Health Care Reform News Around the Nation for the Week of April 7
Colorado House and Senate Democratic lawmakers unveiled legislation last week that would impose stricter rules on how health insurance providers set premium rates and require them to pay claims in a timely manner, the Denver Post reports.
One bill would allow the state Division of Insurance to reject premium rate increases. Under the bill, insurance companies would have to justify rate increases, and the Division of Insurance would have the right to consider the frequency of claims, surplus reserves and other financial factors in rejecting or approving the rate.
Current state regulations require insurers to disclose rates but do not require state approval to increase rates.
A separate bill would strengthen laws that require insurers to pay claims promptly, and a third bill would allow the state insurance commissioner to impose stricter penalties on insurers that deal with customers dishonestly (Hoover, Denver Post, 3/31).
The Kentucky General Assembly on Wednesday approved a bill (HB 440) that would require health insurers to allow parents to keep unmarried children on their health plans until age 25, the Louisville Courier-Journal reports.
Parents would have to pay extra to keep adult children on their plans. The bill also would require insurers to provide physicians and other health care providers 90 day's notice before changing a payment rate. The bill now goes to Gov. Steve Beshear (D) (Louisville Courier-Journal, 4/3).
Maine Gov. John Baldacci (D) on Tuesday announced that he supports a proposed 50-cent-per-pack cigarette tax increase to fund the state Dirigo Health program, Blethen Maine/Portland Press Herald reports.
In March, Baldacci said that while he supported the language of the bill, the timing was not right to discuss the matter. However, Baldacci now says he is prepared to work with lawmakers on the bill because the state's budget is balanced, Blethen Maine/Press Herald reports.
Dirigo provides coverage for about 14,000 state residents through funding from premiums paid by employers and their employees, as well as so-called offset payments from insurance companies. The program also covers 5,600 Medicaid-eligible adults at a cost to the state of about $5 million (Cover, Blethen Maine/Portland Press Herald, 4/2).
NJ FamilyCare, a subsidized health program in New Jersey, did not verify eligibility for all of the program's beneficiaries, and more than 873 people with annual gross incomes of more than $85,000 received benefits through the program, according to a report by State Auditor Richard Fair, the Bergen Record reports. Uninsured children and parents in families with annual incomes below 350% of the federal poverty level are eligible for the program.
According to the three-year audit, state Department of Health and Senior Services officials sought to check applicants against the state's wage, disability and unemployment records to verify income, but the records did not have data on self-employment and rentals, interest or dividends.
State auditors also found that DHSS officials did not attempt to recover $4.6 million in unpaid fees to NJ FamilyCare by 16,300 former beneficiaries and that the program paid $43.1 million in claims for 13,000 residents even though the agency had not verified the residents were still eligible for coverage (Wright, Bergen Record, 4/1).
Auditors also found that the state's Medicaid program did not adequately monitor medical equipment providers. Between July 2005 and December 2007, the state spent $2.1 million for equipment that nursing facilities should have paid for. The state also spent $6.7 million more in state and federal money than was needed for oxygen equipment and adult incontinence briefs (Hester, AP/Philadelphia Inquirer, 4/1).
Assistant State Auditor Stephen Eells said the Office of State Auditor did not forward any of the cases tied to NJ FamilyCare to criminal justice officials, adding, "We just want to get the weaknesses fixed. That's our goal. This is something they are going to pursue and get fixed" (Bergen Record, 4/1). However, state criminal investigators are looking into the Medicaid program cases (AP/Philadelphia Inquirer, 4/1).
The New York state Senate on Tuesday approved legislation that would allocate about $59.2 billion -- or nearly half of the $124 billion state budget proposed for fiscal year 2009 -- for health care, the New York Times reports (Peters, New York Times, 4/2).
The bill would expand eligibility for New York's version of the State Children's Health Insurance Program to children in families with incomes up to 400% of the federal poverty level, up from 250% of the poverty level. The expansion would cost $25 million annually and be paid entirely by the state because of Bush administration regulations tightening eligibility in SCHIP (Matthews, Rochester Democrat and Chronicle, 4/2).
The legislation also includes a provision that would recalculate the state Medicaid hospital payment formula, for a savings of $57 million in the first year (New York Times, 4/2). The savings would be used to increase spending for hospital clinics, emergency departments and ambulatory care. The state also would allocate $45 million for community clinics, medical services and additional payments for providers who have evening and weekend hours, state budget officials said.
Under the legislation, the payment system for outpatient care would be based on the type of care provided, rather than a flat fee, according to Deborah Bachrach of the state Department of Health. She said the physician fees would increase by 35% annually under the plan.
The bill also includes $17 million in proposed cuts to nursing homes, compared with $117 million in cuts proposed by Gov. David Paterson (D), and restores $37 million of a proposed $43 million reduction in home care. Lawmakers also approved funding for a loan-forgiveness program and grants for physicians who agree to practice in medically underserved areas (Rochester Democrat and Chronicle, 4/2).
Meanwhile, Paterson announced $105 million in grants to develop a statewide electronic health record system, the AP/New York Post reports. Paterson said that the state should develop security measures to protect patient privacy.
Richard Daines, the state's health commissioner, said the EHR grants are part of an overhaul of the state's health care system (AP/New York Post, 3/29).
The Pennsylvania House on Tuesday voted 131-72 to approve legislation (HB 2005) that would limit the ability of insurers to consider certain factors, such as health history, when setting rates for health plans offered to individuals and small businesses, the Pittsburg Post-Gazette reports. The measure would allow insurers to set rates based on age and geographic region.
The bill also would require insurers to spend 85% of premiums on health care. Insurers violating the rule could be required to issue rebates to policyholders. In addition, the legislation would allow the Pennsylvania Department of Insurance to disapprove requests for rate increases if an insurer has not operated efficiently or has not controlled costs for avoidable hospital-acquired infections or chronic disease management.
The provisions of the bill are similar to those included in Gov. Ed Rendell's (D) Prescription for Pennsylvania plan to reduce health care costs and improve quality, the Post-Gazette reports.
The state House on Tuesday also approved legislation (HB 2098) that would permit insurers to decline payment to hospitals for preventable medical errors that result in death or serious disability (Fahy, Pittsburgh Post-Gazette, 4/2).
Meanwhile, a tax-subsidized program that helps Pennsylvania physicians pay medical malpractice insurance premiums lapsed last Monday, the AP/Philadelphia Inquirer reports. The five-year, $1 billion MCare abatement program was established in 2003 and provides subsidies to more than 35,000 physicians and other medical professionals (Levy, AP/Philadelphia Inquirer, 4/1).
Rendell supports a 10-year extension of the abatement program but has said that he will not approve an extension unless lawmakers show progress in making affordable health coverage available to the uninsured (Fahy, Pittsburgh Post-Gazette, 4/1).
The state House on Thursday voted 93-1 to approve a bill that would require defendants in medical malpractice lawsuits to be given a 60-day notice before a lawsuit is filed, the AP/Tennessean reports. The bill also would require that an independent medical expert evaluate the merits of a case before the lawsuit is filed, according to bill sponsor state Rep. Doug Overbey (R).
The legislation will now go to the Senate for its consideration. Last year, the Senate unanimously passed similar legislation (Johnson, AP/Tennessean, 4/4).
Washington, D.C., Council member David Catania (I) on Monday proposed a $50 million plan that would require all district residents to obtain health insurance and provide subsidized care for those who qualify, the Washington Times reports (Emerling, Washington Times, 4/1). Catania, chair of the council's Committee on Health, said the Healthy D.C. bill would provide coverage for about 25,000 uninsured residents who are ineligible for Medicaid and the D.C. HealthCare Alliance.
Under the plan, residents with incomes lower than 200% of the poverty level would receive subsidies, paying monthly premiums between $20 and $100, depending on income. The plan would take effect in July 2009, and residents would have until January 2010 to enroll before fines of $250 would be assessed.
About $21 million of the cost would be paid by the city, and CareFirst BlueCross BlueShield would contribute about $5 million. CareFirst also would make its provider network available to program beneficiaries. The plan would generate additional revenue by:
- Increasing the tax on commercial health care premiums from 1.7% to 2%;
- Imposing a 2% premium tax on HMOs; and
- Doubling the cigarette tax to $2 per pack.