Health Care Reform News Around the Nation for the Week of May 19
Efforts by the state of Connecticut to expand disclosure among the HMOs in its Medicaid program have resulted in insurers dropping out of the program and have "left Connecticut's Medicaid program in turmoil, jeopardizing health care for thousands of poor residents," according to the Wall Street Journal
According to the Journal, the "dispute" between the HMOs and the state began in late 2004 when Sheldon Toubman, a staff attorney at the New Haven Legal Assistance Association, filed a request under the state's freedom of information law to determine the frequency that HMOs rejected pharmacy requests to fill Medicaid enrollees' prescriptions. In 2007, Gov. M. Jodi Rell (R) "demanded more accountability" from HMOs participating in Husky, the state's Medicaid program, "essentially treating them as a public agency," according to the Journal.
When two of the four HMOs participating in the Husky program refused to cooperate with Rell's requests, Husky officials took over administrative duties for the program, including the ability to set provider rates and manage the pharmacy benefits.
In November 2007, Rell said she would terminate contracts with any HMO that refused to comply with her demands for greater disclosure.
In April, two of the HMOs pulled out of Husky. As a result, 120,000 Medicaid beneficiaries were forced to transfer to another insurer or to traditional Medicaid, which for some "meant delays in care, unfamiliar doctors or using facilities that were far away," according to the Journal. A third HMO will begin leaving the Husky program on July 1, and an estimated 226,000 beneficiaries will be reassigned -- some for the second time -- by the end of the year.
Anthem Health Plans and Health Net of Connecticut are challenging the public disclosure requirement in the Connecticut Supreme Court, while not-for-profit Community Health Network of Connecticut recently dropped out of the lawsuit. WellCare Health Plans had agreed to comply with the disclosure requirement but later opted to withdraw from Husky.
Although contracts with three new providers -- who have agreed to follow the public disclosure requirement -- should be signed by July 1, two of the insurers "have no existing Husky networks of doctors, hospitals and other health care providers," according to the Journal (Zhang, Wall Street Journal, 5/13).
Hawaii lawmakers last week overrode Gov. Linda Lingle's (R) veto of a bill that would enroll the state in I-SaveRx, a program that allows residents to purchase lower-cost prescription drugs from other countries, the AP/Honolulu Advertiser reports.
Hawaii is the sixth state to enroll in the program, which began in Illinois in 2004 and can provide savings of up to 55%. It will be available to all state residents by July 1, 2009.
Critics of the program said that they were concerned about the safety of drugs from other countries and that they were not sure whether it is legal (Niesse, AP/Honolulu Advertiser, 5/9).
Indiana Family and Social Services Administration Secretary Mitch Roob recently announced that CMS has approved an expansion of Hoosier Healthwise, the state's version of the State Children's Health Insurance Program, the AP/Chicago Tribune reports.
The federal approval allows the state to increase eligibility to children in families with incomes up to 250% of the federal poverty level. The state had approved an expansion of the program to 300% of the poverty level, but CMS denied the request because of new eligibility rules set by the agency in August 2007.
Roob said that the expansion will allow about 5,000 additional children to enter the program this year, and eventually as many as 10,000 (Kusmer, AP/Chicago Tribune, 5/9).
Iowa Gov. Chet Culver (D) on Tuesday signed into law a bill (HF 2539) that provides an additional $25 million over the next three years to extend coverage to more than 50,000 uninsured Iowa children, the AP/Chicago Tribune reports.
The law also sets the goal of establishing universal health coverage for all state residents within five years. In addition, the law:
- Allows children to stay on their parents' health plans until age 25;
- Establishes a medical records task force to study expanded use of electronic health records; and
- Establishes standards to reduce the rate of childhood obesity in the state (Glover, AP/Chicago Tribune, 5/14).
The provisions included in the bill were based on recommendations by a bipartisan commission that was appointed by Culver to study improving health insurance access (Beaumont, Des Moines Register, 5/14).
In related news, Culver on Tuesday signed into law a $1.2 billion health and human services budget (SF 2425) that includes a 1% increase in Medicaid provider payments. According to the AP/Tribune, the increase will generate $5.1 million to fund an increase in nurses' salaries (Glover, AP/Chicago Tribune, 5/14).
The bill also provides $5.5 million for hospitals to offset their Medicaid costs, according to Culver (Des Moines Register, 5/14).
The Louisiana Senate on Monday voted 27-8 to approve legislation that would change the way Medicaid funding is divided among charity hospitals in the southern region of the state, the New Orleans Times-Picayune reports.
The bill (SB 402), sponsored by state Sen. Bill Cassidy (R), is intended to correct what some lawmakers see as a disparity in the amount of tax dollars going to New Orleans Charity Hospital facilities compared with the amount going to the other hospitals in the charity hospital system run by Louisiana State University.
Under the proposal, LSU would be directed to work with the state Department of Health and Hospitals to create a formula to distribute indigent care funding based on the number of uninsured people in each region of the state by Feb. 1, 2009. The new formula would have to be approved by the state House and Senate health care committees and would be phased in over five years, beginning in 2010.
The bill would not affect financing for private and community hospitals, rural hospitals or charity hospitals in Alexandria, Monroa and Shreveport (Moller, New Orleans Times-Picayune, 5/13).
Minnesota Gov. Tim Pawlenty (R) on Tuesday vetoed legislation that would have expanded access to publicly sponsored health coverage, saying the bill would not reduce health care costs or improve quality, the Minneapolis Star Tribune reports (Duchschere, Minneapolis Star Tribune, 5/13).
Last Monday, the House voted 83-50 to approve the measure, and the Senate voted 52-13 to approve the bill. The bill would have expanded eligibility requirements for MinnesotaCare, the state's insurance program for low-income residents, and would have established an outreach program to enroll those who qualify for the program. About 39,000 additional residents would have been eligible for coverage (Salisbury/Stassen-Berger, St. Paul Pioneer Press, 5/13). Providers also would have received financial incentives to provide residents "medical homes" (Wolfe, Minneapolis Star Tribune, 5/12).
The bill for the first time would have defined health coverage affordability as 10% of income for couples with incomes of $56,000 annually and 5% for couples with incomes of $28,000 annually. In addition, the bill would have funded a $47 million public health effort to encourage state residents to cut back on smoking and alcohol consumption, and to lose weight (St. Paul Pioneer Press, 5/13).
Pawlenty in his veto message wrote, "The state cannot afford to further expand subsidized health programs without certainty of reform that will control cost" (Minneapolis Star Tribune, 5/13).
Enrollment in the Oklahoma Employer/Employee Partnership for Insurance Coverage, the state's health insurance premium assistance program, has exceeded 10,000 beneficiaries for the first time in the program's three-year history, the Oklahoman reports.
The most current count of beneficiaries is 10,776, up from 1,557 beneficiaries 15 months ago. State residents with incomes up to 200% of the federal poverty level are eligible for the program, and the Oklahoma Health Care Authority has requested permission from the federal government to increase the income eligibility threshold to 250% of the poverty level (Raymond, Oklahoman, 5/14).
Six insurers in southeastern Pennsylvania on Tuesday launched a three-year, $13 million initiative to compensate physicians who track their patients' health care and conditions, the Philadelphia Inquirer reports.
The incentive program is part of the first phase of Gov. Ed Rendell's (D) Prescription for Pennsylvania plan, which aims to expand insurance coverage to uninsured state residents and reduce medical errors.
According to officials at the Governor's Office of Healthcare Reform, which is coordinating the incentive program, more than 150 family practitioners at 32 primary care practices and up to 220,000 patients in the southeastern region of the state will participate in the initiative.
The program seeks to make caregivers more accessible through e-mail or telephone calls and will provide them with rewards based on how well they dispense proven treatments and keep patients healthy. Physicians also will use computer software to track their patients' treatment. In addition, physicians will designate certain times that sick patients could get an appointment within 48 hours (Goldstein, Philadelphia Inquirer, 5/13).
Virginia Gov. Tim Kaine (D) and the Riverside Foundation on Wednesday announced that the foundation this summer will launch a pilot program that aims to reduce the cost of health insurance for employees at small businesses that cannot afford to offer health coverage, the Newport News Daily Press reports.
The foundation had hoped to receive matching state money for a $1 million donation to the pilot program; however, the General Assembly did not approve the funding because of budgetary constraints.
Under the program, the foundation, employees and employers each will contribute one-third of the cost of health insurance, with the foundation paying up to $75 per month per employee. The program likely will be aimed at businesses with two to 50 employees, and eligibility is expected to be limited to employees with incomes up to 200% of the federal poverty level (Payne, Newport News Daily Press, 5/15).