Latest California Healthline Stories
Daunting Challenges Await Exchange Board
The five-member board directing the California Health Benefit Exchange will need to navigate a complex path as it takes steps to set up a statewide marketplace for health insurance coverage. Experts already are predicting a few pitfalls that will be especially challenging.
Medical Loss Ratio Threshold Goes to 80%
The Department of Insurance already regulates a 70% medical-loss ratio on insurers of individual health plans so it was not a huge leap to bump that limitation to 80%, given the new federal standard at that level, according to Janice Rocco, deputy commissioner of health policy for the DOI.
“We maintain the [current state requirement of a] 70% medical-loss ratio,” she said, “and we also need to comply with the federal 80% ratio, which is calculated in a different way than the state ratio.”
The state Office of Administrative Law agreed, and yesterday granted the Insurance Commissioner and his department the authority to enforce those federal standards.
Mandate Bills Merit Independent Review
Maternity care. Tobacco cessation. Mammograms. HPV vaccinations. Hearing aids for children.
These are just a few of the legislative attempts at mandates for health insurance coverage in California. Each of those proposals needs to be evaluated before it hits committee. The under-the-radar group that does those evaluations — the California Health Benefits Review Program — has issued 68 CHBRP reports since 2004.
The CHBRP held its annual legislative briefing yesterday in Sacramento. And, honestly, it was worth attending just to hear men in suits say the acronym “Cha-BURP” over and over again.
Who Wins if Republicans Repeal Health Reform Law?
The debate over the nation’s health care overhaul has reached its highest pitch in months, but most industry stakeholders are sitting out of Republicans’ fight to repeal the law. The industry’s silence illustrates an emerging consensus: with the exception of a few groups, even former opponents of the overhaul now want the law to stay.
Will Insurance Czar Be Regulating Health Rates?
A bill in the Assembly and an emergency action sought by the Department of Insurance could give the state insurance commissioner a lot more enforcement power over health insurers’ dollars. But is that new power necessary?
Broader Enforcement Power for Insurance Commissioner?
A few hours after he was sworn in as the new commissioner of the California Department of Insurance, Dave Jones said he wanted the state to make sure PPO health insurers spend 80% of their revenue on health benefit payouts.
That 80% figure is the new federal mandate, and Jones wants to make it clear to insurers that the state is going to check up on them and enforce that law, according to Janice Rocco, deputy commissioner of health policy for the DOI.
“Historically, the department has reviewed for 70% medical loss ratios in the individual market,” Rocco said. “Now that federal law meets 80% individual standards, we feel it’s important that the federal law be enforced at the state and federal level.”
Health Insurance Regulation Proposal Is Back
This week’s large rate hike announcement by Blue Shield makes the perfect backdrop for debating an Assembly bill to regulate those kinds of rate increases, according to Assembly member Mike Feuer (D-Los Angeles), who introduced AB 52 last month.
“It sure adds fuel to the significance of AB 52,” Feuer said. “I am optimistic that the day is coming when insurers will need to justify increases like this.”
Feuer’s bill was eligible to go to committee yesterday.
Is California Ready for Health Care Profit Sharing?
If value-based purchasing of health care spreads as many predict it will, would a logical next step be to reward consumers for choosing a low-priced alternative by sharing some of the profit? We asked insurers, consumer advocates, employers and employer groups to weigh in.
Looking Back, Heading Forward: A Checkpoint on the Road to Reform
A year that began with unprecedented health reforms also featured unpredictable political twists and still unanswered questions over policy. As 2010 draws to a close, experts look back on the path to implementing the federal health law and what’s been tabled for next year.
Governor Transition Might Hinder Grant
The new governor takes office on Jan. 3 — but that would be too late for California to apply for a large federal innovation grant, according to a number of health care advocate groups.
“We’re in this lull period,” Lucien Wulsin of the Insure the Uninsured Project said, “with the outgoing Schwarzenegger administration and the incoming Brown, there’s this whole handoff thing.”
And since the innovation grant application has to go in by Dec. 23, Wulsin said that’s a little worrisome.