A weekly compilation from Aetna of health care-related developments in Washington, D.C. and state legislatures across the country

The pressure is mounting on President-elect Barack Obama to do something about health care reform sooner rather than later. Senator Max Baucus last week unveiled his plan (see below) to reform health care, and Senator Ted Kennedy is expected to do the same in the near future. Outside the Capitol, The Business Roundtable, the National Federation of Independent Businesses, AARP and the Service Employees International Union are pressing, in a letter sent last week, Obama to make an overhaul of health care a priority in his Administration’s first 100 days. This timeframe would be a monumental challenge, given the nation’s economic woes.
Federal
Senator Baucus, Chairman of the Senate Finance Committee, released an 89-page blueprint for health care reform titled “Call to Action: Health Care Reform 2009.” The plan calls for several policies with which Aetna agrees, including an individual mandate, subsidies for low-income individuals, expanded health information technology, tax credits to small businesses, Medicaid and SCHIP expansion, a comparative effectiveness research institute, medical liability system reform and a strong focus on primary care, wellness, prevention, transparency and quality care. But some aspects of the plan are problematic: a “play or pay” employer mandate; a federal health insurance exchange (similar to the Massachusetts Connector); a competing public plan; and lowering Medicare Advantage payments. Aetna has been helping to inform the Senator’s health reform plan, through Aetna Chairman Ron Williams’ testimony before Congress in June, and through both formal and informal conversations. Senator Kennedy also plans to release a health reform proposal later in the year, and Aetna has been invited to participate in those conversations as well. Whether the two proposals can be forged into one legislative package by January remains to be seen, but it seems clear that each will support a major push for health care reform early in 2009.
States
ARIZONA: Proposition 101, a ballot measure billed as an attempt to amend the state constitution to protect the rights of Arizonans to make their own health care and health insurance choices, was defeated by fewer than 11,000 votes. Proponents argued the measure would prevent the government from enacting a single-payer health care system. However, the scope of the language helped fuel the argument that it would apply to the state’s Medicaid/SCHIP programs and private managed care plans as well. Legal experts opined that if the measure had passed, a strong case could be made that the state’s use of private plans to deliver Medicaid benefits limits consumers’ choice of providers. Likewise, commercial plans’ use of physician networks could have come under legal scrutiny.
MAINE: As expected, the “People’s Veto” measure has passed, repealing the newly enacted beer, wine and soda taxes that would have replaced the savings offset payment (SOP) used to provide subsidies for the state’s Dirigo Health plan. The legislature passed the beverage taxes to avoid contentious litigation around the SOP and to create an equitable, sustainable funding mechanism for Dirigo. Currently, the SOP is levied on health plans and TPAs according to a formula that has been challenged every year since its inception in 2003. The SOP for 2008 was reduced from $140 million to $48 million and is the subject of litigation again this year.
NEW YORK: In anticipation of the legislative special session set for November 18, Governor David Paterson has proposed increasing the covered lives assessment by $120 million this year and next, a move already defeated once in 2008 by the State Senate. The Governor also proposed shifting the funding source for mental-health parity small employer subsidies to the revenue stream raised by insurance taxes known as “HCRA” (the Health Care Reform Act). This shift would amount to $88 million this year and $91 million next year. The state set aside $100 million annually to subsidize small businesses when it passed the mental-health parity law. It is not clear what would happen to the additional $21 million for the two years. The Governor also reintroduced his proposal to increase the State Department of Insurance’s Section 332 assessment, which is a tax on all lines of insurance premiums. The Republican majority will continue to control the state Senate until January 2009 and remains committed to opposing new taxes.
PENNSYLVANIA: The House Insurance Committee held a three-hour roundtable discussion last week with Highmark, IBC, the insurer trade representative, providers, Capital Blue Cross and UPMC Health Plan of PA concerning the proposed Highmark-IBC consolidation. The contentious meeting pitted the insurance industry against Ken Melani of Highmark. Highmark dismissed the Department’s expert report on competition as an academic exercise completed during a different economic climate (this past September). This could open the consolidation to the same argument: the Blues projections were based on a different economic environment. The House Insurance Committee plans to meet again on November 19 to discuss what, if anything, it will recommend to the Insurance Commissioner. The House and the Senate Banking and Insurance Committees have until November 29 to submit comments to the Insurance Commissioner. It is not clear what position the House will take. The Senate (at least as a majority position) is prepared to recommend disapproval or conditional approval.
Resources
Transforming Health Care in America

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© 2008 Aetna Inc.

There are several factors to consider when shopping for health insurance quotes online. Like not putting your information into lead generation affiliate web sites!  Read more below.

Rule #1 - Avoid Affiliate Sites: When shopping online for health insurance quotes there are several factors to consider. Most sites out there are affliate sites that do not actually provide any service to you directly. Instead they sell your personal information to several agents or brokers (some times as many as 30!) When they turn around and sell your information to someone else, you have lost control over your personal information often times including date of birth. You don’t want that!

For example, when people search in Google for “California Health Insurance Quotes” the first listings that come up are generally affiliates that make money by selling your information to insurance agents. And not just one agent, but sometimes as many as 30 agents. The last thing you want is 30 insurance agents calling you to try and give you a quote, and calling you back 3-4 times as well. That can get very very frustrating.

Rule #2 - Check the Site for a Phone Number: The best way to make sure that doesn’t happen to you is to use a site where the phone number is clearly displayed. Generally that means they would be willing to take your call and hear from you directly if you prefer. You should avoid sites that do not have a prominately displayed telephone number on them.

Rule #3- Deal with a Licensed Agent It is best to deal with a licensed professional insurance agent who has taken the time to develop an online web presence as well as having an office in the state you are dealing with.

Rule #4 - Check their License Status: The next suggestion is to check the department of insurance for your state and make sure the person you are talking to is a licensed insurance agent. For example in California, you can visit the California Department of Insurance. There are many people out there pushing health discount card plans as “Guaranteed issue” that are not licensed insurance agents. If they are unlicensed, you may want to consider reporting them to you states department of insurance as well.

Rule # 5 - Get It In Writing: Finally you should insist on seeing the plan in writing before you apply. It doesnt have to kill a tree, it can be a pdf, or published information on the website that explains the plan benefits, but it is a good idea to see that what the agent is telling you is also in black and white. Just because the agent says “You are covered” doesn’t mean you really are going to be when claim time comes.

Rule #6 - The Price is the Price: Many people do not realize the prices for health insurance are fixed by the insurance company. So if you choose to try to buy direct (and run into hassels with the applicaiton process) or decude to buy from a licensed insurance agent - the price you pay is the same for the same plan.

Rule #7 Get Educated: Lastly educate yourself about the difference between HMO, PPO, and HSA style plans. And become familiar with the terminology like co-pay, deductible, co-insurance, out of pocket maximum, and the like. Use the agent you are speaking to as a resource, but if she cannot explain it to you clearly; its time to find a different insurance agent.

Thank you for taking the time to listen to an old insurance agent who has had to help too many people out of bad plans that cost too much and didn’t cover what was necessary. The internet is a wonderful tool that allows people to find what they need quickly and easily, but…

To contact me, you can call me at 1-877-758-7587, or log onto my website http://www.healthinsuranceplus.com or a “California Health Insurance Quote” I look forward to hearing from you.