experts.

TEXAS: Several Republican lawmakers are proposing an unprecedented solution to the state\’s estimated $25 billion budget shortfall: dropping out of the federal Medicaid program. The Heritage Foundation, a conservative think tank, estimates Texas could save $60 billion between 2013 and 2019 by opting out of Medicaid and the Children\’s Health Insurance Program, dropping coverage for acute care but continuing to fund long-term care services. With 3.6 million children, people with disabilities and impoverished Texans enrolled in Medicaid and CHIP, the Texas Health and Human Services Commission will release its own study on the effect of ending the state\’s participation in the federal match program. Some lawmakers say not being able to reduce benefits or change eligibility to cut costs is ‘bankrupting our state.’ State Rep. John Zerwas, an anesthesiologist who authored the bill commissioning the Medicaid study, said early indications are that dropping out of the program would have a tremendous ripple effect monetarily, and he worries about who would carry the burden of care without Medicaid\’s ‘financial mechanism.’ Currently, the Texas program costs $40 billion per biennium, with the federal government footing 60 percent of the bill. As a result of federal health care reform, millions of additional Texans will become eligible for Medicaid. Lawmakers want to examine whether Medicaid enrollees could be served more cost efficiently with better outcomes in a state-run program.

WASHINGTON: Governor Chris Gregoire says she gets the message following the recent elections, and as a result has announced that she will seek supplemental budget cuts of $55 million before the end of the year. Voters signaled a strong aversion to additional tax hikes to balance the budget by recently passing initiative 1053, which restores the two-thirds vote requirement for the legislature to raise taxes, and initiative 1107, which repeals a tax on bottled water and carbonated beverages. Also, voters rejected initiative 1098, which would have instituted a state income tax. Among the programs Gregoire is considering for possible cuts is the state\’s Basic Health Plan. The Governor said she is open to the idea of a one-day special session if there is agreement with legislative leaders on quick action.

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Easy To Insure ME has the answers Easy To Insure ME / Health insurance quote / individual health insurance

Health Insurance

Federal

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

States

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

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

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

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

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

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

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

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

NEW JERSEY: Last week Governor Chris Christie declared a fiscal state of emergency calling a special session of the legislature to lay out his plan for dealing with state’s current $2.2 billion budget shortfall. His plan calls for significant cuts or eliminations across 375 state programs and withholding $500 million of state education aid. Of note on the program side is a $12.6 million reduction in Charity Care funding to hospitals, which pays for care to uninsured residents. In legislative action, the Assembly Financial Institutions and Insurance Committee held a three-hour public hearing on out-of-network reimbursement. Much of the hearing focused on the markedly higher billing practices of ambulatory surgery centers and one non-par hospital. Aetna presented testimony regarding its experience with the non-par hospital, citing their disparate year-over-year increase in charges compared to other similarly situated hospitals. Chairman Schaer indicated the committee will work over the next several months to craft a solution.

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

OKLAHOMA: The second session of the 52nd Oklahoma Legislature convened in Oklahoma City on February 1. Legislators quickly turned to the state’s $1.3 billion budget deficit described by Governor Brad Henry (D) in his eighth and final state of the state address and FY 2011 executive budget. During his address, the Governor focused on his plans for resolving the $1.3 billion budget deficit through precise budget cuts. His only reference to health insurance was to encourage the expansion of Insure Oklahoma, a program developed by the state in partnership with small employers to provide affordable health coverage. The legislature is scheduled to adjourn on May 28 but only after addressing a range of legislation including several bills of interest to Aetna.

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

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

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

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Health Insurance

PricewaterhouseCoopers and Medco Health Solutions released two new views of cost trends in health care during the past week, building on the release of the Milliman Medical Index.   PwC Health Research Institute\’s ‘Behind the numbers: Medical cost trends for 2012,’ examines the medical cost trends for employers in 2012.  This new report found ‘Medical cost trend is expected to increase from 8 percent in 2011 to 8.5 percent in 2012.’  And two main drivers identified by PwC are provider consolidation and cost-shifting to the private sector.

Providing a view of prescription drug utilization and pricing trends, Medco\’s Annual Drug Trend Report showed this week that while the overall growth of prescription drug prices is at an historic low (as a result of increased use of generic drugs), the cost of specialty treatments is still increasing at an alarming rate.  According to Medco\’s report ‘Specialty drug trend was 17.4 percent in 2010, fueled by unit cost growth of 11.5 percent.’

Federal

There is no Federal report for this week.

States

ARIZONA: The Department of Insurance (DOI) held a public hearing on rate review as part of its Health and Human Services (HHS) grant activities. The DOI has retained Mercer Consulting to assist in performing a gap analysis to identify areas that need to be addressed in order to comply with the requirements of the Affordable Care Act (ACA). During the hearing, it was noted that the state\’s current statutory scheme does not authorize the DOI to review a health insurer\’s medical loss ratio, potentially not allowing the state to meet the HHS requirement of having ‘an effective rate review process.’

The Director of Insurance and the Governor\’s office also hosted their first workgroup on the implementation of an exchange. Despite the legislature\’s refusal to pass an exchange bill, there is concern at the executive level about a lack of preparedness in the event the ACA is not repealed or found unconstitutional. This week\’s topic was the qualified health plan certification, and participants focused on not adding requirements beyond the ACA minimum benefit requirements.

CALIFORNIA: The Appropriations committees of both houses are wading through many bills that would have varying impacts on state finances.  Bills meeting certain dollar thresholds are sent to ‘suspense’ filing for consideration at later hearings.  Most of the legislation that Aetna and other allies have opposed has been sent to the ‘suspense’ filing, including a bill on rate regulation and all bills on benefit mandates, because of the fiscal impact of each bill and potential conflicts with federal guidance on essential benefits. These bills may be revived at a later date, or they may be held by the committees.  We expect the majority of the bills to be voted off the suspense file by the end of the month, including.

Rate regulation – According to Appropriations, there would be an annual fee-supported special fund cost of at least $30 million to DMHC and CDI.
Rate regulation – According to Appropriations, there would be an annual fee-supported special fund cost of at least $30 million to DMHC and CDI.
Autism mandate – According to the committee analysis, this bill would result in annual costs to the following state entities:
CalPERS: $9 million
Medi-Cal, for enrollees in managed care plans: $114 million
MRMIB plans (Healthy Families, AIM, MRMIP): $37 million

In state budget news, the governor will release his May revision to the state budget next week, taking into account new revenue figures that show the state taking in more than $2 billion in unanticipated new tax dollars. The governor still believes that asking voters to extend the higher tax rates set to expire this summer is the right thing to do because the higher revenue forecasts would not close the entire budget shortfall.  Republicans, however, have been quick to argue that higher revenue forecasts mean that extending tax rates is not needed at this time.

CONNECTICUT: The legislative session adjourns June 8, but the legislature has yet to reach a conclusion on several major issues, including an exchange bill, a rate review bill and the SustiNet bill.  Although the SustiNet compromise bill language is not public, the Administration and press reports have said that the bill does not include a public option but would create an advisory board on health reform implementation and examination of future state reforms. In addition, an anti-most favored nation clause bill has passed the House and now goes to the Senate for its consideration. Aetna supported the bill with amendments. The bill is expected to pass. Additionally, the recently released HHS rate review rule may push legislators to advocate for adoption of the federal 10 percent trigger for rate review in Connecticut, just in case the federal law is repealed.

DELAWARE: The Department of Insurance (DOI) submitted a medical loss ratio (MLR) waiver application to HHS for its individual health insurance market. The DOI-requested adjustment proposes a three-year phase-in of the MLR as follows: 65 percent for 2011, 70 percent for 2012, and 75 percent for 2013.

GEORGIA:  Governor Deal has signed legislation that applies state prompt-pay standards to self-funded plans.  Aetna will be working with self-funded customers who have questions about the validity of the new law and its application to their plans, which are generally covered by ERISA.

INDIANA: Insurance Commissioner Stephen Robertson submitted an MLR waiver request to HHS seeking relief from the MLR regulation for the individual market and for consumer-directed health plans in both the individual and small group markets.  Specifically, for the individual market, Indiana is requesting that the MLR be waived for the individual market through 2014, or, as an alternative, that it be phased in as follows: 65 percent in 2011, 68.75 percent in 2012, 72.5 percent in 2013, 76.25 percent in 2014, and 80 percent in 2015, with an exemption from the MLR requirement until 2014 for new market entrants (defined as those that have not previously sold individual major medical health insurance products in Indiana for the previous 10-year period). For consumer-directed health plans in the individual and small group markets, Indiana is requesting a permanent waiver from the federal MLR requirements.

MAINE: Governor LePage has signed into law an Act to Modify Rating Practices for Individual and Small Group Health Plans. The new law is designed to open up Maine\’s individual and small-group insurance market to competition. It also is supposed to:

help lower health insurance premiums by broadening Maine\’s community rating system and allowing insurance companies to base their premiums on a more flexible set of criteria.
allow Maine residents to purchase insurance in four New England states beginning in 2014.
set up a reinsurance pool to cover individuals with serious illnesses. The pool would be subsidized by a covered lives assessment capped at $4 per member per month.

The Maine People\’s Alliance (a progressive advocacy group), the Maine Democratic Party, and others are looking into the feasibility of initiating a referendum on the new law. In order to get a referendum on the November ballot, opponents would have to file approximately 60,000 signatures with the secretary of state no later than 90 days after the enactment of the bill on May 17, 2011.

MONTANA: Governor Brian Schweitzer has decided to reconsider his amendatory veto of legislation that prohibits the state from enforcing the individual responsibility requirement contained in the ACA.  Noting the critical role that the individual mandate plays in lowering the cost of coverage, the Governor\’s amendatory veto argued that the prohibition against enforcing the mandate in Montana should be contingent on whether residents have access to affordable coverage.  However, on May 13, the Governor reversed his position and signed the bill into law, as permitted under Montana\’s statutory procedural guidelines.  The provisions of the law include legislative findings stating that the ACA individual coverage requirement will cause unnecessary expense and inconvenience to individuals and employers, and therefore the legislature prohibits any agency of the state from enforcing the provisions of the ACA and subsequent federal regulations that relate to the individual coverage requirement. The law specifies that the prohibition extends to requiring public employees to purchase or maintain coverage and state officials or employees from participating in boards, commissions, or entities of the NAIC that are assigned to recommend provisions that implement the individual mandate.

NEVADA: HHS informed the Nevada Division of Insurance that the state\’s application for a transitional waiver from the MLR provisions contained in the ACA has been denied and amended.

In its response letter, HHS admits that application of the ACA MLR standard could in fact lead to destabilization of the state\’s individual market but argues that the transitional waiver requested by the state (72 percent) exceeds the amount necessary to prevent destabilization and would ‘deny consumers an excessive amount of benefit.\’  For this reason, HHS determined that Nevada should be granted a one-year transitional waiver under which the MLR for the state\’s individual market will be 75 percent in 2011.

SB 440, which would create the Silver State Exchange, had its first hearing on March 18 in the Finance Committee, but no action to advance the measure was taken.

NEW JERSEY: Last week the Department of Banking and Insurance (DOBI) announced that Horizon Blue Cross Blue Shield of New Jersey has officially withdrawn its application to convert to a for-profit entity.

In the final round of public budget hearings, the non-partisan Office of Legislative Services (OLS) and State Treasurer, Andrew Sidamon-Eristoff, testified that state revenue is now expected to exceed forecast by $600 to $900 million due to higher income tax collection. This was welcome news as the legislature and the Christie Administration wrestle with various program cuts under the current budget proposal. Leadership in the legislature has called for restoration of property tax rebates and reconsideration of the proposed changes to the Medicaid program.  It has been reported the Administration is seeking to change Medicaid eligibility to 33 percent of the federal poverty level. Democratic legislators have come out en masse opposing this change.

NEW YORK:  James Wrynn will be the deputy superintendent for Insurance under the Department of Financial Services (DFS) after the consolidation of the New York State Insurance Department, of which he is currently superintendent, with the Banking Department. Benjamin Lawsky was nominated to be the superintendent of the DFS. At packed confirmation hearings, Lawsky appeared before the Senate Insurance Committee and then the Senate Banking Committee. Lawsky said he understands that prior approval has become ‘overly politicized.’  He said he would make addressing this his ‘number one priority.’ He also said he planned to meet with all stakeholders on this issue in the coming months. He was unanimously approved by both Insurance and Banking Committees but must still appear before the Senate Finance Committee for its approval.

The NYS Department of Insurance held public hearings on exchanges that reports say were not well attended. The New York Health Plan Association testified that the success of any health insurance exchange boils down to the affordability of coverage it can offer.  The HPA said the best way to preserve affordability is through an independent authority, which could be created by passing very limited exchange legislation before the end of the legislative session. Such legislation could establish the governance and infrastructure of the exchange and charge it with conducting research to make recommendations regarding the policy issues that need to be addressed by 2014. A key issue to address is how to ensure that the exchange is financially sustainable by 2015, as the law requires.

NORTH CAROLINA: Legislation implementing an Exchange Advisory Board met with some consumer opposition last week.  Opposition centered mostly on the way in which the exchange will be funded.

OKLAHOMA:  In the final week of the legislative session, leadership in both chambers announced the formation of a special joint legislative committee to study how the new federal health care law affects Oklahoma. Senate Pro Tem Brian Bingman and House Speaker Kris Steele ordered the formation of the joint committee and announced that ‘studying this issue in more depth makes for healthy legislative process. The scope of this law is vast, so we need to make sure we are prepared to address this law in a conservative way that is best for Oklahoma.’ The committee will have bipartisan membership. The joint committee will hold a series of public meetings over the legislative interim focusing on how the ACA affects Oklahoma. The committee will also explore how to best approach the law as the state awaits the outcome of its lawsuit challenging the law\’s constitutionality. The committee will then make recommendations on how the state should address the federal health care law.

As a result, legislation that would create an Oklahoma health insurance exchange will not be heard this year.

TEXAS: The health care collaboratives that would be set up by pending legislation (Senate Bill authored by Senate Health and Human Services Chair Jane Nelson are intended to promote higher quality of care at lower cost. The collaboratives would allow groups of providers, such as hospitals and doctors, to bargain collectively with the people who pay them. The goal is to give providers more leverage in price negotiations with an eye to cutting overall health care costs. But staff at the Federal Trade Commission (FTC) say giving these collaboratives antitrust protection could have the opposite effect and could harm consumers. Staffers have flagged this key provision of the Lieutenant Governor\’s health care agenda for the session, indicating that a tool intended to improve the efficiency and quality of care in Texas might in actuality ‘lead to dramatically increased costs and decreased access to health care for Texas consumers.’ To get around any antitrust issues, SB 8 specifically gives collaboratives exemption from antitrust laws. The bill is in the final stages of passage and could be headed to the House floor at some point in the last 10 days of the legislative session.

Meanwhile, uncertainty hung over the Texas Capitol at the end of last week as budget negotiators worked to bridge the gulf between the House and Senate spending plans and avert a special legislative session. What had been a $5 billion difference Wednesday was narrowed to a few hundred million dollars as the House agreed to the Senate\’s proposal on public education. To help pay for the $3 billion added into the budget, the House relies on the $1.2 billion of additional state revenue announced by Comptroller Susan Combs this week. Lt. Gov. David Dewhurst said he was optimistic that a deal was in the offing. Negotiators are taking it down to the wire trying to complete their work by the end of the legislative session on May 30.

WISCONSIN: The Wisconsin Office of Free Market Health Care\’s (OFMHC) survey to gather stakeholder input on the design of a potential Wisconsin Health Insurance Exchange closed last week.  Now, the OFMHC will develop its plan for the exchange.  OFMHC has been tasked to design and implement a Wisconsin Health Insurance Exchange that utilizes a free-market, consumer driven approach.

Article Source: http://www.articlesbase.com/insurance-articles/health-insurance-reform-weekly-medical-cost-trends-for-2012-4821782.html

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Easy To Insure ME has the answers individual health insurance / Golden Rule insurance // Aetna health insurance

Nicholas Wright

The term ‘high risk’ is a bit of a misnomer. Not everyone who an insurance company considers high risk has a high risk lifestyle. They don\’t jump out of planes, or work as underwater welders. No, ‘high risk’ is insurance code for ‘likely not to pay.’ Anytime you are in a situation where you might have to pay another bill before your insurance bill, anytime you\’re health is put at risk, you become so classified.

In many ways, it\’s just as hard to shake off this label as it is to shake off a bad police record. If you\’re unemployed, working part-time, or have been recently diagnosed with a disease like cancer, you may find it almost impossible to get health insurance. However, if you are uninsured, not to worry – there are things that you can do. The government provides many programs for individuals with distressing situations that leave them unemployed — especially on the state level. If you happen to live in California, here are some things that you can do to get cheap health insurance:

Medi-Cal and Healthy Families

This is a program for those who cannot afford health care, especially families who can\’t afford their own health plan. You can get coverage if you\’re pregnant, if you\’re the caretaker of someone with a disability, if you\’re terminally ill, or a if you\’re a single parent with a child who is still living at home. It is also worth knowing that even if you don\’t qualify for Medi-Cal and Healthy Families, there is a good chance your children will (the income qualifications are higher for children then they are for adults). Usually the qualification is $40,000 or so for a family of 4. Along with health coverage, Medi-Cal and Healthy Families also offers income assistance to families in need as well.

Medicare

Usually, Medicare only applies to those individuals 65 years of age or older. However, if you have a disability or a serious medical condition, Medicare will often help you. To qualify, your disability will have to last at least a year (or at least be projected to last that long), or is expected to be the cause of your death (cancer, etc). In order to get Medicare if you are disabled, you have to apply for Social Security Disability Insurance (SSDI) for 2 years before you can enroll in Medicare.

Article Source: http://thehealthinsuranceblog.org/

Health Insurance

CALIFORNIA: The California Department of Insurance (CDI) has announced the release of e-mail notification system that will alert consumers when new individual health insurance rate filings are submitted.  CDI has previously announced that it would begin publicizing rate filings for individual health insurance policies.  Consumers are able to sign up online in the manner used for traditional e-mail updates.  CDI has also developed a consumer website with rate filing information.

NEW JERSEY: Following recent enactment of Governor Chris Christie\’s budget, the Democrat-controlled legislature passed supplemental appropriations bills to restore $24 million in funding for state\’s uninsured health coverage program, known as FamilyCare, as well as $7.4 million in aid for women\’s health and family planning programs. The FamilyCare restoration, if signed into law, would have allowed adults with income between 134 to 200 percent of the federal poverty level to remain in the program. Despite bipartisan support in the Senate, Governor Christie vetoed the legislation, saying that the state has reset spending to a level that taxpayers can afford. Legislative leadership has indicated they may try to override the governor\’s veto. Overriding the governor\’s veto would require a two-thirds majority in both houses.

NEW MEXICO: The Public Regulation Commission (PRC) has appointed John G. Franchini as the new Superintendent of Insurance, a position that has been vacant since the May 4 resignation of his predecessor, Morris Chavez.  Franchini was selected from among five finalists and will assume his new duties in mid-August.

OHIO: While the Strickland Administration has advised state agencies to begin planning for the next biennium at both current levels and with a 10 percent cut in funding levels, the Budget Planning and Management Commission has been conducting hearings preparing for Ohio\’s biennial budget adoption. The current budget ends on June 30, 2011 and is billions in the red. Testimony before the Commission has focused on increasing efficiencies by combining certain administrative functions of local and state governments and utilizing performance audits to determine if tax dollars are being spent efficiently. The Center for Community Solutions suggested to legislators that principal stakeholders in Medicaid (such as managed care companies and hospitals) be given budget targets and be asked to come up with ways to slow the growth of Medicaid. Conversely, the Health Policy Institute of Ohio guided legislators to the possibility of Ohio ‘rebalancing’ its long-term care spending to shift utilization from long-term care facilities to home and community-based services.

While PPACA-related budget priorities will take place after the next biennial budget is adopted, it was previously determined that the federal expansion of Medicaid eligibility as part of health care reform will cost the state $190 million in 2014 –rising to $332 million by 2019. Absent any federal law changes, annual costs will rise substantially in 2020 and beyond, as the federal government\’s match for new enrollees will drop to 90 percent of the total cost. The total state cost of Medicaid expansion from 2014 to 2019 is projected to be $1.45 billion.

OKLAHOMA: The Department of Insurance (DOI) announced last week that a final contract for the new temporary high-risk pool has been signed and sent back to HHS.  The DOI is in the process of drafting the application that will be used with the pool.  Oklahoma was awarded $60 million for use over 40 months.  Several candidates are being interviewed to be the High Risk Pool Manager.  Open enrollment will begin August 1 with an effective date of September 1.  Additionally, Oklahoma was the only state to request an open enrollment period for the PPACA provision requiring coverage of children under 19 in the individual market.  HHS has decided open enrollment periods will be permitted at the discretion of insurance companies.  On a separate issue, the Oklahoma Supreme Court has scheduled oral arguments to take place on August 4 in the lawsuit filed by Commissioner Kim Holland, on behalf of the DOI, challenging the constitutionality of a new 1 percent claims-paid fee passed by the legislature in late May.  The bill is scheduled to take effect August 27, absent court intervention.

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A weekly compilation from Aetna of health care-related developments in Washington, D.C. and state legislatures across the country. EasyToInsureME has the answers.

Week of April 25, 2011

The U.S. Supreme Court announced Monday that it had rejected a request from the state of Virginia to fast-track its challenge of the Affordable Care Act (ACA), which was signed into law in March 2010. The Court did not disclose the reasons behind its decision.  Since the 4th and 11th Circuits will be hearing arguments in the next two months on the constitutionality of the individual mandate, it is much more likely that once these two Circuits have spoken the Supreme Court will be more inclined to resolve the matter with some finality.

While the lawsuits filed by a number of states march on through the normal appeals process, some of the states are taking the unusual step of turning down money available to help fund implementation of the law. Oklahoma, for one, has turned down $54.6 million in demonstration grants to distance itself from the law. But Idaho Governor C.L. ‘Butch’ Otter upped the ante last week when he issued an executive order prohibiting state agencies from implementing any aspect of the health reform law and from accepting federal funds tied to implementation of the law. While some question whether such outright defiance of the law would hold up as constitutional, the situation underscores the bitterness felt by some state leaders toward the law. In some cases, implementation can be expected to move at a snail\’s pace, if at all, until the U.S. Supreme Court weighs in on the issue.

Federal

With Congress on recess last week, there is no Federal report for this week.

States

ARIZONA:  The legislature adjourned last week after a contentious and partisan session. Governor Jan Brewer has until May 2, to sign or veto legislation, but the final status on several bills affecting health insurers and their customers is already known:

A bill that would have established the Arizona Health Exchange, governed by a board of directors that included insurer representation, was voted out of committee but did not make it out of the House. The legislation was based on the NAIC model.
A bill that would have required health insurers to provide a written claims information report within 30 days of receiving a request from a plan, plan sponsor, or plan administrator was passed in both chambers but died when a required conference committee failed to consider the matter prior to adjournment.
A bill that would have established the procedural mechanisms for an interstate compact to work with other states to avoid implementing provisions of the ACA was passed by both chambers but was vetoed by Governor Jan Brewer.
A bill that would have prohibited contracts from requiring providers to assume the cost of acquiring vaccines and would have mandated reimbursement of providers for vaccine acquisition costs and administration was scrapped. Health insurers committed to meeting with the Arizona Academy of Pediatrics to reach a resolution without legislation.

In other matters, the Department of Insurance announced that it will hold a series of community meetings around the state to provide information about health insurance premiums in the individual and small group markets.

CALIFORNIA:  Governor Jerry Brown signed a bill into law last week that eases administrative and cost burdens on employers and individuals, come tax time, by conforming to federal rules relating to the taxation of dependent coverage. As a result, employers and their employees will not have to deal with the complications of complying with differing tax rules.  Aetna joined a diverse coalition of business, labor, and other groups in helping to focus attention on the need for this legislation. Also, the California Health Benefits Exchange board met for the first time last week, a step toward implementing the first reform-prompted insurance exchange in the nation. The Board spent most of it time on administrative decisions and announced the appointment of interim administrative director, Pat Powers, who is now president of the nonprofit Center for Health Improvement.

In other news, Aetna is seeking amendments to a bill that would direct state regulators to develop a single prior authorization form to be used by providers and plans in seeking authorization for prescriptions.  The bill already has been amended to reflect some the industries\’ concerns. But other issues remain to be resolved, including the timeframe that plans would be allotted to approve prior authorization requests.  Aetna and others are seeking more flexibility on that issue and want to ensure the legislation does not conflict with what CMS or other national workgroups are developing. The bill passed the Senate Health committee last week.

CONNECTICUT:  The Governor and legislative leadership announced a budget deal last week that does not include a proposed premium tax increase. A premium tax increase (from 1.75 percent to 1.95 percent) was designed to raise $25 million for the state but would have triggered retaliatory taxes for Connecticut-domiciled insurers, including Aetna, sending approximately $49 million to other states. A coalition that included Aetna, the state trade association, property/casualty insurers and life insurers was able to convince state leaders that lowering tax credits (until 2013) to drive about $25 million in new revenue was a better id.

The administration and Democratic legislative leaders also announced an agreement on the proposed SustiNet state-run health plan. This agreement combines aspects of the SustiNet bill with the Connecticut Healthcare Partnership bill.  The new deal calls for opening the state employee health plan to municipalities and some non-profits but not to the public. The agreement also would establish a ‘SustiNet cabinet’ advisory panel within the lieutenant governor\’s office to oversee health reform efforts in the state. The agreement does not call for the state to combine the Medicaid and state employee and retiree health plans into a large pool (as the current SustiNet proposal would).  Legislative language for the new proposal is still being developed, but it is clear the bill will not include the SustiNet quasi-public authority or a public option.

In the next fiscal year, municipalities would be allowed to buy coverage through the state employee and retiree plan, under the new agreement. Non-profits that have contracts with the state could buy in beginning the following fiscal year. The agreement does not include allowing small businesses to buy coverage through the state employee plan. Whether the state health plan is ultimately expanded further will depend how the initial round of pooling goes and whether expansion is considered necessary once federal health reform rolls out. As part of health reform, the state plans to establish an insurance exchange by 2014.

GEORGIA: America\’s Health Insurance Plans (AHIP) will be submitting a letter to Governor Nathan Deal urging him to veto prompt-pay legislation that would apply insurer claims-payment standards to self-funded plans.  Also passed and awaiting the Governor\’s signature is a bill that would allow for sale of coverage across state lines.

MAINE: A revised state supplemental budget that covers a $65 million gap between revenues and spending is now law. Last week Gov. Paul LePage signed the bill, which had unanimous, bipartisan support. Most of the $65 million gap resulted from cost overruns in the state Department of Health and Human Services. The supplemental budget appropriated unspent funds from various state agencies to fill the gap. The budget addresses spending in fiscal 2011, which ends June 30. A two-year budget starting July 1 is still being deliberated.

NEW YORK: Less than one week after the Cuomo administration held a meeting to gather input on a health insurance exchange, Senate Republicans will hold their own open Roundtable on Exchanges this week to gather similar input. The roundtable discussion will be chaired by Senate Insurance Committee Chair Jim Seward and Senate Health Committee Chair Kemp Hannon. Although only trade associations were invited to participate, the meeting will be open to observers. At the administration\’s first exchange meeting, the consumer lobby made it clear that they support an exchange that is either a government agency or public authority that is an active purchaser. The NYS Association of Health Underwriters advocated for a merger of the individual and small group markets combined with an expanded definition of small groups up to 100. Some small businesses, however, spoke against such a merger. The Business Council of NYS made the point that an exchange with all of New York\’s mandated benefits, aggressive purchasing and extensive consumer components may not be sustainable.  There was no discussion of financing. It is anticipated that future meetings and public hearings will be scheduled by the Cuomo administration to solicit public input.

Citizen Action of New York is pushing for a health insurance exchange that is exactly opposite of the market-based model advocated earlier this month by the Manhattan Institute. The consumer group said in a statement last week that some of the recommendations of the pro-business Manhattan Institute ‘would undermine the rights of consumers.’ Citizen Action\’s research and education affiliate, Public Policy and Education Fund of New York, recommends one statewide exchange that functions as an independent authority and coordinates its enforcement efforts with the state Insurance Department and the attorney general. Citizen Action also wants heavy consumer representation on the governing board and a significant increase in penalties for violations of the new federal law.

TEXAS: The House passed a bill  that would allow the state to enter into a health care ‘compact’ with like-minded states. The bill, passed on a party line 102-46 vote, is a grab for some of the control over health care currently held by the federal government. Lawmakers in several other states are considering similar initiatives. The bill would require at least one state partner and approval from Congress before it could go into effect. Proponents say the bill would help Texas stretch its health dollars further and better deal with spiraling costs. Critics say it would remove a key federal safety net and cut back on already strapped programs for the the poor and elderly. The legislation faces a final procedural vote before moving to the Senate.

WASHINGTON: The Governor is expected to sign legislation establishing a state health insurance exchange as a non-profit, public private partnership with a governing board consisting of nine members.  The bipartisan legislation directs the board, in consultation with the Washington State Health Care Authority, to develop a range of recommendations for establishing/implementing the exchange using stakeholder input and recognizing the need for a private market outside of the exchange. The board\’s recommendations would need to be ratified by the legislature during the 2012 legislative session.

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Health Insurance

Recently barred fast track resolution by the U.S. Supreme Court, opponents of the Affordable Care Act (ACA) have resumed their legal quest to derail the law through the traditional Circuit Court route. Twenty-six states last week filed a motion in the 11th Circuit Court of Appeals in Atlanta urging the court to strike down the health care overhaul law. The motion asks the court to uphold a Florida federal judge\’s ruling that the law\’s core requirement, that everyone purchase health coverage, is unconstitutional. The filing comes about a month after the Obama administration formally appealed the Florida ruling. Once the 11th and 4th Circuits rule on ACA appeals, the U.S. Supreme Court is finally expected to take on the issue and become the final arbiter — but probably not until late 2012.

Federal

Last week the Republican-controlled House approved two bills  that would repeal funding for construction of school-based health centers and assist the states in establishing school-based health centers, as otherwise authorized by ACA.  Both items are part of a package of bills that are coming to the House floor to either repeal or revise ACA provisions that provide funding for various parts of the health care reform law. Neither will make it though the Democratic Senate, nor get past the President\’s veto pen. This effort is all about setting up various lines in the sand from which to bargain with respect to the bigger battle over the budget and the national debt.  Whether either side will back down remains unclear. But it is clear that Republicans and Democrats are preparing for a major fight just around the corner.

On the Senate side, the top Republican on the Senate Finance Committee, Senator Orrin Hatch (R-UT), introduced legislation designed to further erode a provision of ACA.  The Senator\’s legislation proposes repeal of the Medicaid/CHIP Maintenance of Effort (MOE) provision in ACA, which would give the states financial relief from the funding requirements demanded by ACA.  While the House companion bill (Congressman Phil Gingrey, R-GA) may have better luck than the Hatch bill in the Senate, this effort may have more life than other anti-ACA proposals because the states are in dire financial straits and both Republican and Democratic governors are clamoring for relief from Washington.

States

CALIFORNIA: The 2011 version of a hospital transparency bill was unanimously voted out of the Senate Health Committee last week. The legislation would prohibit hospitals from including provisions, commonly referred to as ‘gag-clauses,’ in contracts with health insurers. These provisions prevent disclosure of hospital cost and quality information to health plan members. Individual hospital systems, the UC System and the California Hospital Association continue to oppose the bill, while insurers, payers and labor unions support the measure.  Also, the Senate Health Committee last week announced its new policy of making almost all benefit mandate proposals two-year bills. The Chair believes that the legislature should wait until the federal government defines essential health benefits under the ACA.  The only exception to this committee policy will be the maternity mandate bill, which the Chair believes is certain to be part of the essential benefits package.  There have been a dozen benefit mandates bills introduced this year.

COLORADO:  The Colorado General Assembly passed an insurance exchange bill after the Senate concurred to amendments added by the House. Passage of the bipartisan-sponsored bill is the culmination of nearly nine months of work that drew the support of the governor, business and the health insurance industry. Key bill provisions include:

Establishes an exchange as a nonprofit, unincorporated public entity
Designed to foster a competitive market, the exchange shall not solicit bids or engage in the active purchase of insurance
No duplication of Division of Insurance regulatory authority, including rate review
All carriers licensed in Colorado may be eligible to participate
Governed by a nine-member board of directors appointed by the governor and legislative leadership; plus three non-voting ex officio members
Majority of voting board members shall not be directly affiliated with the insurance industry
A legislative implementation review committee will review grant applications, financial and operational plans and have the ability to propose up to five bills per session
No separate state appropriation was made to fund the implementation

The bill does not address substantive issues such as the merging of the individual and small group markets or the size of eligible small employers.

CONNECTICUT: Governor Dannel Malloy last week signed a biennium budget bill, without a proposed increase in the premium tax. To avoid paying $50 million in retaliatory taxes to other states, insurers supported temporarily lowering the amount of premium tax credits that can be used, from 70 percent to 30 percent for two years.  The budget includes the tax credit measure, which will sunset in 2013 .

Legislators are now focusing on other issues, including rate review. If enacted, the current rate review bill would: require a lengthy notice and public hearing timeline for all proposed rate increases; authorize the Healthcare Advocate and the Attorney General to be parties to any hearing; and broadly define ‘excessive’ to include consideration of commissions, transfer of funds to a holding or parent company, the rate of return on assets or profitability, and a ‘reasonable’ profit margin. The bill would also require that plans send written notice to insureds or subscribers of both the proposed rate and, later, the new rate. This bill would be effective July 1, 2011. The estimated cost of holding hearings for all proposed rate increases of 10 percent or more is $2 million, for a department that has an annual budget of $25 million. The bill was voted out of the Appropriations Committee nonetheless. If the bill were to be voted on today, it likely would pass. However, Insurance Commissioner Thomas B. Leonardi raised concerns about the potential cost and workload. The current law allows for the insurance commissioner to hold a rate hearing at his discretion. Leonardi said rates that aren\’t justified by actuarial science will be rejected. Senate Insurance Chair Joe Crisco called the bill a ‘work in progress’ and said he and other legislators will be working with Leonardi.

KANSAS: Kansas has joined the growing list of states asking the federal Department of Health and Human Services (HHS) for a waiver of ACA\’s minimum loss ratio (MLR) requirements. If granted, the waiver would allow Kansas carriers until 2014 to fully comply with the 80 percent requirement under federal law. In a letter to HHS Secretary Kathleen Sebelius, Insurance Commissioner Sandy Praeger proposed a rule modification for the individual market to allow for a gradual implementation of the 80 percent requirement. The waiver would offer companies appropriate time to adjust their business practices and maximize opportunities for new companies to enter the Kansas market. The current MLR requirement for major medical coverage in the state\’s individual market is 55 percent.  Commissioner Praeger\’s letter proposes adjustments to the MLR standard at 70 percent in 2011, 73 percent in 2012, 76 percent in 2013 and 80 percent in 2014. To date, Maine is the only state to have received approval from HHS for a waiver. Guam and nine other states — Florida, Georgia, Iowa, Kansas, Kentucky, Louisiana, North Dakota, Nevada, and New Hampshire — have submitted waiver applications that are pending.

MAINE: The House last week voted 76-72 to approve an ambitious health care reform bill introduced by the Republican majority. The bill would overhaul Maine\’s health insurance system and create a new one designed to foster more competition. If enacted, the bill would repeal Maine\’s standard benefit package and geographic access rules (Rule 750 and Rule 850) and expand the rating bands to open up the individual and small-group insurance market to greater competition. The changes in rating for individual health plans and small group plans would be phased in over four years, with a maximum rate differential of 1.5:1 to 5:1, based on age, for individual and small group health plans. The bill also would authorize the renewal of short-term health insurance policies for a period not to exceed 24 months, instead of the current 12-month limit. By 2014, the bill would allow Maine residents to purchase insurance across state lines in four New England states: Connecticut, Massachusetts, New Hampshire or Rhode Island. In addition, it would establish an individual market reinsurance pool to be funded through a covered lives assessment capped at $4 per month, per person. The bill is likely to pass the Senate as well, where Republicans hold a 20-14 majority.

In other legislative action, the Health and Human Services Committee heard testimony on a bill to repeal Maine\’s 2003 Pharmacy Benefit Management (PBM) law. The law requiring PBMs to disclose contractual agreements with drug makers has been detrimental to the growth of competition. Medco testified that the law has led the company to turn down business in Maine. Express Scripts and Caremark, which is owned by drugstore chain CVS, also testified in support of repeal, portraying the law as the ‘most extreme in the country.’ Michael Cianchette, an attorney for the LePage administration agreed, saying that Maine should conform to the national norm. Community pharmacies, which face competition from PBMs\’ mail-order operations, oppose the repealer.

NEW JERSEY: Both chambers of the legislature are fully engaged in budget hearings as the legislative and executive branches work toward passing a balanced budget by the June 30 deadline. Proposed changes to Medicaid have been a hot button issue, as the state attempts to address a $1.3 billion deficit in the program.  The Department of Human Services testified that it has already started moving 200,000 Medicaid participants to managed care plans and will be working the Department of Health and Senior Services to take similar action with the long-term care population.

On the legislative front, Senate President Stephen Sweeney announced last week that he will be amending his bill to reform health benefits for public sector employees. The current legislation calls for a moratorium on governmental entities joining the State Health Benefits Plan (SHBP).  Due to alleged conflict of interest claims, the Senate President has decided to remove this provision, which will continue to allow local governments the option of providing health benefits through either a commercial plan or the SHBP. Reform of public employees\’ benefits is major part of Governor Chris Christie\’s initiative to save more than $300 million in the coming fiscal year.

NEW YORK: The New York City Human Resources Administration (HRA) wants the state to be aware that a statewide exchange solution may not work well for them. The HRA released a brief discussing the creation of a Navigator program, which gives grants to qualified organizations to provide health insurance education and enrollment assistance services. HRA\’s brief focuses on such a program in the city and looks at the most effective ways to implement the required services.

OKLAHOMA:  The health care compact measure pressed by state Sen. Clark Jolley cleared the House last week and now returns to the state Senate for final consideration. The bill lays out the basis for Oklahoma\’s participation in an agreement with other states in an attempt to restore authority and responsibility for health care regulation to member states. The compact would allow Oklahoma to create health care policies by joining an interstate compact that supporters believe supersedes prior federal law. The compact, which has been introduced in 14 states, was signed recently into law in Georgia. The concept is also advancing in Missouri, where a compact proposal cleared the state Senate and is headed to Governor Jay Nixon. Compact proposals are also alive in Montana, Colorado and Texas.

TEXAS:  Republicans pushed the next two-year budget through the Texas Senate last week by using a procedural maneuver to bypass Senate tradition requiring a two-thirds agreement to consider any legislation. Senators voted 19-12, along party lines, to approve the plan. The move clears a path for negotiations to begin with the House on the $176.5 billion spending plan. The plan would make about $11 billion in cuts, which is less severe than those in the bare-bones House version. Public schools and Medicaid providers, including nursing homes, would take the brunt of the cuts. In the face of criticism on both sides of the aisle, Senator Steve Ogden, the bill author, offered an amendment that stripped about $3 billion in rainy-day fund money from the budget. The move helped garner support from conservative Republican senators but cost the support of key Democrats.

Ogden\’s GOP-condoned compromise replaces about $3 billion in rainy-day money by underfunding Medicaid, pushing those payments to the end of the budget period. Absent increased revenue from an improving economy, the budget would then force across-the-board cuts to state agencies other than basic public school operations. Ogden\’s plan underfunds public schools by about $4 billion. It cuts reimbursement rates to Medicaid providers by 6 percent, compared to more than 10 percent proposed in the House. Senate leaders are bracing for tough negotiations with the conservative House. The state is facing a revenue shortfall of at least $15 billion. The legislature has until May 30 to reach a deal and avoid a special session to resolve the issue.

VERMONT: The House last week voted to approve a single-payer measure, which now advances to the governor\’s desk for signing. Governor Peter Shumlin is expected to sign it. The bill passed in the House by a vote of 94-49 and was passed earlier in the Senate by a 21-9 vote. In addition to establishing a single-payer system, the bill would establish new rate review requirements and a Vermont Health Benefit Exchange that would be operational by 2014, in accordance with the ACA. A single-payer system would begin in 2017, when the ACA begins to allow states to request waivers to opt out of many of its requirements, or earlier with federal approval.

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Health Insurance

As per the present scenario of lifestyle, it is quite unpredictable in terms of health. So, one should always be prepared with Georgia health insurance plan for individuals. If god forbids, you may not be aware of the unforeseen medical conditions that might leave you in problem. At this particular time slot, it is the individual health plan that would come to your rescue. It is very imperative that you realize the need and start taking an attempt towards getting the best individual health insurance plan for safeguarding yourself against any mishap. When looking for such type of insurance plan, you should start checking out some good offers on the internet. Besides just loading you with details for plans and companies that can offer some reasonable and all-inclusive health insurance, the insurance seeker would achieve a platform for doing comparison also.

Georgia health insurance for individuals, as the name says it all, is bought for one person only. In fact, it can be bought for every single person in a family to give them complete safety. As per the rules of the individual health insurance plan is concerned, insured amount in this case is obtainable for the single person that is covered under the plan. Now, the premium of the individual health insurance depends on the age category of the individual and the amount that is being insured. If you have taken such kind of policy for every member of the family; then, each policy has to be managed as a detached policy. No one person can use of the insured sum of other for his medical purposes. This will enable the insured person to safeguard himself against any unforeseen incident that might require immediate hospitalization.

The best part of the Georgia health insurance plan for individual is that it allows the person to get maximum coverage for the medical issues associated with him. Apart from this, the policy would never lapse for the insured person, even if he or she reaches its maximum renewable age group. Also, such type of insurance policies is just about ideal for those families that have higher health risks. In this way, they will get each of the family member would get proper coverage for their illness. Indeed, the coverage would include hospitalization charges, operation cost, room charges, medication, doctor\’s visit and also various kinds of appliance charges that are incurred by certain hospitals. Well, what is best about such policies is that the insurance seeker does not have to spend even a single penny from his pocket.

Certain areas that are meant to be a part of Georgia health insurance plan for individuals are personal accident, maternity insurance, heart diseases and also neurological surgeries. Well, insurance is a matter of solicitation and the aspirant insurance seeker should read out the papers carefully by paying attention to each and every feature included. After all, it is the matter of resting your trust on a company in terms of health and no compromises or neglection would be acceptable.

Georgia health insurance plan is the ideal choice to get every member if your family covered for different ailments, as per their requirement.

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Health Insurance

Giving insurance covers for your employees can help you attract the best in the business. Group health insurance is an ideal step, if you wish for your business entity organization to be filled with people who are good. A group Georgia health insurance policy is much cheaper contrasted to an individual insurance plan as the cost of premium is spread across all the employees in the company. Georgia health insurance plan for group provides a lot of advantages and it is indeed the right decision, read on to learn the various benefits. Such a plan helps in elevating the morale amongst employees. Let\’s face it everyone wants benefits and when the company plans a safe future for them they feel more motivated. Safety measures are most the important benefit of a group health insurance. Knowing that the organization cares about one\’s health, people will be agreeing to work harder. Top management can also be at ease knowing that the wellbeing of their employees will be taken care of if something were to go wrong.

The pricing procedure in Georgia health insurance plan for group is fundamentally the same as pricing in other industries. The insurance company must produce enough revenue to cover the cost of its claims and expenses and contribute to the surplus of the company. It differs in that the price of a group insurance product is initially determined on the basis of expected future events and may also be subject to experience rating so that the final price to the bond holder can be determined only after the coverage period has ended. Georgia health insurance plan for group\’s pricing consist of two steps. The determination of a unit price, referred to as a rate or payment rate for each unit of benefit. The purpose of the total price or premium that will be paid by the contract holder for all of the coverage bought. The approach to group insurance rate making varies depending on whether physical rating or experience rating is used. In the case of physical rating, the premium rate is decided separately of a particular groups claim experience.

Numerous group insurance plans are cost efficient, if you generally have twenty five or more employees. This comprises of the owners or principles of the company. The more employees you have the more your cost is lessened. Certain companies stay away from purchasing small business group health insurance programs because they are worried about the continuation and the manpower that it will take. This seems to be an insurmountable solution for most. The good news is, most insurance companies, along with Georgia health insurance plan providers, will do the work for you by offering you a safe web based site for your company employees to sign up for medical, voluntary dental, life, hearing, spending accounts, complete applications, and manage their policies. The payroll subtraction can also be provided. Getting to start up in obtaining information is easy. Study can be carried out online by visiting the insurance websites. The sites are user friendly and have a wealth of information on the programs they can customize to suit your needs. Take your time to purchase around to find the company that will give you with the best solution on reasonable and quality insurance.

Georgia health insurance plan for group is a beneficial idea, in terms of corporate level as it comes with varied benefits that would also include the family of the employee insured.

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Health Insurance

‘Insurance is a matter of solicitation’! This is one such phrase that makes it viable to go through the documents of the insurance plan and be aware of all the advantages, with risk factors. Well, this does not mean that buying Georgia health insurance plan is a risky matter or it would mar your hard earned money. These health plans are quite safe and meant to provide a medical safety to the whole family. In today\’s world of shaky finances and unemployment, health insurance are somewhat a lot of people tend to get rid of to save a few dollars. Health insurance premium might come out to be slightly costly, but so is health care. No one wants to get unwell or have an accident, but regrettably life is unpredictable. And it is this unsure life that makes it necessary for the people to get Georgia health insurance plan.

By raising the out of pocket subtractions on your insurance you can cut your premium costs. Though, only raise the deductible to an amount you know you can pay for. Then, put the amount of the deductible in a savings account so it is there when you need it. If not, you are on a plan where your company takes on a portion of the premium of Georgia health insurance plan, believe shopping around for better rates. You may be surprised what an autonomous insurance agent can offer you. Typically, when one thinks about what one wants covered, we memorize to take into consideration doctor visits, injuries, sickness, lab work, hospital stays, and those kinds of fun things, but there are many supplementary things that many do not think about that requires additional coverage. It is especially important to make sure all your needs will be met if you have your health insurance through your employer. Do not suppose that Georgia health insurance plan through your employer will be good enough for you. You may need to add extra advantages to your insurance to get the suitable coverage that you need.

The examination shows that people with Georgia health insurance plan are more likely to have a routine doctor and get care when they need it. This is largely due to they know they are sheltered by the plan and they will not need to be agonize of where the find the funds to settle the bills. Hence, having a good plan and lead to you getting an enhanced health care as well. Getting a plan will defend yourself and your family from hunting for money to pay off the medical bills which can be really pricey. As health is something erratic, no one can predict when they will fall sick. A healthy person can abruptly be diagnosed with a life taking disease while a smoker can live with no dangerous sickness. These are all beyond our predictions. A brilliant Georgia health insurance plan will help you to save before the rainy days appear. You may think that you do not need one as there is public healthcare available. But ask yourself these questions whether you can you wait for your turn and how long is the waiting list.

Georgia health insurance plan is designed to help every individual, who buys it. Indeed, the plan is aimed at giving regular medical services to the applicant with complete health care.

Article Source: http://www.articlesbase.com/insurance-articles/need-for-georgia-health-insurance-plan-5472183.html

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Georgia Health Insurance has multiple health care resources to gather the right information and get the best health insurance rates available. To know more about Georgia health insurance plan, GA Health Insurance, Health Insurance Quotes visit http://www.georgiahealthinsuranceratesplans.com/