Archive for July, 2007
July 29th, 2007 | 
Author: The group health insurance rates at my day job increased 33% this year, after rising just over 30% last year. I have a family of three, and the new health insurance rates are now 11% of my salary, which in my opinion, is too high (while I won’t disclose my actual salary, I will state that I earn a fair amount). The new health insurance rates made me think about getting individual health insurance for my family.
Group vs. individual health insurance? Before we go further, it is important to understand the difference between individual health insurance and group health insurance. Basically, group health insurance plans guarantee all members of the group coverage, regardless of their health risk. Because coverage is guaranteed with group plans, they can be more expensive for relatively healthy individuals than an individual plan, which is priced based on your specific health history. In my case, my family and I are healthy, so it is a good idea to investigate individual health insurance options.
Determine your health insurance needs to find the best plan
When comparing health insurance plans, it’s important to make sure you are not only comparing apples to apples, but also getting the best plan for your needs. Make sure you get the best health insurance plan for your needs, whether that is an HMO plan, PPO plan, high deductible health insurance plan with a health savings account, hybrid, or other. [More on health insurance options].
Finding and purchasing health insurance while self-employed
One of the biggest concerns among the self employed individuals is health insurance costs, which can be expensive. Some self-employed individuals may be eligible for a group health insurance plan if they meet certain criteria, or they may be eligible for other health benefits, such as COBRA benefits. For example, if you are leaving a traditional job to become self-employed, you may be eligible for COBRA. If you are not leaving a job that offers health insurance, then ignore the tip regarding COBRA coverage.
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Anyone who has spent some time with Affiliate Marketing will say that it is more of an art than a science. You need to know where your target audience is, and importantly, you also need to know which method work best to promote your product. Clearly, affiliate programs are not as easy as you think they would be, if that is your thought as a newcomer.
The first thing for you to do is find out a niche for yourselves. Of all the niches (Mind you, you will find about 1000s of niches when you start searching for profitable niches in affiliate programs), health is often considered one that can never die down. Irrespective of how much money a man or a woman spends in luxuries and accessories, health is one aspect he would never ignore.
That’s why Health Affiliate programs are probably the easiest to promote.
The confusing point is – You have over 100 and more health affiliate programs. You can very well sign up with some bottom rung health affiliate programs and start promoting the product. But remember in affiliate marketing – Your promotion technique is probably not as important as the product itself. Wow – Did you now know a trick to successful affiliate marketing or what?
Tap into a health affiliate network that promotes quality health products, and one that would probably find a good acceptance ratio from your target audience.
Confused? Let me explain this for you.
Any health affiliate network that provides a conversion rate of 5% on clicks or more can be considered for selection. What I mean is this – If you use PPC as a promotion technique, for every 100 clicks, you should have 5 sales or more.
Best health affiliate programs are able to do this kind of conversion.
Best affiliate programs will also have wide range of health products (I am not talking about the number of products, but the range of it). Good affiliate programs would also provide excellent discounts on volume orders. But most importantly, best affiliate programs would provide products to you that have wide acceptance amongst people.
Clearly, it works for you to partner with the best affiliate programs.
If this is a niche that appeals to you, click here to learn more.
Q: What is home health care?
A: Home health care is a service that permits patients to receive personalized health care, maintaining their quality of life in the privacy and comfort of their homes.
Q: Why home health care?
A: Home health care is a cost-effective option for receiving health care services. Returning to one’s home and family can quicken recovery and improve the quality of life for both patient and family or caregiver.
Q: Who pays for home health care?
A: Most health insurance companies, HMOs, PPOs and Workers Compensation cover home health care. In addition, Medicare and Medicaid pay for home care services. Some insurance providers do not cover all home health services. Our staff will verify health coverage for the patient.
Q: What criteria are required for Medicare to approve services?
A: The following criteria are used to meet Medicare requirements:
• The patient is a Medicare recipient.
• The patient must be homebound. This is defined by Medicare as “normal inability to leave the home and that leaving the home requires considerable and taxing effort.”
• The skilled care must be medically necessary as determined by the physician.
Q: What if I have a problem at night or on the weekend?
A: We have registered nurses on call 24 hours a day, 7 days a week.
Q: Do I need a physician’s order for home health care?
A: Yes, all health care provided in the home occurs under direct order and supervision of the patient’s physician.
Q: What types of services can be provided at home?
A: Many medical conditions that previously required hospitalization can safely be treated in the home. Home care services may include but are not limited to:
Skilled Nursing:
• Observation and assessment of condition
• Patient and family education of disease process
• Management and evaluation of patient care plan
• Medication education and management
• Dressing changes
• Home safety education
• Wound care
• Catheter care
• Injections
• IV therapy
• Ostomy care
• Pain management
• Diabetic care
• Nutritional support
Assistance with Daily Living:
• Bathing/dressing
• Transfer/ambulation
• Light meal preparation
• Light housekeeping
• Grocery shopping
• Medication reminder
• Laundry
• Companionship/Conversation
• Reading/writing
• Pet sitting/walking
• Escort to appointments
• Live-ins
• Respite
• Exercise therapy assistance
Q: How does Paloma Home Health Care, Inc. ensure quality care in the home?
A: Providing continuous quality care to patients is paramount to all we do. All patients are given a patient satisfaction survey that is incorporated into our ongoing evaluation process to continually increase our patient satisfaction. New programs and processes are developed through our quality improvement team to promote favorable outcomes.
Q: How do I find out more about home health care?
A: Please call our office to learn more about how you can benefit more about the service, at 972 346 2013
Q: What services can Paloma Home Health Care, Inc. offer?
A: Our services include but are not limited to:
• Supportive Care Education of Disease Process
• Individual and Family Counseling
• Management and Evaluation of Patient Care
• Observation and Assessment
• Home Safety and Emergency Education
• Medication Education
• Assistance with ADLs
• Nutrition Education
• Restorative Therapy (Physical, Occupational and Speech)
As the owner of an independent health insurance agency and the founder of a website for comparing health insurance providers I often get asked, “What type of health insurance do YOU have?” Of course, no one health insurance company or health insurance plan is right for everyone because everyone has different needs, lives in a different area, etc… but I can certainly feel comfortable telling people that I personally have a Health Savings Account (HSA) and I absolutely love it!
Here are 7 reasons why I love my HSA:
#1 All Contributions to my HSA are Tax Deductible
Every single dollar that I contribute into my HSA http://www.easytoinsureme.com/united-health-one.html every year is deductible on the front of my personal 1040 tax return (up to certain annual limits imposed by the IRS – for 2010 the maximum deductible HSA contribution is $3,050 for singles and $6,150 for families with those age 55 or over getting an extra $1,000 allotted maximum contribution amount). This HSA contribution deduction is great because it is an “above the line” deduction meaning that it is deducted before arriving at your Adjusted Gross Income (AGI) number. To make this deduction even better there are absolutely no income phaseouts for the HSA contribution deduction so you could be Bill Gates or Warren Buffet and still take the full HSA contribution deduction. The more money you make the more attractive this deduction is to you.
#2 The Money in my HSA Grows Tax Free
All of the money in my Health Savings Account grows tax free as long as I use the money in the account for qualified medical expenses or wait until I am age 65 or older and use it for my retirement. Yes, you heard me right “Tax Free” not just “Tax Deferred” as you may be accustomed to hearing about with a 401K or other similar tax deferred account.
#3 I Can Choose any Health Insurance Company I Want
Another reason I love my HSA is that the HSA itself is simply a savings account with some special paperwork so that it receives special treatment from the IRS. The HSA itself is NOT health insurance but is simply the second component of what is commonly thought of as a HSA health insurance plan with the first component being a high deductible health insurance plan (according to the IRS a high deductible health insurance plan is any health plan with a deductible of at least $1,200 for singles and $2,400 for families – so still pretty low minimums). What this means is that many different banks offer Health Savings Accounts and you can choose the bank that you prefer to set up your HSA and then buy your high deductible health insurance plan from any insurance company that you like. You can even purchase a plan from United Healthcare one year and then shop around in year two and switch to a potentially cheaper plan with Humana and then in year three switch to Blue Cross Blue Shield, etc. This ability to constantly comparison shop and not be tied to one particular insurance provider is a great benefit to an HSA (as your actual savings account component of the plan still stays with your original bank).
#4 I Pay Very Low Monthly Premiums
The higher the deductible is on your health insurance plan then the lower your monthly premium payments will be. Since a high deductible health insurance plan is a requirement for opening a Health Savings Account then one of the nice things about the plans is that the monthly premiums are comparatively very low! I would much rather save a large sum of money every month by paying less in premiums each month than paying extra for a very low deductible and co-pays.
#5 I Am Firmly In Control of My Health Care Dollars
The beautiful thing about an Health Savings Account as compared to a Flexible Spending Account is that while Flex Spending Accounts require you to use up the money in the account every year all of the money that you contribute to an HSA rolls over from year to year. In fact, as mentioned above, even if you don’t end up using the money in your HSA for medical expenses (a good thing!) then when you reach age 65 you can withdraw the money tax free for your retirement. Most HSA custodians will give you an option to place your HSA money into a savings account, investment account, etc. as the decision is up to you as to where you place your HSA account money.
#6 I Can Rest Easy
Admittedly some people simply sleep better at night knowing that they have a very low deductible and low co-pays for things like doctor’s visits and prescriptions and I understand that but I like to think of it like this - After your first year of contributing the maximum to your HSA then unless you use up all of the money with a large unforeseen medical bill then you will have enough money in your HSA for years two and on that even if you have to meet your deductible then as long as your HSA health insurance plan covers all expenses 100% once the deductible is met then you effectively have zero out of pocket costs because you already have the money in your HSA account! Sure, if you start an HSA tomorrow and you have only contributed a couple hundred dollars into the account so far and you get hit with a big medical bill then you will have to come out of pocket for your deductible amount but once you have maxed out your HSA contribution for a year or two then you are essentially home free with potentially no additional out of pocket costs even for large medical bills!
#7 HSA Setup is Very Easy
If you can open a savings account then you can open a Health Savings Account just as easily. If you can apply for a regular health insurance plan then you can apply for a high deductible health insurance plan just as easily. Almost every bank has HSA’s available and almost every health insurance company has high deductible health insurance plans available. Setting up an HSA is so easy that I probably took twice as long to write this article as it would take you to apply for both a Health Savings Account at your bank and a high deductible health insurance plan at your health insurance company.
According to the U.S. Census Bureau, Texas leads the country in the number of people without Texas health insurance. Although nearly one in five Americans, are not insured, it is estimated that one in three Texans are uninsured. In Texas Medical Association report, “additional 5.5 million Texans – including 1.4 million children – lack health insurance”.
In a report published by the Texas Comptroller of Public Accounts, “The uninsured are a diverse group that includes people who cannot afford private health insurance, working in small businesses that do not ‘ insurance, who simply choose not to buy health insurance, even if they can afford it, who are eligible – not registered – government-sponsored programs such as in Medicaid or the Children’s Health Insurance Plan (CHIP), and recent immigrants.
The most notable omission from these reports is that it is often difficult for people to navigate the selection of Texas get health insurance. There are a multitude of choices and decisions. Do I get an individual or family coverage? Should I go with a health organization (HMO), preferred provider organization (PPO) or another type of plan? What kind of deductible should I choose?
The task to find Texas health insurance is even more daunting because, as you move from a health insurance company to another, you find that each offers a different set of options. Accordingly, it is difficult to compare apples with apples proverbial.
Most people do not realize that a full-service agency based in Texas health insurance can help every one of individuals and families to small business owners and Medicare beneficiaries understand the options that are their disposal to obtain insurance. Better still, these agencies offer their services and free support. It is because they are compensated by insurance companies, rather than the insured. Therefore, you can collect the benefits of their expertise impartial, free of charge.
Best of all, some of these agencies have implemented easy to use online systems that allow you to obtain quotes, compare Texas health insurance plans and even apply online – all from the comfort your home. In fact, you can view the plans of health insurance, life insurance, dental plans, health insurance plans and all in one place.
To obtain quotes for health insurance, for example, simply enter your details into an online form, and then provide some basic information about you and other family members you wish to insure. The system will then generate quotations from a variety of companies, which allows you to compare side by side. You can sort the results by a number of factors, including the health insurance company, plan type, deductible, co-payment, and the estimate of the premium. Once you decide which plan you prefer, you can apply online.
Every day, health insurance is a growing number of people with affordable health insurance Texas. In return, those who obtain health insurance rest easier know that their families and they are protected.
FEBRUARY 5, 2010
This Week in Health Care Reform EasyToInsureME FEBRUARY 5 2010
Despite proclaiming to focus on other issues, such as the economy and jobs, President Barack Obama injected new energy into the health care reform debate this week.
On Monday, President Obama held a Q&A session via YouTube in which he responded to questions submitted during his State of the Union address. He commented that “it is my greatest hope” to have health care reform legislation “not just a year from now, but soon.” He also responded to criticisms regarding the lack of transparency around the reform negotiations.
On Tuesday, at a town-hall-style meeting in New Hampshire, President Obama rejected the notion that health care reform was dead, saying “we’ve got to punch it through.” Further, on Wednesday, he met with Senate Democrats reiterating his commitment to reform and encouraging lawmakers to press forward. He also suggested that Republicans play at least some role in negotiating a final bill.
Health Care Reform Negotiations
Democrats Look for Path Forward: Recent statements made by Rep. Charles Rangel (D-NY) are the first concrete signs that Democrats have started working to revive comprehensive health care reform legislation. Rep. Rangel indicated to the media that lawmakers have begun writing a compromise bill based on the legislation passed by the Senate last December. The bill will incorporate changes agreed upon last month by White House negotiators and members of the House and Senate.
Senate Majority Leader Harry Reid (D-NV) did not commit to a timeline for reform, but hopes that Democrats can agree to a path forward by next week. So far, he has been unable to identify compromise language that will win the needed 51 Senate votes.
At the same time, Speaker of the House Nancy Pelosi (D-CA) indicated that the House would vote on a small piece of the overall health care reform package next week. The proposed bill would overturn the insurance industry’s exemption from federal antitrust laws. The Senate version of health care reform did not include this measure because Sen. Reid could not secure the 60 votes needed to include it; however, Sen. Reid indicated the Senate would reconsider the measure.
Additional Activities
President Obama’s Budget Assumes Health Care Reform: On Monday, White House officials released a proposed $3.8 trillion 2011 budget including several measures aimed at improving health care:
· Hiring more fraud detectives to root out waste in Medicare and Medicaid
· Providing $25.5 billion to help state Medicaid programs swelling with enrollment due to unemployment
· Eliminating Congressional earmarks for building hospitals and other facilities, including $10 million for Alaska and $35 million for Mississippi
· Initiating or increasing funds for the following research projects:
o quality improvements for seniors with chronic conditions
o effective medical treatments for the costliest conditions
o expeditious ways to adopt electronic medical records
o medical fields such as genetic medicine that may provide breakthrough treatments.
Further, the budget assumes that some form of health care reform legislation will pass Congress. It includes a “reserve fund for health care reform” totaling $634 billion as a “down payment” for the legislation and also assumes that the reform effort will generate $150 billion in savings over 10 years.
States Begin Initiatives to Expand Coverage: With the fate of national health care reform in question, state legislators are pushing their own bills to expand coverage. Last Thursday, California’s State Senate passed a measure to create a government-run health care system, ignoring a veto threat from Gov. Arnold Schwarzenegger. The measure is now with the State Assembly. Missouri legislators have introduced a similar bill to create a government-run plan whereas lawmakers in other states, including Virginia and New Jersey, are working to tweak existing state programs to expand coverage. Tight budgets in all of those states may hinder these efforts.
Virginia Senate Says No to Individual Mandates: On Monday, Virginia’s Democratic-controlled State Senate passed measures that would make it illegal to enforce an individual health care mandate. This decision comes in direct conflict with the House and the Senate health care reform bills, both of which require all individuals to purchase health insurance.
Public Opinion
Majority of Americans Doubt Passage of Health Care Reform, but Growing Optimism: A survey released by the Pew Research Center on Wednesday shows growing optimism around the passage of health care reform. While the poll indicates that the majority of Americans (60 percent) do not believe health care reform legislation will pass this year, the figure is down from the 67 percent who said – just after a special Senate election was held last month in Massachusetts – that such legislation would not pass.
Poll Indicates Damage Done On Health Care Reform: A poll released Tuesday by Public Policy Polling shows that Republicans currently have the advantage over Democrats in the ballot races for Congress, regardless of the final outcome of health care reform. In general, the poll shows that 43 percent of voters surveyed would vote for a Republican, whereas 40 percent would vote for a Democrat. When asked about the implications of the health care overhaul.
* If health care reform passes, 45 percent would likely vote Republican and 40 percent would likely vote Democrat.
* If health care reform does not pass, 43 percent would likely vote Republican and 38 percent would likely vote Democrat.
The poll also shows that 36 percent of respondents support the President’s health care reform effort, while 51 percent oppose it.
Looking Ahead
Currently there is no timeline for the development of a comprehensive health care reform package. However, Speaker Pelosi is moving forward with smaller pieces of the bill, starting next week with the repeal of the antitrust exemption for insurance companies.
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 $61 billion and cover three million people over ten years. In contrast, President Obama contends his plan would cost $950 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.
Week of March 15, 2010
The White House last week continued to rail against rising health insurance premiums to help build popular support for his health care reform package. But the effort to focus the blame for rising costs on insurers was questioned, in particular, by state insurance experts and economists quoted in a New York Times story last week. Insurance commissioners said that trying to hold down premiums before costs were under control would be very risky. This approach could mean solvency issues in some cases, they told the Times. To help educate Americans about the true drivers of rising health care costs, America’s Health Insurance Plans, the industry trade association, last week launched a new national ad campaign. The ad demonstrates that health insurance company costs represent a small slice of the overall health care cost pie.
Federal
With a cadre of staff operatives searching for the right health insurance reform provisions among those previously discarded from the House, Senate and the President’s proposals, Democratic leadership has been relentlessly pursuing every possible pathway to pass a final bill. The expected process would have: 1) the House pass the Senate-adopted reform bill (which most House members hate), 2) the House passing a bill to “fix” all the things it hates using a reconciliation legislative vehicle, followed by 3) the Senate passing the very same reconciliation bill — requiring only 51 votes in the Senate. The House Budget and Rules Committees are expected to start the review, hearing and mark-up process of the reconciliation bill this week. The Senate commitment to using reconciliation was made official in a scathing letter from Leader Harry Reid to the Minority Leader. Along the way the two Chambers will need to see the latest CBO “scores” on the bill before voting, and 216 House Democrats will have to resolve policy disagreements over abortion, federal health insurance rate review and authority, and other substantive issues. Additionally, the House will have to trust that the Senate can pass the reconciliation measure without changing one comma. Partisanship has blossomed into open hostility over health reform. Whether Congress can overcome these policy, process and political mine fields remains as murky as ever, but Democrats have chosen to try and will push for resolution by the Easter recess.
The Senate has passed Jobs Bill II and shipped it off to the House, where passage is not certain. Within the bill are two health-related items of note. First, the COBRA eligibility and subsidy program will be extended to the end of 2010. (These provisions are set to expire at the end of March.) Second, the bill contains a suspension until September 30, 2010 of the cut to physician Medicare reimbursements for the current calendar year. (This provision is also set to expire at the end of March.) Aetna urged Congress to apply the “doc fix” to next year’s reimbursement as well, since insurers’ Medicare rates are based on what doctors are paid, but in the end Congress failed to make this change. Aetna and the industry will continue to find ways both to establish a more lasting, if not permanent, doc fix and to devise a legislative solution to the disconnect between doctor reimbursement and Medicare Advantage rates for 2011 and beyond.
States
ARIZONA: Budget issues remain front and center as the governor and Republican leadership proposed a plan they hope will close the $700 million deficit this year and reduce the anticipated $2.6 billion deficit in 2011. Righting the state’s fiscal ship has become a very partisan exercise, with the Republicans supporting reductions in Medicaid and KidsCare, and the elimination of full-day kindergarten. As the special session on the budget is running concurrently with the regular session, no other bill hearings were held. The oral chemotherapy parity bill may be dead for this year as proponents did not meet the deadline for submitting amendatory language.
CALIFORNIA: The Assembly Accountability and Administrative Review Committee chaired by Assemblyman Hector De La Torre held a hearing last week to examine how the Department of Managed Health Care (DMHC) and the Department of Insurance (CDI) has handled issues surrounding the rescission of policies in the individual market. According to a report prepared for the committee by Bryan Liang, director of the Institute of Health Law Studies at the California Western School of Law, fewer than 300 of 6,000 former policyholders are participating in health insurers’ agreements to settle such cases. Republican committee members were highly critical of this witness, while De La Torre was critical of the Departments. The DMHC reported that since their settlements were completed there have only been nine rescissions over the past two years, proof that the DMHC and the health plans have revamped their processes for rescission and have worked to address the problem.
COLORADO: A bill mandating maternity and contraceptive coverage in individual policies continues to receive significant attention in the Senate. The most recent amendment proposes requiring maternity coverage in at least three of the plans marketed by an insurer. It would also allow a current member of a plan without maternity coverage to switch to a plan with maternity coverage from the same carrier during the first trimester. The other major bill would require that second level appeals be performed by physicians who are actively involved in clinical practice. This measure is counterintuitive in the current economy, since it would result in outsourcing appeals and drive up costs for plan sponsors and their employees.
CONNECTICUT: A proposal that would require health insurance plans to cover oral chemotherapy in the same way that intravenous chemotherapy is covered made it through the legislature’s Insurance and Real Estate Committee last week. Currently, many health plans treat the two kinds of cancer treatments differently. Chemotherapy treatments that come in pill form are often categorized as prescription drug benefits that can require patients to pay a larger share of the cost. Cancer patients, doctors and patient advocates spoke in favor of the bill, while insurers and the Connecticut Business and Industry Association opposed it, arguing that it would put a mandate on health plans that could raise costs and make it more difficult for employers to afford insurance.
GEORGIA: A bill restricting the use of rescissions in individual health insurance policies passed a Senate committee last week. Aetna continues to work with its trade organizations to educate legislators about the adverse effect of this type of legislation. Discussions also continue regarding legislation affecting the use of rental networks.
KANSAS: Roughly half way through the legislative session, several health care bills are still moving through the process. On the regulatory front, the Insurance Department has proposed a regulation that would mandate coverage of routine patient care costs while the insured is enrolled in a cancer clinical trial – a mandate that was rejected by the legislature in 2008. A hearing will be held on April 20, and Aetna will have an opportunity to present testimony on this issue. Bills still alive include mandates for autism and orally administered chemotherapy, legislation prohibiting dental contracts that require the dentist to follow a fee schedule for non-covered services, and a ban on “most favored nation” clauses by some insurers. Another bill would allow small employers to create individual HRAs to fund premium payments on individual policies, require administering insurers to offer employees the option of receiving health insurance coverage through a high-deductible health plan with an HSA, and requiring insurers who offer small group health plans to offer high-deductible health plans with HSAs, while authorizing tax deductions for health insurance premiums for individual insurance policies. Separate legislation would amend the definition of “eligible employee” to include part-time workers (currently less than 30 hours per week). Pending legislation concerning hospital charges would prohibit charging private-pay patients more than 25 percent of what the hospital’s highest volume private payer would pay for the same goods or services. Legislation that died includes a telemedicine mandate and creation of a health care insurance database for employers.
KENTUCKY: Health issues that are being hotly debated by the legislature right now include an autism mandate, a dental bill that would not allow insurers to hold dentists, optometrists or ophthalmologists to a fee schedule for non-covered services, and a bill setting a reimbursement floor for chiropractic services. The chiropractic services proposal would allow chiropractors to bill, and would require insurers to reimburse, an evaluation and management (E&M) CPT code on each and every visit. In addition to billing for follow-up services for manipulations and other therapies, the chiropractor would be allowed to submit, and the insurer required to pay, for another E&M code on each and every visit. The legislation would also add a new mandated benefit to the Kentucky statutes. Currently, reimbursement for chiropractor visits is required only if the chiropractor performs a service already covered by the health benefit plan. Under the proposal, any service within the scope of practice of a chiropractor that is billed would become a mandated benefit. Finally, the bill would require health benefit plans to provide reimbursement without the chiropractor having to provide any documentation that the services were medically necessary. Each of these bills has, or is expected to, pass at least one chamber.
SOUTH DAKOTA: Several important legislative deadlines are approaching, resulting in a flurry of activity. Bills or resolutions not passed by the second chamber by March 9 died. But the Governor has already signed a bill that amends the premium rate-setting procedure for the high-risk pool so that rates for a given classification are 150 percent of the average actively marketed premium. The pool will have to offer three or more plan designs, remove coverage requirements for the plans (such as disease management) and remove set cost-sharing values. The bill was signed by the Governor on March 1 and will become effective on July 1, 2010. The Governor has also signed a bill prohibiting rating based on injuries caused by domestic violence and legislation requiring refunds of premiums for partial months, in the case of mid-month cancellations. Both chambers have passed legislation prohibiting contract language requiring dentists to accept a fee schedule for non-covered services, and the bill awaits the Governor’s signature. Finally, the legislature passed a resolution opposing the federal health care reform proposals passed in the U.S. Senate and House.