Health Care Reform News Around the Nation for August 18
Two UnitedHealth Group subsidiaries are challenging a proposed rule by the Florida Office of Insurance Regulation that would require state insurers to use the same application forms and medical questionnaires for all small businesses with between two and 50 employees, Florida Health News reports.
The rule aims to close the health insurance price gap between companies with a certain number of employees -- often 10 -- that can submit group applications and companies with fewer employees that are required to submit individuals' medical histories. Companies that submit group applications tend to receive a lower price in the first year, followed by a "steep increase" the next year, while companies with fewer employees can get charged up to 15% more than the rates the carriers have filed with the state, according to Florida Health News.
The two UnitedHealth Group subsidiaries, UnitedHealthcare of Florida and United HealthCare Insurance, have said that the office lacks the authority to require the change.
The Division of Administrative Hearings will hear arguments in the case on Aug. 22 (Gentry, Florida Health News, 8/13).
On Monday, Massachusetts Gov. Deval Patrick (D) proposed a state regulation that would require businesses to contribute more to employee health coverage or pay an annual "fair share" penalty, the Boston Globe reports.
Under existing state law, businesses with more than 10 full-time workers must offer health coverage or pay an annual penalty of $295 per worker. Employers could choose either to cover at least 33% of their workers' premiums within the first 90 days of employment or ensure that at least 25% of their full-time workers are enrolled in an employer-sponsored plan.
The proposed regulation would require employers to comply with both requirements or pay the annual penalty. Public documents released on Monday stated that the regulation, if adopted, would be implemented on Oct. 1.
The new rule would generate an estimated $45 million this fiscal year, which would be used to close a funding gap in the state's health insurance law. A public hearing on the proposed regulation is scheduled for Sept. 5 (Lazar, Boston Globe, 8/12).
Blue Cross Blue Shield of Michigan and the American Society of Clinical Oncology are collaborating to collect and analyze treatment information on tens of thousands of people with cancer in Michigan in an effort to improve care and reduce costs, the Detroit News reports.
According to BCBS officials, similar initiatives have reduced hospital deaths and saved millions of dollars in unnecessary medical expenses.
For the initiative, the groups will collect data from 11 oncology practices in Michigan that account for 180 physicians treating 16,000 patients annually. The data will be entered into ASCO's national registry, which includes information about a number of aspects of cancer treatment, including chemotherapy-related side effects and pain management, from 25,000 cancer professionals at about 385 oncology practices.
Physicians who provide data will receive $3,000 apiece.
BCBS says it plans to spend approximately $500,000 this year on the project.
According to ASCO CEO Allen Lichter, BCBS is the first insurer to help its physicians offset the costs of collecting and compiling treatment information.
BCBS spokesperson Helen Stojic said that although data collection began in May, the insurer will not know what the exact savings are for about 18 months, although preliminary results will be available in September (Rogers, Detroit News, 8/8).
More Nevada specialists are participating in Medicaid, despite recent cuts to some reimbursement rates, according to a state survey, the Las Vegas Sun reports. The state Legislature had allocated $17 million to increase physician reimbursements this month, but state budget cuts prevented the rate increase.
A Nevada Health and Human Services Division of Health Care Financing and Policy survey found that:
- More than 96% of the state's ob-gyn's have signed up to accept Medicaid beneficiaries, compared with 71% in 2006;
- Eighty-eight percent of psychiatrists are participating in Medicaid this year, compared with 58% in 2006;
- Participation among dermatologists, gastroenterologists and neurologists increased by 20% each;
- Participation declined among general practice physicians from 71% in 2006 to 68% this year, general surgeons from 77% in 2006 to 58% this year and internists from 94% in 2006 to 79% this year; and
- No urologists in the state participate in Medicaid.
Division Director Charles Duarte said he had expected that the state budget cuts would result in fewer physicians participating in the program overall (McGrath Schwartz/Ryan, Las Vegas Sun, 8/13).
On Monday, New York Gov. David Paterson (D) proposed cutting this year's state budget by 1%, or $1.04 billion, including $506 million in Medicaid cuts, to avoid a looming budget deficit, the New York Times reports (Peters, New York Times, 8/12).
Paterson has asked state lawmakers to return to Albany, N.Y., on Aug. 19 to reopen budget discussions and consider his cuts or find their own solutions to avoid a deficit that is expected to reach $6.4 billion next year Scott, New York Post, 8/12). If approved, this year's budget will be $120.2 billion -- a 3.9% increase over last year's budget but less than the inflation rate, which was 4.2% during the first half of 2008.
Paterson is proposing slowing Medicaid spending growth from the budgeted 4% to 1.7% this year (New York Times, 8/12). According to the Rochester Democrat & Chronicle, because the federal government pays for half of New York's Medicaid program and local governments pay 16% of the program's costs, "cuts in programs would have to be considerably above $1 billion to meet Paterson's state-savings figure" (Gallagher/Sharp, Rochester Democrat & Chronicle, 8/12).
The Medicaid cuts include $269 million in funding for hospitals and nursing homes (New York Post, 8/12).
State Senate Majority Leader Dean Skelos (R) said that instead of cuts, lawmakers should be working to reduce Medicaid fraud and collect tobacco taxes from products sold on American Indian reservations, which could reach $400 million annually (Karlin, Albany Times Union, 8/12).
West Virginia's redesigned Medicaid program is restricting benefits for more than 90% of child beneficiaries because of insufficient efforts by the state to enroll children in an expanded plan, according to a report released Thursday, the Charleston Gazette reports.
The Medicaid changes took effect two years ago with the creation of Mountain Health Choices. The program covers more than 230,000, or 30%, of West Virginia children and offers expanded benefits for children whose parents sign "personal responsibility" agreements to improve their children's health.
The agreement requires that beneficiaries see a physician, keep appointments and avoid seeking care at emergency departments. Eight percent of parents with children enrolled in Medicaid have signed the agreement.
Children of parents who do not sign the agreement receive "basic" coverage that provides fewer benefits than traditional Medicaid. This format is intended to encourage parents to take a greater interest in their children's health, but the redesigned plan is "seriously flawed" and is "not working as currently structured," the report states.
The report, authored by Georgetown University Center for Children and Families Deputy Executive Director Joan Alker, states that beneficiaries receive a mailing notifying them that they must sign up for the expanded benefit package within 90 days after they become eligible to renew coverage.
However, the date is not indicated in the mailing and parents are not warned that benefits could be reduced, according to the report. The study also states that the program has had "no real impact" on improving health or promoting healthy behavior.
The report found that children comprise 85% of state residents affected by the Medicaid changes.
State officials defended the plan as offering "very good" health coverage (Eyre, Charleston Gazette, 8/8).
Medicaid officials said all children in the program receive comprehensive care, including regular screenings (AP/Wheeling News Register, 8/8).