Insurance CEO

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

Week of June 8, 2009

President Obama once again jumped into the Congressional health care reform process last week when he met with key Senators on health care and then sent Senators Kennedy and Baucus a letter outlining his priorities for health care reform. In the letter, the President says he is open to an individual coverage requirement, as long as the poor are excluded from the mandate. His position is very similar to that adopted by Aetna several years ago. But if some were energized by the letter, others were disappointed. President Obama calls for any reform package to include a public health insurance option alongside private plans, an idea that many Republicans strongly oppose. Based on the response of some to the letter last week, the process this summer (see below) could become a contentious one. The President has asked the House and Senate to finish legislation by early August so that he can have a package to sign in October.

Voting is now underway for Modern Healthcare's online poll to determine the "100 Most Powerful People in Healthcare," and Aetna's Chairman and CEO Ron Williams once again is nominated as one of the finalists. To vote, click here.

Federal
The pace of health care reform is accelerating as both the House and Senate sense the public is anxious for action, the President is anxious for action, and the number of legislative days left before the August break is dwindling. The Senate Finance Committee met last week to review its three options papers (Delivery, Coverage and Financing) and will dive further into the details this week. The Committee hopes to release its most specific document to date on June 17 and could begin its mark-up the week of June 22, a process that could take 2-5 days. The HELP Committee is on a similar schedule. It released/leaked a 171-page (one-third of the whole bill) document on coverage, with quality and wellness/prevention still to come. This document may be well short of the final product, but it does provide some insight into the Committee's direction on coverage: Individual and employer coverage mandate; aggressive rating reforms (e.g., no gender or health status allowed); no annual/lifetime limits; a cap on non-claim costs; state-based exchanges; and a public plan. HELP will hold a hearing this week and will begin its mark-up around June 17, which might take ten days. All of this is designed to get a merged Finance/HELP bill to the Senate Floor by the last two weeks in July. The House is on the same pace. The Energy & Commerce Committee has publicized a rough outline of the House bill (a public plan, national exchange, soft individual mandate, national minimum benefit package), which will be marked-up by three House committees in early July in time for a House floor vote in late July/early August.

States
CONNECTICUT: The House did not take action on an amended Senate bill limiting offsets for disability premiums by the end of the regular legislative session on June 3, in effect killing the bill for this year. The State Senate had passed the amended bill one week earlier. The original bill prohibited any social security offsets, potentially increasing disability premiums by an estimated 40 percent or more. Aetna testified at the hearings, launched a legislative outreach for plan sponsors, and met with key members of the Insurance Committee extensively. The original bill was defeated in Committee. However, Sen. Edith Prague revived her bill and after many meetings and proposed compromises, insurers and plan sponsors succeeded in getting the prohibition on offsets limited to SSDI paid to or on behalf of dependent children.

MAINE: The legislature passed a bill repealing the savings offset payment (SOP) mechanism used to fund subsidies for the state's Dirigo health plan and replaced it with a flat 2.14 percent assessment on paid claims. The SOP has been the subject of repeated litigation since its inception in 2003. Health plans were able to get the effective date moved from July 1 to Oct. 1, 2009. The new flat tax applies to claims paid on or after September 1, 2009 and establishes the payment date as 30 days after the end of each month.

MICHIGAN: The House of Representatives and Senate are continuing discussions on their respective health care reform packages. The House is using two work groups to prepare its bills for consideration by the House Health Policy Committee this week. The Michigan Association of Health Plans is participating in the work groups, trying to move House Democratic leadership away from a package of legislation that would harm the individual insurance market. The Senate Health Policy Committee held a single meeting on its reform package. Senator George has announced a public hearing in Detroit on June 15 to hear public testimony on the package. There is considerable opposition to Senator George's plan for covering all of the state's uninsured up to 300 percent of the federal poverty level through payment in lieu of taxes from Blue Cross Blue Shield of Michigan, a hospital tax that would be matched by federal funds and a 1.8 percent paid-claims tax that would be paid by insurers and self-funded health plans.

NEBRASKA: The Nebraska legislature recently adjourned after passing several significant bills, including: a bill that amends the Health Insurance Access Act to allow an uninsured access coverage plan to include prescription drug and preventive care coverage, and that removes income as a criterion for eligibility; a bill that amends the state's autism treatment program to require that for every $2 of funding that comes from the state, the program must generate at least $1 in matching private donations; a bill that amends the medical assistance program statute to increase the income eligibility requirements for children under age 19 from 185 to 200 percent of FPL; and a bill that extends the maximum age on sickness and accident policies of an insured's dependents to age 30, up from 23. In addition, several important bills died this session, including one that would have established a commission to develop a comprehensive plan for affordable health insurance with an individual mandate and guaranteed issue as components.

NEVADA: The Governor signed legislation requiring health insurers to cover screening and treatment of autism spectrum disorders for covered persons until the age of 18 or, if enrolled in high school, age 22. The bill also includes coverage limitations for autism treatment, and provides for licensure of behavior analysts and certification of certain autism treatment providers. Beginning January 1, 2011, all group plans would be required to provide coverage, while individual policies will be required to offer a benefit rider to subscribers.

OKLAHOMA: The legislature adjourned May 27, ending a session marked by the early defeat of a controversial autism coverage mandate bill known as "Nick's Law." Ultimately, the only autism-related bill to travel to Governor Brad Henry's desk was a measure regulating autism service providers and establishing an applied behavioral analysis research pilot project. The legislature passed a bill that would establish the Health Care for the Uninsured Board (HUB) to work with the insurance commissioner to certify health insurance programs, educate uninsured consumers about choosing coverage and utilizing medical care, and help qualified individuals become enrolled in a subsidized plan. The bill also authorizes carriers to offer people under 40 a benefit plans that lacks state-mandated benefits providing disclosures are in place. Finally, the bill authorizes the Oklahoma Health Care Authority to add to the premium assistance program, the option to enroll in a high-deductible health plan compatible with a health savings account. Several pieces of significant legislation were killed, including one that would have required health benefit plans to cover all health care services that were deemed by the provider to be medically necessary.

TENNESSEE: The health "Silent PPO" bill, which Aetna helped amend earlier this year, has passed the House and will likely continue to move forward. The Workers' Compensation Advisory Council will review the proposed "Silent PPO" bill related to workers' compensation this week. Aetna continues to work with the sponsor on language and a possible summer study, but he still insists the bill be heard this year. To do so, he must ask the House and Senate to re-open their committees, which have been closed for the year.

TEXAS: As a result of partisan political wrangling, the legislature adjourned this week after failing to pass any legislation that would continue the life of the Texas Department of Insurance. The agency is now scheduled to go into "wind down mode" beginning September 1, 2009. The Governor will likely call a special session to resolve this issue and other issues left undone during the regular session. He could also enter an Executive Order moving the TDI's functions to other agencies temporarily. The legislature did manage to pass some significant bills, including one that would codify a balance billing dispute resolution process. Another bill expands the state's autism mandate from age 6 up to 9 and includes the state's employee group. Other bills provide rules regarding ranking of physicians by health plans (consistent with Aetna's current process); allow the direct employment of physicians by hospitals, which should help eliminate the state's balance billing problem; and require all public colleges and universities to sponsor their own health plans for students. Bills defeated included the Texas Medical Association's omnibus "Code of Conduct" bill. Also, 13 separate bills relating to MLR all died, as did the Speaker Pro Tem's "Silent PPO" bill, which also attempted to regulate self-funded plans, was voted down on the Senate floor.

WASHINGTON: Small employers now have an additional tool to help mitigate the costs of rising health insurance premiums. With the passage of recent legislation, small employers willing to develop and implement an outcome-based employer wellness program can negotiate modest premium reductions with insurers if the employer is able to meet the goals established for the program. Program goals could focus on, for example, increasing the percentage of employees receiving age-appropriate health screenings, increasing the percentage of employees receiving flu shots, or setting a target for the number of employees who stop smoking.

Resources
Transforming Health Care in America
America's Health Insurance Plans

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