Health Care Reform News Around the Nation for the Week of March 25
The Arizona Senate last Tuesday approved legislation that would increase financial oversight and expand membership of Healthcare Group of Arizona, which insures roughly 23,000 self-employed residents or small-business employees, the Arizona Republic reports. The program was facing a more than $20 million deficit at the end of the last fiscal year, prompting lawmakers to freeze enrollment and allocate $8 million to help reduce the deficit.
The legislation would open the program to new members, but sole proprietors would no longer be eligible. The bill also would:
- Eliminate a provision that requires companies to be uninsured for a minimum of six months before becoming eligible;
- Increase financial oversight of the program by requiring regular financial reporting and actuarial oversight; and
- Cap enrollment growth of employer groups at 10% annually.
The Kansas Senate on Wednesday voted 30-8 to approve legislation that would phase in a $14 million expansion of the State Children's Health Insurance Program over two years, the AP/Wichita Eagle reports.
The bill would increase the income eligibility threshold next year to 225% of the federal poverty level and to 250% of the poverty level in 2010. The change would extend coverage to an additional 5,500 children in middle-income families.
The House will debate its version of the bill this week (AP/Wichita Eagle, 3/20).
The Massachusetts Health Insurance Connector Authority on Thursday voted to approve a 10% increase in premiums for insurers participating in Commonwealth Care, less than the 15% plans had originally requested, the Boston Globe reports. Commonwealth Care is Massachusetts' subsidized insurance plan for people who do not qualify for Medicaid but cannot afford coverage.
Under the new contract, the state would assume more of the financial risk if beneficiaries use more medical services than expected. The board also increased premiums and copayments for some beneficiaries to partially offset increased payments to insurers (Dembner, Boston Globe, 3/21). Between 35% and 40% of Commonwealth Care beneficiaries with incomes greater than 100% of the federal poverty level will face premium increases (AP/Boston Herald, 3/20). State Secretary of Administration and Finance Leslie Kirwan on Thursday said that Commonwealth Care will cost "significantly" more than the $869 million included in Gov. Deval Patrick's (D) fiscal year 2009 state budget proposal (Boston Globe, 3/21).
In related news, many Massachusetts safety net hospitals in urban areas say they are facing budget shortfalls and have been forced to cut back on investing in new equipment because payments for charity care are being phased out under the state health insurance law, the Globe reports. Ellen Murphy Meehan, executive director of the Alliance of Massachusetts Safety Net Hospitals, and other hospital officials say a large percentage of patients seeking care at safety net hospitals remain uninsured, and hospitals still must treat such patients, although they no longer receive funds to provide the care.
Murphy Meehan said that central to the problem is the relatively slow enrollment in Commonwealth Care, the Globe reports. Massachusetts Health and Human Services Secretary JudyAnn Bigby said the state is working to assist safety net hospitals (Krasner, Boston Globe, 3/18).
A proposed Montana ballot measure would expand SCHIP and Medicaid enrollment to about 30,000 more uninsured children in the state at a cost of about $20 million per year beginning in 2009, supporters of the measure say, the Billings Gazette reports. Proponents of the measure need 22,308 signatures of Montana voters to qualify it for the November ballot.
The measure would increase the SCHIP income eligibility threshold from families with incomes up to 175% of the federal poverty level to 250% of the poverty level. In addition, SCHIP and Medicaid only would be expanded if adequate federal matching funds were available, according to the measure. The federal government matches about 80% of SCHIP funding and 60% to 65% of Medicaid funding in the state. A fiscal note on a petition to place the measure on the statewide ballot says the initiative would transfer $22 million from the state treasury to finance the expansion.
State Insurance Commissioner John Morrison, a leader of the Healthy Montana Kids campaign, said that the expansion should not take away from other programs and that a budget surplus forecasted for this year should absorb the cost of the measure. In addition, Morrison said that the expansion would generate up to $75 million in federal matching funds.
If voters approve the measure in November, the 2009 Legislature still would have to authorize the funding expansion (Dennison, Billings Gazette, 3/18).
New Jersey Senate Health Committee Chair Joseph Vitale (D) last week announced a universal health coverage proposal that would require all residents to obtain health coverage within three years, the New York Times reports. About 1.4 million state residents are uninsured (Chen, New York Times, 3/18).
The first phase of the plan would focus on expanding the state's NJ FamilyCare program to provide more coverage for uninsured children and their parents. Also during the first phase, the state would try to overhaul the health insurance market to reduce costs, particularly for small businesses and the self-insured. According to Vitale, the first phase would cost an estimated $28.8 million and would be paid for by redistributing unused state and federal funds that already are allocated for health programs for low-income residents.
In the second phase, the state would continue to enroll residents in FamilyCare and create a self-funded, state-sponsored health insurance plan for all residents, the Philadelphia Inquirer reports. Beneficiaries of the state-sponsored plan would pay for coverage based on family income and size (Lu, Philadelphia Inquirer, 3/18). Subsidized coverage would be available to residents with incomes up to 350% of the federal poverty level (Livio, Newark Star-Ledger, 3/18). According to Vitale, the second phase of the plan would cost an estimated $1 billion and eventually would be funded with savings from a reduction in charity care, as well as premiums from beneficiaries and other sources.
Once the state plan is made available, all residents would be required to obtain some kind of health coverage. After the mandate takes effect, residents could be required to provide proof of insurance when they file their income tax returns, and people who cannot provide proof would be automatically enrolled in the state plan and charged premiums based on their ability to pay.
State House Budget Committee Chair Louis Greenwald (D) -- who, along with several other lawmakers, joined Vitale at a news conference to announce the proposal -- said the plan would not increase taxes (Philadelphia Inquirer, 3/18). Supporters of the proposal hoped to introduce legislation last week and enact the plan before the July 1 budget deadline (New York Times, 3/18).
Pennsylvania Gov. Ed Rendell (D) last Tuesday said he supports legislation (SB 1137) by House Democrats that would expand a subsidized health coverage program for uninsured adults, the AP/Houston Chronicle reports (Levy, AP/Houston Chronicle, 3/18). The previous day, the Pennsylvania House voted 118-81 to approve the bill, which would expand the state's adultBasic program to residents with incomes up to 200% of the federal poverty level (Fahy, Pittsburgh Post-Gazette, 3/18).
The bill likely would extend coverage to about 270,000 uninsured state residents and is expected to cost $1.1 billion by 2012-2013 (Scolforo, AP/Philadelphia Inquirer, 3/18). The proposal also would give grants to small businesses that provide health care to low-income workers, establish a health savings account option and phase out the MCare abatement program over a 10-year period. MCare helps physicians pay medical malpractice premiums in the state.
The bill, called Pennsylvania Access to Basic Care, is intended to serve as an alternative to Rendell's Cover All Pennsylvanians health care initiative. However, the House proposal "faces an uncertain future" in the Republican-controlled state Senate, according to the Post-Gazette (Pittsburgh Post-Gazette, 3/18).
In other Pennsylvania news, the Pennsylvania Health Care Quality Alliance on Wednesday launched a Web site that provides consumers with quality measures for different hospitals in the hope of helping them make more informed health care choices, the Pittsburgh Post-Gazette reports (Fahy, Pittsburgh Post-Gazette, 3/19).
The site includes quality information for state hospitals on treatment of heart attacks, heart failure, pneumonia and hospital-acquired infections during a certain year. According to the alliance, the four categories were chosen first because they are the most common and costly illnesses for hospitals to treat (Loviglio, AP/Contra Costa Times, 3/19). The data are derived from several sources, including Medicare, Medicaid, the Pennsylvania Health Care Cost Containment Council and the Joint Commission, the Post-Gazette reports (Pittsburgh Post-Gazette, 3/19).
The West Virginia Medicaid program has violated state law by failing to follow a standardized system for indexing and numbering its rules, according to a petition filed by Legal Aid of West Virginia in the state Supreme Court, the Charleston Gazette reports. The West Virginia Administrative Procedures Act establishes the system for filing new qualification rules and regulations. State agencies are required to title, number and index their rules and file them with the Office of the Secretary of the State.
Legal Aid alleges that Medicaid's failure to follow that system makes it very difficult for residents to determine which regulations are in effect. Bruce Perrone, director of Legal Aid, has asked the court to order the agency to comply with the law. The lawsuit also is seeking to prevent the secretary of state from accepting any future rules that do not comply with the law (Eyre, Charleston Gazette, 3/14).