Customized Briefing for Kimberly Barry-Curley
From NAHU
Leading the News
Legislation and Policy
Public Health and Private Healthcare
Systems
Senior Market News
June 7, 2011
Uninsured
Leading the News
MLR Provisions May Yield $1.4 Billion In Health Insurance Rebates.
The Los Angeles Times /Kaiser Health News (6/7, Andrews) reports, "The Obama administration estimates that starting in 2012 the
medical-loss ratio (MLR) provisions may result in as many as nine million people being eligible for rebates totaling $1.4 billion; in the
individual market...the average rebate could be $164 per person." The article explains, "Under the health-care overhaul, insurers beginning
this year must spend at least 80 percent of the premium dollars they collect on medical claims or quality improvement efforts." In other
words, profits and administrative fees cannot be more than 20 percent. Insurers "that don't meet these new 'medical loss ratio' standards
have to refund the extra premiums collected to consumers." In May, in what may a harbinger of things to come, Aetna received permission
from Connecticut insurance regulators to decrease its premiums on certain individual policies.
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Legislation and Policy
Analysis: Health Reform Waivers Aim To Stabilize Insurance Market.
Ricardo Alonso-Zaldivar says in an AP (6/7) analysis piece that "President Barack Obama's administration has granted nearly 1,400
waivers easing requirements of the new health care law, and some critics on the right say Obama is giving his political allies a pass from
burdensome requirements everyone else will have to live with." But, after reviewing the data on waivers that the Administration has
granted, and consulting with healthcare experts, Alonso-Zaldivar concludes the "Obama's health care law allows waivers to prevent loss of
coverage, cost spikes or disruptions to a state's health insurance market." And, Paul Ginsburg, "president of the Center for Studying Health
System Change, a nonpartisan research organization," noted, "I wouldn't see that as special deals as much as bowing to reality."
The Daily Caller (6/7, Boyle) reports, "The Daily Caller has learned the Department of Health and Human Services (HHS) never had
the authority to issue waivers from Obamacare's annual limit requirements." The healthcare law did not confer that authority on HHS. But,
"through new rules and regulations, HHS gave itself the power last summer using a broad interpretation of certain parts of the law." The
DC says that "there's at least an appearance of political favoritism in favor of those who lobbied for HHS to grant itself waiver power," such
as the United Food and Commercial Workers and AARP.
The Kiowa County (KS) Signal (6/7) prints a letter from Kansas Congressman Tim Huelskamp and other state lawmakers to HHS
Secretary Kathleen Sebelius asking her "to release additional information about waivers that have been granted or denied to businesses
and labor unions seeking not to have to comply with the rules and regulations of the Patient Protection and Affordable Care Act (PPACA)."
Huelskamp said, "Equal treatment under the law should allow anyone who seeks exemption to be granted it. It is sheer hypocrisy to say
that this is about healthcare 'equality,' but still grant special privilege exemptions to labor unions and businesses."
California Challenge To Federal Healthcare Law Set For Oral Arguments On July 13.
CQ (6/7, Norman, Subscription Publication) reports, "Yet another challenge to the healthcare law will be the subject of oral arguments in an
appeals court - this one a suit dismissed by a California federal judge in 2010 for lack of standing." Under an order issued last week "by the
Court of Appeals for the 9th Circuit, oral arguments will be heard July 13 in a case filed by the Pacific Justice Institute and Steve Baldwin, a
former state lawmaker." PJI and Baldwin "alleged that the law is unconstitutional because it requires employers to buy health insurance for
workers and because the revenue provisions did not originate in the House of Representatives." CQ notes that a fourth suit filed by 26
states is scheduled for oral arguments this week in Georgia.
Texas House Panel Approves Multistate Healthcare Compact.
The AP (6/7, Ingram) reports, "A Texas House panel revived legislation Monday to allow Texas to govern federal healthcare benefits on its
own by joining a multistate agreement challenging federal healthcare law." The plan "would allow Texas to adopt its own healthcare rules
in lieu of federal regulations if Congress approved." Critics "argue that if Texas enters the compact, the state gives up its right to increased
federal funding for Medicaid and Medicare."
Alabama Implementing Reforms Despite Healthcare Law Opposition.
Politico (6/7, Kliff) reports, "When it comes to health policy, Alabama is a Republican-controlled state that pushes back against the grain in
just about every way. It has a governor gunning to set up a health exchange, a Medicaid director skeptical of block grants and a rapidly
expanding Children's Health Insurance Program." In fact, Alabama "'is interested in moving forward on health reform [and was] interested
in the exchange concept before the law was passed,' said Tricia Brooks, a senior fellow at the Georgetown University Health Policy
Institute who recently spent time in Alabama working on CHIP." Yet, Gov. Robert Bentley (R) "has challenged the health overhaul in court
and signed on to Republican Governors Association efforts to roll back health reform's maintenance-of-effort requirements."
Medica Plan Provides Look At How New Health Insurance Exchanges May Work.
The Minneapolis Star Tribune (6/7, Crosby) reports that Minnetonka, Minnesota-based Medica "is launching a new plan for businesses that
it says will help them gain more control of healthcare costs, while giving employees more say in designing their insurance plans," thereby
providing "a glimpse into how new health insurance exchanges could work, well ahead of the 2014 federal mandate." The plan is called
"My Plan." Businesses having 51 workers or more may take part in the program starting July 1.
The Pioneer Press (6/7, Snowbeck) reports, "Using an online program, workers will see their employer's specific contribution for
insurance benefits and then shop among 20 Medica health plan options with a variety of deductibles, copayments and covered services."
Employees "will be able to see how selecting a plan option with richer or skimpier benefits translates into more or less spending from their
own pockets." The Pioneer Press points out, "The Medica program is just the latest example of a trend in which employers are giving
workers the equivalent of block grants that can be used to buy coverage on what are called private health insurance exchanges."
Clinician Survey Seeks To Identify, Understand Barriers To EHR Adoption.
Government Health IT (6/6, Mosquera) reported, "The Agency for Healthcare Research and Quality plans to survey 300 clinicians to
identify and understand the barriers that Medicaid providers encounter in deploying and becoming meaningful users of electronic health
records," according to an announcement in the June 3 Federal Register. "Once the data is collected, AHRQ will develop technical
assistance and support for putting EHR systems into operation in provider practices or upgrading existing systems."
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Public Health and Private Healthcare Systems
Senate Democrats Roll Out Two-Pronged Strategy On Medicare.
Roll Call (6/7, Dennis, Subscription Publication) reports Senate Democrats "are attempting a balancing act on Medicare -- by showing
openness to containing the program's ballooning costs but still drawing the line at cutting benefits. ... In a move that appears designed for
media consumption, five Democratic Senators up for re-election in 2012 sent a letter Monday to Vice President Joseph Biden asking him to
hold firm against cutting benefits for seniors and to reject the House-passed proposal to transform Medicare during his bipartisan
negotiations to increase the $14.3 trillion debt limit." However, also yesterday, Sen. Charles Schumer "left open the possibility of reaching
a deal that would include trimming Medicare," but only "as long as it doesn't reduce benefits to the beneficiary."
SCOTUS To Hear Case That Could Refine States' Medicaid Responsibilities.
Kaiser Health News (6/7, Chase) reports a "case before the US Supreme Court that could redefine states' responsibilities on Medicaid
services and ultimately determine whether Democratic Gov. Jerry Brown can go forward with cuts he says are vital to closing the state's
budget gap." California "has been trying for years to cut its reimbursement rates for hospitals and other healthcare providers." In 2008,
state lawmakers and the former governor approved a 10 percent cut in payments to healthcare providers. Providers sued the state to try to
stop the payment reductions. "The court will focus on whether outside groups, such as hospitals and other providers, as well as Medicaid
recipients, have the right to sue when they believe the state is violating federal law."
Medicaid Will Stop Paying For Certain "Never Events."
The Kaiser Health News (6/7, Galewitz) reports, "Medicaid will stop paying for about two dozen 'never events' in hospitals, such as
operations on the wrong body part and certain surgical-site infections, federal officials said" last week. More than 20 states already "have
such a nonpayment policy. The 2010 federal health law, in effect, expands the ban nationwide. The rule gives states until July 2012 to
implement it."
Advocates Criticize New Jersey Governor's Proposed Changes To Health Programs.
The Asbury Park Press (6/7, Jordan) reports, "Gov. Chris Christie's proposed changes to New Jersey's healthcare safety net programs will
hurt residents already struggling to pay bills and receive crucial medical care, advocates told a state Senate panel on Monday." Among
changes sought by the Gov. Christie: "Adults with an annual income as low as 25 percent of the poverty level would no longer be eligible
for subsidized healthcare through Medicaid or NJ FamilyCare." Democrats at the "meeting said the savings from tighter enrollment would
likely be dwarfed by new costs when greater numbers of uninsured patients show up for care at hospitals and other points of service."
Anthem To Drop Automatic Credit Card Payments.
David Lazarus writes in his Los Angeles Times column (6/7) reports that health insurer Anthem Blue Cross, which has over 8 million
members in California, is telling customers that it will stop accepting automatic credit card payments as of August 1, and those who want to
keep paying by credit card must call a company service rep and pay a $15 "convenience fee" every time they do so. Alternatively,
customers can sign up for automatic card payments, but will be charged a $2 monthly fee for Anthem monthly statements, although it says
that it will waive the fee for a while to let customers adjust. Anthem is also ending the option of making bimonthly or quarterly payments.
Unable to get an explanation for the changes from a company spokeswoman, Lazarus speculates that Anthem "is making a money grab,"
perhaps to avoid paying costly credit card fees.
Senior Market News
Benefits Of CLASS Act Touted.
Laurie Edwards-Tate, president and founder of At Your Home Familycare in San Diego, California, wrote in the Washington Times (6/6),
"The CLASS Act, a federal program created as part of national healthcare reform legislation in 2010, will make about $27,000 per year in
assistance available to those who need it, taking a big chunk out of the financial obligation of long term care, according to the Private Duty
Homecare Association." Edwards-Tate said that "without CLASS coverage or something similar in tandem with private insurance plans,
increased spending on long term services would add $44 billion annually to the cost of Medicaid/Medicare over the next decade." She
added that because of the growing number of baby boomers, HHS Secretary Kathleen Sebelius "and her staff at the Department of Health
and Human Services need to wage a strong advocacy campaign to enlist employer support in making the CLASS Act available to
thousands of employees."
Uninsured
Cancer Costs Putting Treatment Out Of Reach Even For Patients With Insurance.
Reuters (6/7, Sherman) reports that cost studies presented at the American Society of Clinical Oncology meeting suggest that many
patients with care are discontinuing their medical care because the costs are too high even for those with health insurance.
The Wall Street Journal (6/6, Hobson, Subscription Publication) "Health Blog" noted that according to one study of 216 patients with
breast cancer, out-of-pocket medical costs averaged $712 a month. Notably, all but one of the respondents had health insurance, mostly
Medicare, and 83% had a prescription-drug coverage plan. And, a study published recently in the Journal of Clinical Oncology found that
about 13% of cancer patients spend more than 20% of their income on medical expenses and health insurance.
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