Latest California Healthline Stories
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.
Changing Health Care Role for California’s Businesses?
It’s an alarming lead statistic in a report out this week: About 20% of working Californians don’t get health care insurance through their employer.
What that means is that it’s not just the unemployed and disabled who are struggling to find health care coverage. It’s also a large number of people with jobs.
But will any of that change under the pending national health care reform law? Businesses with fewer than 50 employees won’t be required to provide health insurance. So will state lawmakers need to enact some kind of legislation to address it?
Going From No-Show to Showing Teeth
It was two weeks ago that the California Department of Managed Health Care was a sort of agency-non-grata at a legislative oversight hearing. The Assembly budget subcommittee hearing was targeted at the DMHC’s perceived lack of response to complaints that the insurance industry was short-changing emergency departments across the state.
When the DMHC didn’t show up to that oversight hearing, it prompted a fair share of derision and antipathy — and it confirmed emergency department officials’ fears that the agency was ignoring their complaints.
Yesterday, the agency showed that it has been listening, by levying nearly $5 million in fines on seven health care insurers.
Emergency Departments Chafe at Low Payments, Lack of Help
Emergency departments in California often struggle to get paid for treating patients with a certain type of health insurance. In those cases, reimbursement is routinely delayed or denied, physicians say. Doctors complain that state officials are refusing to address the problem.
Report Looks at Money and the Uninsured
More need, less money — that seems to be the summary of every report on health care in California. So researcher Kiwon Yoo was somewhat surprised to see in her own report for Insure the Uninsured Project that funding for counties was not in steep decline in the years she studied, 2006 to 2009.
“There is rising unemployment and a rising number of uninsured during that time, but funding streams remain somewhat stagnant,” Yoo said. “So it was not a precipitous fall, as people thought it would be.”
In fact, the total county funding match rose 1.6 percent — that is, funding from state and federal sources actually rose slightly. “That includes money from vehicle license fees, tobacco settlement funds” and other temporary funding sources, she said. “And these numbers only go up to 2009, and some of the budget measures don’t take effect till 2011 or 2012.”