Week of August 17, 2009 : EasyToInsureME

The highly charged health care reform debate continues to get extensive news coverage, and Members of Congress are clearly feeling the heat. Senate Finance Committee Ranking Member Senator Charles Grassley (R-IA) took the unusual step of issuing a statement last week to reassure voters that a Finance Committee bill will not have end-of-life provisions — one of the more controversial topics at town hall meetings this summer. A Finance Committee bill has yet to emerge, as Committee members search for an approach that can net bipartisan support. But Grassley provided a small glimpse of the Committee’s thinking when he disclosed that the panel “dropped end-of-life provisions from consideration entirely because of the way they could be misinterpreted and implemented incorrectly.” Distancing himself and the Finance Committee from the House bill, Grassley went on to say House legislation is “poorly cobbled together” and could invite unintended consequences.

Federal

With Congress in recess, there is no federal report this week.

States

NEW JERSEY: Newly enacted legislation requires installment payment for maternity services, and it mandates the Department of Banking & Insurance to promulgate a payment schedule for provider services rendered in advance of child delivery. Through the New Jersey Association of Health Plans, Aetna and other carriers will meet with stakeholders to assist the department in implementing this statute. Also enacted into law was an autism coverage mandate. Under the new statute, insurance carriers must extend coverage for medically necessary treatment including speech, occupational, and behavioral therapy. The coverage benefit is capped at $36,000 annually. Also, the state Supreme Court has denied an appeal for stay of approved rider filings by the Small Employer Health Benefits board. A coalition of health care providers, primarily ambulatory surgery centers, sought to delay implementation of an approved rider filed by Horizon Blue Cross Blue Shield of NJ, which limits out-of-network ASC benefits at $2,000. The newly appointed Commissioner of Banking & Insurance denied the providers’ appeal for stay. The coalition’s emergency request for delay was denied by the Appellate Division and finally the Supreme Court upheld the denial.

NORTH CAROLINA: The Governor has signed the proposed budget with no premium tax increase to insurers, thanks to the input of Aetna and many other industry leaders, business leaders and trade groups. Previous budget proposals included increases from 1.9 to 2.25 percent, effective January 2011.

PENNSYLVANIA Health Insurance : Governor Ed Rendell signed a budget bill after exercising his line item veto to strike most appropriations other than those necessary to pay state employees. The bill, introduced by Senate Appropriations Committee Chairman Jake Corman (R-Centre), was passed without amendment so that it could go to the Governor. The 2 percent managed care organization tax remains the big open issue for the budget. Moving the current MA MCO assessment under the sales and use tax is supported by some, but the administration is pushing the added 2 percent tax on all managed care premiums.

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Is maternity / health insurance worth buying in advance, living abroad but want to have baby in the US.?
My sister is working abroad, but wants to have baby here in Texas, US. Is it worth buying health insurance with or without maternity coverage in advance? She is not currently pregnant. I got different quotes from agents/ Insurance companies.

The House is scheduled to leave town for summer recess on July 31, and the Senate’s current schedule sends them home a week later on August 7. It will be next to impossible for the House to address health care reform on the floor in that timeframe, and the Senate Leadership has already put off Senate floor action until September. The focal point in the Senate, the Finance Committee has three options: work out a deal and go to mark-up before the break; put out paper but no mark-up before the break; do nothing now and put it all off until fall. The last option seems to be gaining favor daily and may soon become the choice by default. In the House, the conservative Blue Dog Coalition has the numbers to keep a bill from emerging from the Energy & Commerce Committee, which while not fatal is certainly a wake-up call to Democrats that Congress may be moving too fast on health care reform with little or no real focus on health care costs. The on-again/off-again talks between Blue Dogs and E & C Chairman Waxman broke off at the end of last week with conflicting reports on whether they will resume this week. Technically, House Leadership can proceed to the House floor with approval from only two of the three Committees with jurisdiction. But this would send a very bad signal to the public and could portend even more fireworks on the House floor. The bottom line is that neither chamber of Congress is likely to do anything official before the break, but there could well be a years’ worth of policy and political activity in these last two weeks.

States

CALIFORNIA: The budget plan, which requires a two-thirds vote in the state Assembly and Senate, includes about $15 billion in cuts and some gimmicks to generate revenue in the 2009-10 fiscal year. Next to education, health and welfare programs will absorb some of the largest cuts with $1.3 billion coming out of Medicaid funding and $124 million from Healthy Families, a program that provides health insurance for 930,000 low-income children. The plan borrows about $2 billion from local governments’ property tax revenue, captures $1 billion in redevelopment money from local governments, and temporarily redirects to state coffers $1 billion in transportation funding. Local government groups have told legislators and the media that they will sue the state if these transfers occur. Meanwhile, hospitals are divided over a non-budget related tax proposal designed at drawing down additional federal Medicaid funds. If the proposed two-year fees help generate $2 billion in state funds, California could qualify for an additional $3.2 billion in federal funding. Facilities that either don’t treat Medi-Cal patients or do so on a very limited scale are opposing the measure. Gov. Arnold Schwarzenegger has said in the past that he supports using hospital fees to boost funding for health programs but is non-committal about this bill.

CONNECTICUT: In a special “veto session” held last week, the General Assembly failed to override Governor M. Jodi Rell’s veto of the controversial health care pooling bill but it did succeed in overriding her veto of the SustiNet plan. The pooling bill would have required the comptroller to offer employee and retiree coverage under the state benefit plan to: non-state public employers beginning January 1, 2010; municipal-related and nonprofit employers beginning July 1, 2010; and small employers beginning January 1, 2011. The SustiNet legislation establishes a nine-member Board of Directors to make recommendations to the Assembly by January 1, 2010 for the creation of a SustiNet universal coverage plan by January 1, 2012. The legislature and the governor will have to agree on the issue of self-insurance. SustiNet proposes to make the state liable for all insurance claims, though it is unclear how the revenue would be generated. Estimating the cost of SustiNet at $1.1 billion in 2012, the Governor and Republican legislators said the SustiNet program is simply too expensive, with a projected $8.85 billion deficit looming. Aetna will continue to work with all boards, councils and commissions for real health care reform that improves quality, reduces costs and expands access to insurance.

MARYLAND: The Insurance Administration circulated a draft regulation that would impact payments to non-participating providers under a PPO policy. The proposed regulation would require parity between a member’s in-network and out-of-network cost-sharing responsibility for services provided as 1) emergency care, 2) through a referral, and 3) by a hospital-based physician in a preferred facility. The Commissioner’s position is antithetical to the controlling statutory requirement and his own public statements that insureds are not protected from balance billing in a PPO environment. In addition, the Health Care Reimbursement Task Force, in which the Commissioner participated, considered this issue earlier and decided to make no recommendations regarding PPOs.

MISSOURI: A group of orthopedic surgeons in Springfield has initiated the state-required legal process to achieve an “any willing provider” statute through the 2010 general election ballot. These physicians and possibly other advocates are calling themselves Missourians United for Choice in Health and have reportedly amassed $1.5 million to start the initiative petition process. A coalition of opponents is forming. Aetna is evaluating whether it should be a member of the opposition effort.

NEW YORK: In just two days recently, the Senate passed hundreds of bills previously passed by the Assembly over several months before it adjourned. Health insurance legislation that has gone to Governor Paterson for his signature include bills expanding dependent coverage to age 29, extending COBRA eligibility to 36 months and opening the Family Health Plus program to voluntary employee benefits associations (VEBAs). The Managed Care Reform Act also passed. It would require that a provider be given notice of an adverse reimbursement change to a provider contract and an opportunity to cancel the contract; extend overpayment recovery limitations to all health care providers and permits them to challenge such recoveries; require that providers moving to New York be provisionally credentialed until the final credentialing determination is made; shorten utilization review timeframes for post-hospital home health care services; allow providers to appeal concurrent adverse determinations through the external appeal process; and establish a new external appeal standard for rare disease treatments. The bill also would authorize the Superintendent of Insurance to require that mandated submissions be filed electronically and lower the prompt-payment-of-claims threshold to 98 percent, rather than the current zero-tolerance policy. Bills that failed to pass include prior approval of claims and 85 percent medical loss ratio legislation.

NEW JERSEY: Neil Jasey has was named interim commissioner for the Department of Banking and Insurance. This was a surprising development given the indeterminate nature of the post, due to the upcoming gubernatorial election. Mr. Jasey spent more than 25 years with Prudential serving as general counsel prior to his retirement in 2004. His wife is a current assemblywoman running for reelection.

NORTH CAROLINA: The Governor has rejected a budget compromise that did not include an increased premium tax increase. So it is back to the drawing board and, in all likelihood, another extension of the legislative session. Last month, the Budget Committee of the legislature introduced a proposal to increase the premium tax across all lines of business from 1.9 percent to 2.25 percent effective January 1, 2011. Strong opposition to the tax increase helped take it off the table, but things could change as legislators search for a new budget solution.

OHIO: The state’s budget crisis concluded with Governor Strickland signing a compromise bill that includes a provision placing the contentious and heavily partisan video lottery terminal issue on the November ballot. Bill provisions affecting health care plans include: extending coverage to dependent children up to age 28; transferring oversight of health plans’ network adequacy from the Department of Health to the Department of Insurance; expanding the open enrollment program for individuals with a more gradual reduction in the rate cap; requiring a health insurer to cover a service if the Director determines it is a covered service; requiring a carrier to conduct an external review automatically upon notification by the Director that determination of coverage involves a medical issue; requiring electronic payment of electronically submitted provider claims; submission to the Director of an annual report detailing components of administrative expenses by line of business; requiring filing of small employer premium rates; and requiring employers of 10 or more to offer Section 125 plans. An autism mandate was removed.

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PC out of country health insurance quote, where do I find it?
I have looked at almost all of the PC pages and can't find anything about out of province health insurance. I called on the telephone and all I got was a voice but I could not get directed to speak to a person, even though I went to other services and then they disconnected. I want to get a quote.

Even as partisan rhetoric swirled even stronger around the subject of health care reform, the Senate Finance Committee continued its health reform negotiations last week in what is the last hope for a bipartisan bill from Congress. Senators left Washington late last week to start their August recess, but Finance Committee members have vowed to continue negotiations throughout the month. A bipartisan group of six Senators on the Committee, led by Chairman Max Baucus, briefed President Obama on their work   Thursday, and they also conducted a conference call with a dozen governors. The emerging legislation would expand Medicaid coverage to millions of additional people, and the governors are concerned about the impact on state budgets. No details of the still-developing proposal have been officially released, but participants have indicated the package could shave $100 billion off the cost of the legislation over the next decade, providing coverage to 94 percent of the nation, expanding  Medicaid, abandoning the government-insurance option and possibly replacing it with a state-based co-op plan, and taxing insurance companies that offer health care benefits under the richest plans. Baucus has set a Sept. 15 deadline for a bipartisan deal.

States

ARIZONA: The State Senate last week postponed a vote on a plan to close the state’s estimated a $3.2 billion budget deficit using spending cuts, funding delays, borrowing, and federal stimulus funds. Approved by the House on July 31, the plan’s health-related provisions include: eliminating the KidsCare Parents Program; reducing AHCCCS (Medicaid) reimbursement rates to non-institutional providers by 5 percent but not reducing AHCCCS reimbursement rates to institutional providers; delaying one month’s capitation payment to AHCCCS contracted health plans; and requiring AHCCCS to comply with the federal False Claims Act.

NORTH CAROLINA: In a very positive development, a new budget was issued by the legislature last week that includes no premium tax increases. Previous budget proposals included increases from 1.9 to 2.25 percent, effective January 2011.  Aetna, along with other carriers and trade associations, worked to educate legislators and oppose a premium tax increase. A final vote on the budget is expected soon.  

OREGON: Governor Ted Kulongoski has signed legislation enacting a 1 percent premium tax that will be used to expand access to affordable health care for children. The premium tax will be assessed beginning October 1, 2009 through September 30, 2013.  Rate filings submitted for approval may include the premium assessment as a valid administrative expense or retention element. The law also establishes the Health Care for Oregon Children program, which includes an expansion of SCHIP and a premium assistance program administered by the Office of Private Health Partnerships (OPHP). Under the premium assistance program: Children in families with incomes at or below 200 percent of the federal poverty level (FPL) and who have access to employer-sponsored coverage will receive a subsidy equal to the full cost of the premium; children in families with incomes above 200 percent but at or below 300 percent of FPL will receive assistance on a sliding-scale basis as determined by the OPHP; and children in families with incomes exceeding 300 percent of the FPL will not receive premium assistance but will have the opportunity to purchase coverage through the new OPHP private health option.

TEXAS: With Dallas saddled by the most expensive health care in the state, Mayor Tom Leppert and a local health insurer last week took a step toward changing the city’s direction. They are working on scheduling a North Texas health care summit on Sept. 30 at which company and government executives hope to agree on payment, practice and transparency fixes leading to greater competition based on quality and cost efficiency. In its national quality-to-cost ranking, Texas is rated third worst, behind Mississippi and Louisiana. Dartmouth Institute for Health Policy data indicates that on average Dallas health care providers submit $10,100 in Medicare claims for every enrollee, the highest among Texas cities with more than 50,000 residents. Dartmouth’s data shows that higher health care spending is not associated with better quality outcomes. 

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What is the difference between public health and community health?
What is the difference between public health and community health?
A. Public health involves the health of the nation, and community health involves doctors and other health professionals in a community.
B. Public health protects the health of everyone, and community health protects the health of all those in a particular community.
C. Public health gives free health care to individuals, and community health keeps the food, water supply, and general environment healthy for the community.
D. Public health is concerned with the health of individuals, and community health is concerned with overall health statistics.

Federal

As mightily as it has tried over the last week, Congress has only marginally moved the needle on health care reform. The Finance Committee will go home for the recess without a deal but with a promise to continue negotiating during the break, and with a target date of September 15 for Committee action. In the House, the Blue Dog Coalition of 52 conservative Democrats put a halt to the Energy & Commerce Committee’s process for 10 days when seven coalition members refused to proceed without concessions and compromises on the House health reform bill: a public plan that is optional to providers and that negotiates rates; preservation of the role of agents/brokers; keeping the bill under $1 trillion; and allowing state-based exchanges. The compromise reached allowed the committee to continue its mark-up and ultimately approve the bill. There are 50 additional amendments that the Committee intends to address prior to floor debate in the Fall. The House will try to meld all three Committee versions into one bill in anticipation of a full House debate and vote in September, at the earliest. The Blue Dogs have made it clear that the larger coalition of 52 has not signed off on anything and that the compromise was chiefly designed to allow the Committee process to proceed. No sooner was the Energy & Commerce Committee/Blue Dog compromise struck when opposition came from both the House progressive caucus and the Congressional Black Caucus. The bottom-line is that neither the House nor the Senate will be voting as a Chamber on health care reform until the Fall, when there will be a major confrontation of all competing interests.

States

ILLINOIS: The Illinois Department of Insurance (DOI) published second notice of proposed rulemaking regarding regulation of Preferred Provider Programs that will be considered for adoption by the Illinois Joint Committee on Administrative Rules (JCAR) on August 18. These rules affect both insurers and network administrators that offer incentives to insureds to utilize the services of contracted providers. For example, new network adequacy language would require that when a beneficiary has made a good faith effort to utilize network providers for a covered service but the appropriate preferred specialty providers are not under contract, then the administrator shall ensure that the beneficiary is provided the covered service at no greater cost than if the service had been provided by a preferred provider. Aetna is currently evaluating the proposed rules.

NEW YORK: The Departments of Health and Insurance released their report by the Urban Institute that examines several proposals to reform the state’s health insurance system. The study analyzes the cost and coverage implications of: 1) the Public-Private Partnership proposal that would simplify and expand existing public programs and reform private health insurance; 2) New York Health Plus, which would give all New Yorkers an option to enroll in Family Health Plus; 3) Public Health Insurance for All, a single-payer public health insurance option; and 4) the Freedom Plan, an option that relies on regulatory flexibility and tax credits. Due to the growing state deficit and interest in federal reform, no immediate action is expected on these proposals. However, legislation based on one or more of the models is likely to be introduced, or reintroduced in 2010.

The report’s key findings include: Three of the four proposals would cover all New Yorkers. The Freedom Plan would leave 13.3 percent of New Yorkers uninsured, down from the current 15.8 percent. There would be minimal change in employer-based coverage under the Public-Private Partnership and the Freedom Plan proposals. However, employer coverage would drop significantly under New York Health Plus and end altogether under Public Health Insurance for All. The individual insurance market would cease to exist under Public Health Insurance for All and New York Health Plus. Individual coverage would increase under the Public-Private Partnership and the Freedom Plan. Post-reform expenditures by employers and individuals would also vary widely. Under Public Health Insurance for All, employer and individual spending would be eliminated. New York Health Plus would reduce both individual and small employer spending. Individual spending would remain constant under the Public-Private Partnership proposal while small employer spending would drop slightly. The Freedom Plan would increase individual spending but somewhat reduce small employer spending.

OREGON: Oregon’s health care reform efforts this year included passage of a 1 percent premium tax on health insurers. Recently, the Division of Insurance offered a draft opinion that the tax should be collected on group policies issued in Oregon and polices issued in other states that cover Oregon residents. The Division opinion is contrary to longstanding NAIC guidance and would result in the imposition of a double-tax on all group policies, as well as administrative hurdles in tracking where individuals reside. Aetna is working with the Division in the hopes of modifying this opinion.

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How do I improve the health of my battery in my MacBook, and is this a good health?
I downloaded the iStat Pro widget today, and I looked at the battery health section. It read that my battery health is at 97% after 230 cycles. I've had it since June '08, so I was wondering if that was a good battery health considering its age and cycles.

What else can I do to improve my battery health, or keep it at a good percent, over the years? Any suggestions?