Health Care Reform News Around the Nation for the Week of April 14
Florida Gov. Charlie Crist (R) is traveling through the state touting his proposal that seeks to provide health coverage to up to 3.8 million uninsured residents, the Miami Herald reports. According to the Herald, Crist's plan would remove mandates that require insurance plans to include coverage of up to 50 services, which would allow insurers to offer stripped-down plans with premiums as low as $150 a month.
The plan would include coverage of office visits, outpatient surgery, medical equipment, inpatient hospital stays and emergency care services. Under the proposal, residents who were uninsured for the previous six months could choose from two tiers of coverage for catastrophic and noncatastrophic illnesses.
On Tuesday, the state House Healthcare Council approved legislation that includes some provisions of Crist's plan and that others would establish a public-private not-for-profit corporation to administer stripped-down plans for small businesses (Hatcher/Caputo, Miami Herald, 4/9). Under Crist's plan, state regulators would oversee the program (Bousquet, St. Petersburg Times, 4/9).
Both of the plans are voluntary, but they would require employers to automatically enroll workers in health plans, and employees could opt out. Both plans also would require insurers to provide coverage to dependent children up to age 30 and loosen eligibility requirements for certain plans, including Health Flex Plans and KidCare, the state's version of the State Children's Health Insurance Program (Miami Herald, 4/9).
The Iowa Senate last Monday voted 42-6 to approve a bill (HF 2539) that would expand Hawk-I coverage to tens of thousands of more children, the Des Moines Register reports. Hawk-I is Iowa's version of SCHIP.
The legislation would increase the income eligibility threshold from about $41,000 for a family of four to about $62,000. The expansion would cost an estimated $5 million next year and about $25 million annually by 2011. The bill also would:
- Allow young adult children to remain on their parents' health insurance;
- Encourage the use of electronic health records; and
- Create a consumer advocate position in the Iowa Insurance Division.
The measure does not include a mandate that all children have health coverage. Details of the expansion would be determined by a commission, and the state Legislature would consider the recommendations next year. The bill now moves back to the House, which approved similar legislation in March (Leys, Des Moines Register, 4/8).
Legislation being considered by Maine lawmakers would place a 1.8% fixed annual fee on claims paid by health insurers to help fund the state's DirigoChoice health insurance program, the Portland Press Herald reports. The program is expected to run out of funding in February 2009. Officials had to cap enrollment last year because of costs. About 13,000 residents are enrolled in the program, according to bill sponsor state House Majority Leader Hannah Pingree (D).
Supporters of the legislation say it will help resolve issues related to the variable amount of the fee, which has ranged from 1.7% to 2.4%. The amount is intended to be based on how much money the program, and other initiatives that cover the uninsured, have saved the health care system over 12 months. The bill also would increase the state cigarette tax from $2 per pack to $2.50 per pack (Huang, Portland Press Herald, 4/8).
The Commonwealth Health Insurance Connector on Thursday approved new rules that increase the amount that is considered an affordable monthly premium by about 10% from 2007 levels, the Boston Globe reports. Under the state's health insurance law, residents face a penalty of up to $912 if they are uninsured for the whole year unless the state determines that they are unable to afford coverage.
The new rules establish a sliding scale based on income and family size that indicates whether the state considers premiums affordable. For example, according to the sliding scale, an individual with an annual income of more than $52,500 would be considered able to afford coverage regardless of the premium, while an individual who earns between $37,501 and $42,500 annually would be required to purchase coverage if the premium was $220 per month or less. The new rules will be finalized after the Connector holds a public hearing and a second vote (Dembner, Boston Globe, 4/11).
Missouri Republican House leaders have introduced legislation that would expand health coverage to low-income state residents and require beneficiaries to contribute money to savings accounts to use toward deductibles and copayments, the St. Louis Post-Dispatch reports. The proposal, called "Insure Missouri," is intended to replace a proposal of the same name by Gov. Matt Blunt (R). Blunt's proposal failed to garner enough support among lawmakers.
Under the Republican proposal, individuals with annual incomes less than 85% of the federal poverty level would be eligible for coverage. Eventually, the income threshold could reach 225% of the poverty level. Beneficiaries would use a state Web site to purchase individual insurance policies with a set package of benefits. People who were denied coverage by insurers would be able to participate in a high-risk pool. The state would pay the premiums.
Beneficiaries also would be required to contribute 1% to 5% of their annual incomes, based on a sliding scale, to a savings account to pay deductibles and copays. Those who do not comply with the savings component would lose coverage. Deductibles could be as much as $2,500. The first $300 in preventive health care and two doctor visits would not be subject to deductibles or copays. The bill also would call for changes to the certification process for new medical facilities and enforce a price transparency mandate.
The proposal initially would cost the state an estimated $46 million and expand coverage to an additional 77,000 state residents (Young, St. Louis Post-Dispatch, 4/7).
Texas Health and Human Services Executive Commissioner Albert Hawkins has announced that a plan to provide health coverage to about 482,000 uninsured parents whose children are enrolled in Medicaid or SCHIP will not begin this fall as planned, the Austin American-Statesman reports.
The program, which is mandated by the state Legislature, is intended to reduce the number of uninsured residents with incomes too high to qualify for Medicaid but below 200% of the federal poverty level. Commission spokesperson Stephanie Goodman said the uninsured probably will not have access to the program until 2010 or 2011.
In a letter last week to state Sen. Jane Nelson (R) and state Rep. Dianne White Delisi (R), both of whom chair health committees, Hawkins wrote, "We have now determined that limitations to this model outweigh the benefits." He added that the parents "would not have the level of consumer choice we believe is important for the Texas reform effort." Hawkins noted that the plan would not offer sufficient options to hypothetical applicants seeking either catastrophic care or more comprehensive coverage to care for a chronic disease (MacLaggan, Austin American-Statesman, 4/8).