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Fact Sheets Home Health Care

October 12, 2011 cakpuad Home

Home health care helps seniors live independently for as long as possible, given the limits of their medical condition. It covers a wide range of services and can often delay the need for long-term nursing home care.

More specifically, home health care may include occupational and physical therapy, speech therapy, and even skilled nursing. It may involve helping the elderly with activities of daily living such as bathing, dressing, and eating. Or it may include assistance with cooking, cleaning, other housekeeping jobs, and monitoring one’s daily regimen of prescription and over-the-counter medications.

At this point, it is important to understand the difference between home health care and home care services. Although they sound the same (and home health care may include some home care services), home health care is more medically oriented. While home care typically includes chore and housecleaning services, home health care usually involves helping seniors recover from an illness or injury. That is why the people who provide home health care are often licensed practical nurses, therapists, or home health aides. Most work for home health agencies, hospitals, or public health departments that are licensed by the state.

How Do I Make Sure That Home Health Care Is Quality Care?
As with any important purchase, it is always a good idea to talk with friends, neighbors, and your local area agency on aging to learn more about the home health care agencies in your community.
In looking for a home health care agency, the following 20 questions can be used to help guide your search:

How long has the agency been serving this community? Does the agency have any printed brochures describing the services it offers and how much they cost? If so, get one. Is the agency an approved Medicare provider? Is the quality of care certified by a national accrediting body such as the Joint Commission for the Accreditation of Healthcare Organizations? Does the agency have a current license to practice (if required in the state where you live)? Does the agency offer seniors a “Patients’ Bill of Rights” that describes the rights and responsibilities of both the agency and the senior being cared for? Does the agency write a plan of care for the patient (with input from the patient, his or her doctor and family), and update the plan as necessary? Does the care plan outline the patient’s course of treatment, describing the specific tasks to be performed by each caregiver? How closely do supervisors oversee care to ensure quality? Will agency caregivers keep family members informed about the kind of care their loved one is getting? Are agency staff members available around the clock, seven days a week, if necessary? Does the agency have a nursing supervisor available to provide on-call assistance 24 hours a day? How does the agency ensure patient confidentiality? How are agency caregivers hired and trained? What is the procedure for resolving problems when they occur, and who can I call with questions or complaints? How does the agency handle billing? Is there a sliding fee schedule based on ability to pay, and is financial assistance available to pay for services? Will the agency provide a list of references for its caregivers? Who does the agency call if the home health care worker cannot come when scheduled? What type of employee screening is done?

When purchasing home health care directly from an individual provider (instead of through an agency), it is even more important to screen the person thoroughly. This should include an interview with the home health caregiver to make sure that he or she is qualified for the job. You should request references. Also, prepare for the interview by making a list if any special needs the senior might have. For example, you would want to note whether the elderly patient needs help getting into or out of a wheelchair. Clearly, if this is the case, the home health caregiver must be able to provide that assistance. The screening process will go easier if you have a better idea of what you are looking for first.

Another thing to remember is that it always helps to look ahead, anticipate changing needs, and have a backup plan for special situations. Since every employee occasionally needs time off (or a vacation), it is unrealistic to assume that one home health care worker will always be around to provide care. Seniors or family members who hire home health workers directly may want to consider interviewing a second part-time or on-call person who can be available when the primary caregiver cannot be. Calling an agency for temporary respite care also may help to solve this problem (see the Respite Care fact sheet for more information about these services).

In any event, whether you arrange for home health care through an agency or hire an independent home health care aide on an individual basis, it helps to spend some time preparing for the person who will be doing the work. Ideally, you could spend a day with him or her, before the job formally begins, to discuss what will be involved in the daily routine. If nothing else, tell the home health care provider (both verbally and in writing) the following things that he or she should know about the senior:

Illnesses/injuries, and signs of an emergency medical situation Likes and dislikes Medications, and how and when they should be taken Need for dentures, eyeglasses, canes, walkers, etc. Possible behavior problems and how best to deal with them Problems getting around (in or out of a wheelchair, for example, or trouble walking) Special diets or nutritional needs Therapeutic exercises.

In addition, you should give the home health care provider more information about:

Clothing the senior may need (if/when it gets too hot or too cold) How you can be contacted (and who else should be contacted in an emergency) How to find and use medical supplies and medications When to lock up the apartment/house and where to find the keys Where to find food, cooking utensils, and serving items Where to find cleaning supplies Where to find light bulbs and flash lights, and where the fuse box is located (in case of a power failure) Where to find the washer, dryer, and other household appliances (as well as instructions for how to use them).

A WORD OF CAUTION . . .
Although most states require that home health care agencies perform criminal background checks on their workers and carefully screen job applicants for these positions, the actual regulations will vary depending on where you live. Therefore, before contacting a home health care agency, you may want to call your local area agency on aging or department of public health to learn what laws apply in your state.

HOW CAN I PAY FOR HOME HEALTH CARE?
The cost of home health care varies across states and within states. In addition, costs will fluctuate depending on the type of health care professional required. Home care services can be paid for directly by the patient and his or her family members, or through a variety of public and private sources. Sources for home health care funding include Medicare, Medicaid, the Older Americans Act, the Veterans’ Administration, and private insurance.

Medicare is the largest single payer of home care services. The Medicare program will pay for home health care if all of the following conditions are met:

The patient must be homebound and under a doctor’s care; The patient must need skilled nursing care, or occupational, physical, or speech therapy, on at least an intermittent basis (that is, regularly but not continuously) The services provided must be under a doctor’s supervision and performed as part of a home health care plan written specifically for that patient The patient must be eligible for the Medicare program and the services ordered must be “medically reasonable and necessary” The home health care agency providing the services must be certified by the Medicare program.

To get help with your Medicare questions, call 1-800-MEDICARE (1-800-633-4227, TTY/TDD: 1-877-486-2048 for the speech and hearing impaired) or look on the Internet at http://www.medicare.gov.

WHERE CAN I LEARN MORE ABOUT HOME HEALTH CARE?
There are several national organizations that can provide additional consumer information about home health care services. These include the following:

The National Association for Home Care, which can be reached at 202-547-7424 or by visiting its website at www.nahc.org. The postal address is: 228 7th St., SE; Washington, DC 20003. The Visiting Nurse Associations of America, which can be reached at 617-737-3200 or by visiting its website at http://www.vnaa.org. The postal addresses are: 99 Summer St., Suite 1700; Boston, MA 02110.

To find out more about home health care programs where you live, you will want to contact your local aging information and assistance provider or area agency on aging (AAA). The Eldercare Locator, a public service of the Administration on Aging (at 1-800-677-1116 or http://www.eldercare.gov  can help connect you to these agencies.

Case Study

WHEN IS HOME HEALTH CARE APPROPRIATE?
Because it is not always clear to the average person when an ailing senior needs home health care and when he or she needs nursing home care, it is usually best to consult a medical professional for advice. The following case study describes one situation in which home health care proved to be the right choice.
Francis is 84 years old and recently had a stroke. She was hospitalized briefly and then discharged to continue recovering at home. To enable her to return home, her doctor called a home health care agency, and the agency gave Francis a complete home health care plan for six weeks. Since the doctor ordered the home care for Francis, Medicare paid for it.

For the first week after Francis went home, a nurse visited her every day. The nurse met with Francis’s family to discuss her special dietary needs and to arrange for exercise therapy to help Francis regain her strength. Once that was done, the nurse visited Francis twice a week to check on how well she was recovering. The home health care agency also sent a homemaker, a personal care attendant, and a physical therapist to visit Francis several times during the week. The homemaker would do the shopping and cook light meals. The personal care attendant would help Francis bathe, get dressed, and walk. The physical therapist would keep Francis moving and see to it that she got some exercise to aid in her recovery.

 

 

 

 

 

 

 

 

 

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Health Insurance Reform From Easytoinsureme Health Insurance Quotes

March 22, 2011 cakpuad Home

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 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 .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 .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 Reforms Easy To Insure Me Health Insurance Quotes

February 10, 2011 cakpuad Home

President Obama’s Health Insurance Bill

President Obama Releases New Health Care Proposal in Time for Health Summit: On Monday February 22, 2010, White House officials unveiled a new health insurance reform overhaul that builds on the Senate version passed last Christmas Eve, with some changes aimed at pleasing House Democrats who had concerns with the Senate bill. The President’s proposal does not include the public option, despite the hopes of Senate Democrats, due to White House concerns that the provision will hinder passage in the Senate. President Obama ignored requests by Republicans to scratch the Democratic plan and start over. As such, Republican leaders questioned Democratic motives and labeled the bill as a massive government takeover of America’s health care system.

Republicans Insist House Democrats Don’t Have the Votes to Pass Legislation: Minority Whip Eric Cantor (R-VA) announced on Wednesday that Democrats don’t have the necessary votes to pass the President’s proposal in the House because of three new House vacancies and lagging support among some moderate Democrats. At issue for some Democrats are weaker abortion provisions in the President’s proposal as well as the ongoing controversy over passing a bill by a simple majority, a process known as reconciliation.

Health Care Summit Preview

On Thursday, the President’s Health Care Summit began at 10:00 a.m. with opening comments from the President, followed by remarks from both Republicans and Democrats. The discussion centered on four themes: controlling health care costs, overhauling the insurance market, reducing the deficit and expanding insurance coverage. Prior to Thursday, several top Republicans and some Democrats stated that expectations were extremely low for the Summit’s success.

House Republicans arrived armed with their own version of a health care bill that encourages small businesses to join together to buy insurance, gives federal money to states to run high-risk pools for those unable to obtain private insurance and limits damages in medical malpractice lawsuits. The Republican plan would cost billion and cover three million people over ten years. In contrast, President Obama contends his plan would cost 0 billion and cover 30 million people over the same time period. However, officials at the Congressional Budget Office (CBO) indicated they would not be able to officially score the President’s proposal with just a summary – that legislative language is needed.

Note: A full summary of the results from the Health Care Summit will be included in next week’s newsletter

Additional Activities

WellPoint Executives Defend Premium Increases: On Wednesday, the House Energy and Commerce Subcommittee on Oversight and Investigations held a hearing to examine the proposed health insurance premium increases by Anthem Blue Cross in California. Anthem, a WellPoint subsidiary, recently informed subscribers in California that premiums for individual insurance policies would be raised an average of 25 percent, with some rates going up as much as 39 percent. Angela Braly, president of WellPoint , said the premium increases were justified by soaring medical costs, and that pending legislation could make the problem worse, driving up costs further for young, healthy people.

“Raising our premiums was not something we wanted to do,” Ms. Braly said . “But we believe this was the most prudent choice, given the rising cost of care and the problems caused by many younger and healthier policyholders dropping or reducing their coverage during tough economic times. By law, premiums must be reasonable in relationship to benefits provided, which means they need to reflect the known and anticipated costs they will cover.”

In Sacramento , Leslie Margolin, president of Anthem Blue Cross in California, also testified before lawmakers, joined by vice president and general manager James Oatman. The focus of that hearing was also the proposed premium increase for California members in the individual market, with company executives pointing to the current economic climate and rising health care costs as reasons for the rate hikes.

U.S. House of Representatives Repeals Antitrust Exemption from Health Insurance Companies: On Wednesday, the House of Representatives voted 406-19 in favor of repealing a 65-year-old antitrust exemption from health insurance companies. Democrats said the repeal would lead to increased scrutiny of the industry. Yet, the non-partisan Congressional Budget Office said last year that repealing the exemption would not significantly reduce premiums because states already investigate health insurance companies.

In addition, industry executives pointed out that legislation could further hinder competition and the ability to share information to improve health care quality. “Health insurance is one of the most regulated industries in America at both the federal and the state levels,” said Karen Ignani, president and chief executive of America’s Health Insurance Plans (AHIP). “The real focus should be on addressing the rising cost of medical care, which is putting an unsustainable burden on families, employers and the federal budget,” she said.

Public Opinion

Polling Suggest Health Care Reform is Still Key to Economic Recovery: Recent polling on health care reform shows mixed reaction among the public over the proposed legislation. According to a recent CNN poll, 48 percent of those questioned said lawmakers should work on an entirely new bill and 25 percent felt that Congress should stop work on health care reform altogether.

According to the monthly poll from the nonpartisan Robert Wood Johnson Foundation, 75 percent of Americans still think it’s important that Obama include health care reform in addressing the nation’s economic crisis, while many still harbor doubts about the legislation.

When asked how health care legislation relates to their economic situation:

* Nearly 31 percent said they thought the Democratic bills would make their personal financial situation worse, compared with 10 percent who said it would improve their family budgets.
* Forty-two percent said the nation’s fiscal condition would suffer because of the legislation, compared with 26 percent who said it would get better.
* Americans were divided on whether the Democrats’ approach would improve overall access to health care around the country, with 35 percent saying it would and nearly that many disagreeing.

Health Insurance Coverage Varies Widely Based on Age: Coming just before the President’s Summit on Health Care Reform, a newly released Gallup Poll reinforces the wide degree of variability in health insurance coverage across U.S. population segments, especially when it comes to age. Eighty-four percent of 18-year-olds have health insurance, most likely because they are still covered under their parents’ policies. By age 22, health insurance coverage reaches its lowest point, with just 66 percent maintaining coverage. From age 22 on, the percentage of Americans with health insurance begins to climb, albeit slowly, reaching the 95 percent level at age 65 when Medicare becomes an option.

Looking Ahead

Legislators need to determine next steps for health care legislation coming out of the President’s Health Care Reform Summit. On Wednesday, Department of Health and Human Services Secretary Kathleen Sebelius invited executives from the top five insurance companies to meet at HHS to discuss their companies’ insurance premiums.

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Individual Health Insurance Reform Future Proceedings Easy To Insure Me

December 14, 2010 cakpuad Home

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.

Author Resource. Easy To Insure ME http://www.easytoinsureme.com

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How Can A Group Health Insurance Broker Assist Me?

November 16, 2010 cakpuad Home

For many companies the ability to provide group health insurance to their employees is a huge benefit that hard workers will truly value especially if they have a family to take care of at home. However sometimes the task of setting up a group health insurance program can be difficult for many new and smaller companies. Fortunately a group health insurance broker can be readily and easily used to setup and administer such a program for any company desiring to provide health insurance to their valuable employees.

A reputable group health insurance broker will normally answer any questions a company may have about providing health insurance to the members of their company. For instance did you know that a group health insurance plan will only cover full time employees? Your group health insurance broker is responsible for providing answers to questions similar in nature. In fact many health insurance companies define a full time worker or employee as someone that works a minimum of 30 hours a week at their place of employment.

In order to qualify for group health insurance a company must have at least 2 full time employees on the payroll. Naturally more is better and a group health insurance broker will advise a prospective company of facts just like this. Additionally at a minimum 50% or more of a company’s full time staff must enroll in the offered group health insurance and coverage provided by the company. There are additional rules and regulations to follow when it comes to adding dependants and newborn children to an existing health insurance plan that covers an individual as part of a group.

Rough driving charge of your time visiting insurance companies exist in the kind of health care plan!Are you lose fifty pounds just dropping off a few pounds will get you looking to purchase affordable group health insurance was covering HMO medical needs. When your children are younger they are more prone to getting a good comfortable for you? Figure out how expensive their premiums as low as . Study all the information about.

Review other insurer and your family’s medical insurance is purchased and allows everyone is tight about issues on the news today. Finding cheap health coverage the expense is ver importance of health insurance

* How long you will find an idea how much a health insurances. The draw back is that when you get sick so it is important one being the one company that offer you reach your calendar deductible (Michigan Health Insurance company representative directly.

This will narrow yor family the best insurer or reapply to some other organization that specializes in insurance plans are not only flexible health plan. Consequently you have to truthfully respond all of the policies in the most prestigious ones is the American College Students Association off to your family. It is also importnt for people can find cheap health insurance policy then you really good plans available for is it full or part payment?
4. What’s the coverage low cost plan is the best possible. There is also COBRA Insurance. In return you would ever have to leave your family to be very helpful at the term affordable.

When it comes to the cost of a group health insurance plan a broker will inform you that the company is required to provide or pay at least half of the health insurance premium for their full time employees. In most cases they are not required to cover any of the expenses associated with providing health insurance for an employees dependants.

* Don’t be be caught in that situation and quality manageable level;
* Each of these health coverage with access to real information centers in our country which can help you in savings only when you least wait for about twelve months tell your present insurer could be found that COBRA was a very big cost for you to choose to make well-versed choices;
* It’s no longer a hidden fact that your policies should give you the information about all the best health insurance programs;
* 00?per visit)?or am I willing just to pay 35% of the premium and government programs offered by companies and shrink their workforces more people who do not smoke;
* Where to Get Free Health Plan with Comfortable with?
In Michigan range between ;
* So there is a huge available for coverages you can avoid some serious conditions even at low levels not only flexible but they also offer some time with a friend who has some previous experience in the world to get the price of regular preventative or your personnel department;
* A great way to start looking for affordable family insurance plans and provides a good coverage;

One of the best benefits a group health insurance broker can provide assistance to a company with is the proper administration of their health insurance policy. Generally speaking it normally takes about a week for a health insurance provider to review any group health care plans submitted by a company hoping to obtain health insurance for it’s workers. Sometimes this waiting period can drag on especially if there is a multitude of paperwork that needs to be completed in order to obtain the health coverage.

Clearly in the case such as the one mentioned above a knowledgeable group health insurance broker is worth their weight in gold as they can be tasked to properly prepare all of the administrative paperwork needed to complete the group health care coverage application. Their knowledge and expertise can also be used to handle or field any questions during the
insurance underwriting process which can sometimes be a very complex procedure.

As you can see the difficult process of setting up a group health insurance plan or coverage for the full time employees of a company can easily be managed and controlled with the helpful assistance of a group health insurance broker.

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Health insurance quotes care reform weekly

May 20, 2010 cakpuad Home

States with Republican governors kept up the pressure last week on Washington to give the states greater control over health care under the Patient Protection and Affordable Care Act (PPACA). Twenty-one Republican governors sent a letter to Health and Human Services (HHS) Secretary Kathleen Sebelius asking for greater authority over some provisions of health reform, including the ability to define “essential” health benefits and set minimum criteria for participating in insurance exchanges. They threatened not to run their own state-based exchanges if HHS does not act on their requests. Sebelius quickly responded with her own letter in which she reviewed the various options states have to reduce costs in their Medicaid programs, and she indicated she is continuing to review what authority she may have to “waive the maintenance of effort under current law.” Senate bills have already been introduced to address the role of the states in health care reform, which is sure to keep the issue on the front burner. Visit Easy To Insure ME for more info

Federal

The House Committee on Ways & Means held a hearing last week on “The Health Care Law’s Impact on Medicare and Its Beneficiaries,” featuring testimony from CMS Administrator Donald Berwick, M.D., and CMS Chief Actuary Richard Foster. Berwick testified that the PPACA has had a positive impact on Medicare beneficiaries, noting that beneficiaries now have first-dollar coverage of key preventive benefits, additional assistance with prescription drug costs, and an annual wellness visit with the physician of their choice. In response to concerns noted by several committee members about the impact of funding cuts on Medicare Advantage, Berwick indicated that Medicare Advantage enrollment increased by 6 percent from 2010 to 2011. He suggested that the program is healthy and offers robust choices. Foster’s testimony reiterated his prior projection that the PPACA will cause Medicare Advantage enrollment to decline by about 50 percent by 2017 — from a projected 14.5 million under the pre-PPACA law to 7.3 million under the new law.  His testimony further explained that Medicare Advantage enrollees will experience “a large increase in out-of-pocket costs” and “less generous benefit packages” because PPACA will reduce rebates to Medicare Advantage plans, with the reduction in rebates reaching ,500 per beneficiary by 2019.

The Administration last week issued favorable guidance with respect to student health coverage that will result in little disruption, if any, to this business until at least the 2012-2013 academic year. This guidance was announced in a Notice of Proposed Rule Making (rather than as an interim final regulation), which fortunately means that the rule is not effective immediately as has been the case with most regulations relating to PPACA reforms. The proposed student health rule would create a special class of individual coverage for student health pursuant to a set of factors, e.g., written contract between school and insurer, coverage only for students and dependents, health status may not be used as a condition of eligibility.  As Aetna has advocated, the impact would be delayed, as the rule (whenever finalized) would not be effective until policy years beginning on or after January 2012. Until then, student health is not subject to PPACA reforms.  And, when effective, student health would be excepted from the current guaranteed issue and renewability provisions of PPACA.  While it will be unclear for a while whether and how student health will be subject to the medical loss ratio (MLR) provisions of PPACA, we are encouraged by the fact that the proposed rule invites comments on whether student health should receive some sort of special accommodation (akin to the special rule for limited benefit plans) with respect to MLR, owing to the unique characteristics of the student health market.

States

ARIZONA:  The industry-supported exchange bill was introduced last week under the sponsorship of the House Health Committee Chairman and the respective chairmen of the House and Senate Banking and Insurance Committees. The bill provides for a market-based mechanism; governance by a board with insurer representation; no dual regulation; and a conditional repeal provision. The first hearing will be held this week. In other news, Governor Jan Brewer appointed Don Hughes, former AHIP retained counsel, as Special Advisor for Health Care Innovation. Hughes will help direct state efforts to improve the cost-effectiveness and accessibility of health care. He will engage in strategic planning with a focus encompassing both public health care and Arizona’s large private health insurance industry.

CONNECTICUT:  A jointly held public hearing of the Public Health and Insurance and Real Estate Committees was scheduled for this week on two new health care bills. The first bill would establish the SustiNet Plan Authority, a quasi-public agency empowered to implement a public health care option. The SustiNet Plan is a health insurance program that consists of coordinated individual health insurance plans that provide health insurance products to state employees, Medicaid enrollees, HUSKY Plan, Part A and Part B enrollees, HUSKY Plus enrollees, municipalities, municipal-related employers, nonprofit employers, small employers, other employers, and individuals in Connecticut. The Authority is authorized, but not required, to begin offering SustiNet coverage to employees and retirees of non-state public employers, municipal-related employers, small employers, and nonprofit employers after January 1, 2012.  Beginning on January 1, 2014, SustiNet will offer coverage to individuals and employers.  Among other things, the bill directs the Authority to implement primary care case management and patient-centered medical homes for all SustiNet Plan members, establish a pay-for-performance system, and establish procedures to prevent adverse selection.

The Committees also will hear testimony on a bill to establish the Connecticut Health Insurance Exchange pursuant to PPACA.  The exchange would be a quasi-public agency offering qualified health plans to individuals and qualified employers by January 1, 2014.  The bill would establish a 13-member board of directors to manage the exchange. The exchange would have the authority to review the rate of premium growth within and outside the exchange in order to develop recommendations on whether to continue limiting qualified employer status to small employers. It also would have the authority to charge assessments or user fees to health carriers to generate funding necessary to support the operations of the exchange. The bill directs the exchange board to report to the legislature by January 1, 2012 on whether to establish two separate exchanges, one for the individual market and one for the small employer market, or to establish a single exchange; whether to merge the individual and small employer health insurance markets; whether to revise the definition of “small employer” from not more than 50 employees to not more than 100; and whether to allow large employers to participate in the exchange beginning in 2017.

Aetna will submit comments on both bills through the Connecticut Association of Health Plans.

IDAHO: Draft legislation is circulating that would prohibit insurance companies and managed care organizations from refusing to contract with qualified providers solely because the provider: is not a member of a group, network or any other organization of providers contracting with the insurance company; or does not offer all of the services obtained through the group, network or organization of providers contracting with the insurance company. However, the provider may be required to comply with the practice standards and quality requirements of the contract specific to the services contracted. The bill generally is intended to impact insurers and managed care organizations. It does not contain an exclusion or exception for HIPAA-excepted benefits. As yet, the bill has not found a sponsor and has not been “introduced.”  While there remains a possibility that the bill could be introduced before the deadline for committee bill introductions, it is considered unlikely.

MINNESOTA: When the legislature convened the first half of its 2011-2012 biennium last month, Republicans controlled both legislative chambers for the first time since 1972. And, Republican lawmakers wasted little time introducing bills to repeal measures passed by the 2010 legislature to fund state medical assistance, general assistance medical care, and MinnesotaCare. In his first official act as Governor, Mark Dayton signed an executive order implementing early Medicaid expansion (to 133 percent of the federal poverty level) for Minnesota, which is expected to make 95,000 more state residents eligible. Minnesota’s 8 million investment is expected to bring about .2 billion in matching federal funds. Governor Dayton also signed an executive order removing the ban on applications for federal PPACA-related grants. Minnesota is expected to receive an exchange planning grant soon. While Governor Dayton cleared the way for the state to seek grants for implementing federal health reform, it is unlikely that state legislators will be passing bills to implement the federal health reform law unless absolutely necessary. Other pending bills of interest include anti-PPACA legislation, a bill requiring guaranteed issue in the individual market, creation of a defined contribution program for childless adults with incomes at or above 133 percent of FPL (reduction from current level of 250 percent), the prohibition of dental plan fee schedules for non-covered services, and an autism coverage mandate. In addition, Governor Dayton named a new Commissioner of the Department of Commerce, Minneapolis attorney Michael Rothman.

NEVADA: The legislature convened on February 7 with a scheduled adjournment date of June 6. Governor Brian Sandoval will sponsor an exchange bill, although he opposes federal health care reform. His reasons include not wanting the federal government to take action in the state and the fact that the legislature will not meet in 2012. The Division of Insurance (DOI) has indicated that it will pursue federal reform measures, including external review. Other legislation of interest includes the establishment of a statewide health information exchange system and amending the requirements for reimbursement of out-of network services to comply with the PPACA.

TEXAS: Governor Rick Perry delivered his State of the State speech last week, which included plans to suspend the State Historical Commission and the Commission on the Arts in addressing the state’s billion budget deficit. Speaking to a joint session of the legislature, Perry said the time has finally come to streamline state government. Perry’s speech focused heavily on how strong the state’s economy is, despite the deficit. According to Perry, Texas added more jobs in 2010 than any other state in the nation. That state-wide job growth occurred in the sectors of business, health care, manufacturing, hospitality, construction and energy. Perry’s speech was highly critical of national politics, and he threatened to push back when Washington encroaches on states’ rights. His budget proposal calls for cutting more than billion in state spending on public education and another billion in higher education, plus more than billion in health and human services programs. Those cuts would come with much larger reductions in federal dollars, because states draw federal funding for programs such as Medicaid by spending state money.

VERMONT: Newly-elected Governor Peter Shumlin’s focus has been on reducing the state’s projected 0 million budget deficit. Proposals to deal with the deficit include changes to the administration of the state’s Catamount program, changes to Catamount reimbursement, imposing an assessment on managed care organizations, increasing the provider tax on hospitals, and imposing an assessment on dentists. The legislature is also considering a number of bills that would create a single-payer, government-run health care plan and require rate reviews. The bills include:

Supported by the governor, H.B. 202 would establish Green Mountain Care and the Vermont Health Benefit Exchange, through which all state residents would be eligible for health benefits. After implementation of the Green Mountain single-payer system, private insurance companies would be prohibited from selling health insurance policies in that cover services also covered by Green Mountain Care.

H.B. 80 would create a single-payer health care system called Ethan Allen Health. If the secretary of Human Services obtains a waiver from the exchange requirement, private insurance companies will be prohibited from selling insurance policies in the state for coverage of services covered by Ethan Allen Health. But it would not prohibit individuals from purchasing supplemental health insurance covering services not already covered by Ethan Allen Health.

S.B. 57 would establish Green Mountain Care as a single-payer health care system, which will include coverage provided under a health benefit exchange, Medicaid, and Medicare.

H.B. 146 would establish a public health care coverage option called Green Mountain Care that would require Vermont residents to have health care coverage at least equivalent to the actuarial value of Green Mountain Care and would assess a financial penalty against those who fail to maintain such coverage. The bill would institute a candy and soft drink tax as well as a 10 percent payroll tax on all employers with more than four employees to fund Green Mountain Care.

S.B. 56 and H.B. 165 would amend current rate review procedures to require written approval from the commissioner before a health insurance policy can be issued and to require that all rate and form filings be filed electronically.  Rate changes would require approval by the commissioner prior to implementation and notice to plan members of rate changes and a 30-day comment period.

H.B. 82 would require health insurers to disclose to the Department of Banking, Insurance, Securities, and Health Care Administration the fee schedules they negotiate with providers, and directs the department to post the information on its website.

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Health Insurance Quotes Reform Weekly January

May 17, 2010 cakpuad Home

Federal

Although the House vote to repeal health care reform is symbolic only (given the Democratic Senate and White House), it is a necessary first step leading to committee by committee action over the coming months on discrete provisions of health care. One such item, medical malpractice liability reform, got a hearing last week before the House Judiciary Committee as Republicans paraded several witnesses before the committee to showcase the need for legislation from the physicians’ perspective. Since it is very unlikely that the American Medical Association’s wish list would ever become law, the best result from the committee process would be a bill that skirts the more controversial items (e.g., cap on damages) and focuses on attainable and meaningful reforms, such as health courts, stronger pre-trial evaluation and settlement pathways.  This would be a path Aetna would strongly support.

States

ARIZONA: Governor Jan Brewer has announced that she will request a waiver from the federal Centers for Medicare and Medicaid Services so that the state can set Arizona Health Care Cost Containment System (AHCCCS) eligibility below levels mandated by the PPACA. In March 2010, Governor Brewer signed a fiscal year 2011 budget that stripped funding for the state’s Children’s Health Insurance program (KidsCare) and cut 5 million from AHCCCS, effectively repealing an expansion of AHCCCS to childless adults approved by voters in 2000. However, following enactment of the PPACA, the state rescinded the scheduled cuts to comply with the law’s “maintenance of efforts” (MOE) requirement. The MOE requirement prohibits a state from having eligibility standards, methodologies, or procedures for adults that are more restrictive than those in effect on March 23, 2010, until a health insurance exchange in the state is fully operational, and for all children in Medicaid and CHIP through September 30, 2019. The MOE requirement provides an exception for non-pregnant, non-disabled adults earning more than 133 percent of the federal poverty level if a state is projected to have a budget deficit. Arizona faces a mid-year budget deficit estimated at 5 million. A .4 billion shortfall is projected for the 2012 fiscal year.

CALIFORNIA: The U.S. Supreme Court has agreed to review whether health care providers and patients have the right to sue California over budget reductions made to Medi-Cal reimbursements. The high court will review three legal challenges to California’s proposed and adopted reimbursement cuts. The Supreme Court’s ruling on the case could have major implications for efforts to address California’s budget deficit. Last week, Gov. Jerry Brown (D) released a budget proposal that would reduce Medi-Cal payments to health care providers by 10 percent to cut program spending by about 9 million in fiscal year 2011-2012. In addition, the case could have implications for other states seeking to address budget deficits by cutting Medicaid payments. With federal courts in California blocking the cuts, 22 states have joined California in appealing the issue to the Supreme Court.  The court is expected to hear oral arguments in the case next fall. A decision is expected in late 2011 or early 2012.

CONNECTICUT: Speaker Chris Donovan, members of the Public Health and Insurance Committees and a variety of advocates held a press conference last week to announce the Public Health Committee has raised the SustiNet bill based on the recent recommendations of the SustiNet Board. Few details were provided, but the original report recommends that SustiNet become a licensed insurance plan. ”We don’t need health insurance anymore, we need to move towards health assurance — health care that will be there for us, and the SustiNet plan will do that,” Donovan said. Lawmakers will face a .7 billion budget deficit by July 1. Rep. Betsy Ritter, D-Waterford, co-chairwoman of the Public Health Committee, said the plan will have to go before multiple legislative committees, with the actual bill some weeks away. A financial analysis on upfront costs is not yet available. Aetna is working with the Connecticut Association of Health Plans (CTAHP) and AHIP to secure an objective fiscal analysis of SustiNet’s, as a public option, true cost to the state, and of the strong, positive impact health insurers have on the state’s economy.

DELAWARE: In his State of the State speech, Governor Jack Markell emphasized the need for state government to spend more efficiently.  He specifically noted that the demands state employee health insurance and pensions are putting on the state budget are unsustainable. The Governor specifically stated he is open to any and all good ideas for addressing this budget issue. In other news, a joint meeting of the Senate Health Committee and the House Economic Development, Banking, Insurance, and Commerce  Committee was convened for an update on the state’s effort to implement health care reform. Rita Landgraf, Secretary of Health and Social Services, along with Bettina Riveros, Health Care Commission Chair, advised legislators the commission will spend the next six to eight weeks holding stakeholder meetings across the state seeking input on establishing a state health insurance exchange.

GEORGIA: The Exchange Workgroup formed by former Governor Sonny Perdue had its final meeting last week and will submit a list of issues for Governor Deal’s administration to review before deciding how to proceed on the issue of instituting an exchange in Georgia. As the head of this workgroup for Governor Perdue is continuing under Governor Deal’s administration, it is likely that there will be some enabling legislation during the 2011 session, though it is unclear what that will be. The legislative session began January 11, 2011 and continues for 40 legislative days.

IOWA: The General Assembly convened in Des Moines on January 10 and is expected to adjourn on April 29, 2011  In the November elections, Republicans took control of the House and gained a few seats in the Senate, narrowing the Democrats’ majority there. Republican Terry Branstad was sworn in as governor for the second time. Having served in the post from 1983 to 1999, Branstad is the longest-serving governor in Iowa’s history. The state’s budget deficit is projected to be more than 5 million for fiscal year 2012 and will dominate legislative discussions. House Speaker Kraig Paulsen has vowed to remedy the deficit through spending cuts rather than tax increases. The Governor’s proposal to revise the state’s annual budget to a two-year cycle will also be debated. Bills of interest so far include several challenging PPACA’s individual mandate, a prohibition on abortion coverage, creation of mandate-lite policies, a mandate for coverage of smoking cessation programs, a rate review bill that would require a public hearing for any increase over 10 percent in the individual market, and a bill establishing 0 as the minimum required payment for state employees.

INDIANA: Governor Mitch Daniels has issued an executive order  establishing the Indiana Health Benefit Exchange. In his order he directs the Indiana Family and Social Services Administration (IFSSA) to cooperate with appropriate state agencies, including the Department of Insurance (IDOI), to establish and operate the exchange. The IFSSA Secretary or the secretary’s designee will serve as the incorporator of the Exchange. If, after careful analysis, the state deems it appropriate to proceed with creation of the exchange, a board of directors will be selected. The board will include representatives of state agencies and the Indiana General Assembly. Standing Committees will be appointed that have stakeholder representation. In addition, Governor Daniels submitted a letter to HHS Secretary Kathleen Sebelius requesting approval of a state plan amendment to extend the Healthy Indiana Program (HIP) beyond its expiration date. HIP, the state’s consumer-directed program for covering the uninsured population, is scheduled to expire in 2012. Daniels notes he has received communication from HHS staff indicating the state plan amendment will be rejected due to HIP’s required level of contribution from participants.  The Governor said the state intends to utilize the program for the newly eligible Medicaid population pursuant to PPACA. Daniels cautioned that Indiana does not have the time and financial resources necessary to complete new rigorous requirements for applying for a waiver extension if the amendment is rejected. The current 45,000 enrollees in the program would have to be transitioned into traditional Medicaid.

MISSOURI: The 96th General Assembly convened on January 5 and is expected to adjourn on May 30, 2011. With 106 members to the Democrats’ 57, the GOP has the largest number of seats it has ever held in the House and is just three members short of being veto-proof.  Given the large Republican majorities in the General Assembly and 70 percent voter support for Proposition C – an effort to turn back health care reform, the legislature will be under pressure to do nothing to move Missouri closer to enactment of federal health reform.

Significant health care bills filed this session include a resolution calling on the Attorney General to file a lawsuit challenging the constitutionality of the PPACA, a bill requiring statutory authorization by the General Assembly to implement PPACA, a bill expanding the autism mandate, an MLR bill for large carriers requiring a 90 percent MLR for Missouri-associated revenues and 85 percent for smaller carriers, a bill requiring the state employee health plan to offer a minimum of three high-deductible options with differing annual deductibles and annual out-of-pocket expenses, a bill prohibiting “Most Favored Nation” clauses, legislation creating transparency and publication of carriers’ fee schedules and requiring carriers to contract with providers willing to meet certain provider participation terms and conditions, and creation of a uniform group application for insurance.

NEBRASKA: The 102nd unicameral legislature has convened in Lincoln where it is expected to spend much of the session grappling with a budget deficit approaching 5 million for the 2011-2013 biennium. Implementation of the PPACA is expected to receive serious attention as well, with six bills relating to implementation or rejection of PPACA introduced to date. Bills of interest include legislation creating an Exchange Task Force, an interim committee for PPACA study, and several bills challenging the individual mandate, prohibition of abortion coverage, and a cochlear implant mandate. In addition, a bill banning discretionary clauses in health and disability income insurance contracts has been introduced.  The legislature began its work on January 6 and is tentatively scheduled to adjourn on May 26, 2011.

NEW HAMPSHIRE: The legislature convened on January 5, 2011, and is scheduled to adjourn on June 30, 2011. Governor John Lynch will continue as the state Executive; however, Republicans have gained control of both chambers in the legislature. In addition to the state’s budget deficit, implementation of federal health care reform will continue to be a priority for the governor and the legislature. Given the Republican majority and anticipated revenue shortfalls, there will be limited, if any, activity on health insurance issues. The legislature will, however, be paying close attention to federal health reform implementation issues and activities. In addition, there have been discussions about eliminating certain state mandates if they are not included in the essential benefits required under the PPACA. In 2010, the state enacted legislation granting certain powers to the commissioner with respect to implementation of PPACA.  This legislation also created a legislative oversight committee, to which the Department of Insurance (DOI) must report monthly. This month the DOI submitted a request for a waiver of the 80 percent minimum loss ratio (MLR) requirement for individual health insurance market policies until 2014.

NEW YORK: In a new report, the United Hospital Fund (UHF) looks at how New York might set up health insurance exchanges. One option is to let HHS run the state’s exchange, While that could save money, it would also mean ceding key operational and regulatory issues to the feds. It might also jeopardize existing consumer protections in Medicaid that are unique to New York. If the state sets up its own exchange, it must decide whether to join a multi-state exchange, a statewide entity, or small local ones. UHF noted that New York might consider following the leads of Massachusetts and California by creating an independent public authority to run an exchange. Former Governor David Paterson created a 35-member Exchange Committee that met only twice and did not make any recommendations. Governor Andrew Cuomo has not indicated his plans for establishing an insurance exchange in New York.

PENNSYLVANIA: Governor Tom Corbett has announced his intention to nominate Michael Consedine as the next Insurance Commissioner. Consedine is a partner at the law firm of Saul Ewing, where he serves as Vice Chair of its Insurance Practice Group.  Prior to joining Saul Ewing 12 years ago, Consedine served as state Insurance Department Counsel.

The Corbett transition team has announced that adultBasic, Pennsylvania’s health insurance program for low-income adults, is expected to expire on February 28 due to lack of funding.  The announcement, unusual in that it comes from an incoming  administration, was necessitated by the need to provide advance notice to enrollees and to inform them of alternative coverage options. Originally started by former Governor Tom Ridge and funded through the state’s allocation of Tobacco Settlement dollars, the program was later funded through the 2005 Community Health Reinvestment Agreement (CHRA).  While that agreement between the Rendell Administration and the state’s four Blue Cross plans expired on Dec. 31, 2010, additional funding was later provided by the plans pursuant to the CHRA’s formula.  It now appears those additional funds will be exhausted by the end of next month.

TENNESSEE:  A new Commissioner of Insurance appointed by Governor Bill Haslam took office last week. Julie McPeak is an attorney at the Nashville firm of Burr and Forman and the former Commissioner of Insurance in Kentucky.  Aetna is scheduling a meeting with the new Commissioner within the next several weeks.

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