Don’t Overlook Long-Term-Care Insurance (The New Retirement)

 

Don’t Overlook Long-Term-Care Insurance (The New Retirement)

Healthcare Legislation Update Week of April 7

Week of April 7, 2008

Aetna Chairman and CEO Ronald A. Williams and Verizon Communications Chairman and CEO Ivan Seidenberg, representing the Business Roundtable, joined forces last week with Senate health leaders Senator Edward Kennedy (D-MA) and Senator Mike Enzi (R-WY) at the Capitol to urge swift passage of the Wired for Health Care Quality Act. The bill seeks to replace the current system built on paper records with secure, protected electronic records. An estimated 90 percent of health care records today are kept on paper. Many in the health care and business communities have been calling for a transition to electronic records to help save thousands of lives by preventing medical errors and save billions of dollars through greater efficiencies. In fact, a Rand Corporation study has found that widespread use of health IT could produce annual savings in efficiency and improved health care outcomes of $165 billion. The Business Roundtable, an association of chief executive officers of leading U.S. companies, has made health IT one of its legislative priorities for 2008.

In other important developments last week, the Pennsylvania House of Representatives passed a wide-ranging health-care reform bill opposed by the insurance industry and the National Federation of Independent Business. See below for details.

Federal
Senate Democrats, led by Finance Committee Chairman Max Baucus (D-MT), are poised to unveil a Medicare package to deal with the upcoming 10.6 percent physician reimbursement cut. The Chairman hopes to have enough Republicans, some House Democrats and the White House on board so that process issues don’t derail the effort. The total Medicare package should be smaller than first thought, coming in at $15 billion to $17 billion. Some senators want an even skinnier package at $8 billion. There is no firm agreement yet on where to find the money, but the hit to Medicare Advantage appears, for now, relatively small. Though nothing is certain, the framework seems to be in place to produce a product in time to meet the June 30 deadline.

The Senate’s mental-health parity compromise offer of March 14 received its first House reaction last week in the form of a public statement from Patrick Kennedy (D-RI), sponsor of the House parity bill. He called the offer a “huge sign” that the Senate was serious, and further noted that the Senate offer is not supported by the business community. Senator Mike Enzi has not signed off on the compromise as yet, which could be an astute political move. On two related fronts: (1) Senator Edward Kennedy last week thanked “Aetna and Ron Williams” for all they have done to pass mental-health parity, and (2) on April 22 Aetna and other insurers will participate in a Kennedy & Domenici-sponsored health fair to highlight innovations in behavioral health, with an eye toward promoting the Senate version of mental-health parity.

States
CALIFORNIA: Democratic lawmakers have introduced eight bills to address the growing number of autism diagnoses in children in the state. The bills are the result of three years of state public hearings by the legislature’s Commission on Autism, which consisted of health experts, educators and families affected by the developmental condition. California already has a mental-health parity statute that addresses coverage for autism. However, advocates of the bills have argued that current coverage requirements do not include payment for therapies such as applied behavioral analysis.

CONNECTICUT: State Comptroller Nancy Wyman held a press conference last week to announce the launch of her Enhanced Municipal Employees Health Insurance Plan, a voluntary pooling of municipal resources to purchase health insurance as a large group. Some of the insurers mentioned as potential participants in the program were Health Net, Anthem and Oxford. No legislators were present at the press conference. One of the plan’s supporters said this program would lower municipal taxes by lowering health care costs to the cities and towns. The Comptroller estimated that 20,000 people would join the plan. In addition, she stated that the program would be launched on July 1st and that no legislative action was needed.

FLORIDA: Governor Charlie Crist testified last week in favor of the autism mandate currently pending, which would require broad coverage for autism treatments and therapies. Aetna is working with legislative leadership to amend the bill to reflect language more consistent with industry coverage policies.

GEORGIA: The legislature adjourned its 2008 session on Friday, with several problematic bills failing to pass at the 11th hour. A Medical Association of Georgia bill that would have applied prompt-pay laws to self-insured plans was defeated. Several pharmacy bills that would have had a negative impact on employers offering health benefits to their employees also failed to pass. The bills would have, for example, prohibited generic substitution and required coverage of a 10-day “emergency” supply of off-formulary drugs. Also defeated was a bill supported by the Department of Insurance that would have increased regulation of individual and PPO rates and allowed one-life groups in the Georgia market. It would have required group health insurance carriers to participate in the individual market as well.

IOWA: The House of Representatives recently approved unanimously a health care reform bill that would focus on wellness, health information technology, medical homes, and increases in coverage through expansions in dependent coverage and continuation of coverage requirements. The bill would require both individual and group policies to permit continuation of coverage for unmarried dependent children who are students until the age of 25. For individual policies, insurers would haveto waive preexisting condition exclusions within 63 days of the effective date of a new policy. The legislation also would establish a prevention and chronic care management initiative to improve the overall health of Iowa residents, and it would establish the Iowa Healthy Communities initiative and grant program to provide grants for wellness, exercise, and fitness programs.

KANSAS: The House of Representatives last week passed a health care reform bill that is the result of hard-fought negotiations between the House, Senate and various health care stakeholders. Some key provisions include: Carriers offering group policies would be required to also offer the option of establishing a cafeteria plan; maximum lifetime benefits for the high-risk pool would be increased from $1 million to $3 million; the continuation of coverage period would be extended from 6 to 18 months; implementation of a premium assistance program for families earning less than 50 percent of the federal poverty level; and creation of an “Access to Care Program” to maximize Medicaid and SCHIP enrollment in rural and underserved areas.

MAINE: Two bills were signed into law last week: a colorectal cancer screening mandate for individuals 50 and older or those under 50 with symptoms or at high risk, and a notice requirement for last year’s dependent coverage (to age 25) law. The colorectal screening mandate is effective January 1, 2009, while the notice requirement law takes effect in 90 days. After passing the state budget without funding for Dirigo, the Maine legislature now intends to tackle financing the program separately. The Governor made a public statement in support of a tobacco tax increase to generate more revenue for Dirigo subsidies. That, however, remains a very tough sell in the Senate.

NEW YORK: The bulk of the state budget passed the legislature this week, including the public health and insurance sections. Most significantly, the proposed 1.75 percent HMO tax was defeated, and the proposed $190 million increase in the covered lives assessment was reduced to a $70 million increase. It is widely expected that new taxes and increases may come up again after the November elections, if the state continues to experience significant revenue shortfalls as predicted.

PENNSYLVANIA: The House passed a multi-faceted health care reform bill last week by a 131-72 vote. For both small group and individual markets, it would prohibit medical underwriting and allow only a 33 percent rate deviation based on age, geography and family composition; impose an 85 percent medical loss ratio; prohibit pre-existing condition exclusions; require guaranteed issuance of individual coverage; require prior approval, under vague standards, of all health care rates by the Insurance Department; and allow the Department to set benefit packages and co-payment and deductible levels. The bill was supported by the Governor and the Blues; it was opposed by the insurance industry and the National Federation of Independent Business. The bill now goes to the Senate Banking and Insurance Committee, where it stands in stark contrast to the flexible, tiered approach of a Senate health care bill. Given bigger insurance issues facing that committee, such as oversight legislation of the Highmark/IBC merger, the House bill is not expected to get quick consideration.

WISCONSIN: The State Assembly’s last general floor period of the session recessed in March after the Assembly passed several health care bills that have moved to the Governor’s office for consideration. The bills include: Expanded coverage/uninsured proposals that are designed to cover all children under 19, working families and pregnant women who don’t have access to health insurance (specific provisions do not allow people to drop their private insurance to participate in BadgerCare Plus); a chiropractor claims practices bill that would establish a number of new requirements related to the handling of chiropractic claims; and changes to the Health Insurance Risk-Sharing Pool, including the expansion of eligibility for premium and deductible subsidies, and a requirement that payments to providers consist of usual and customary payment rates instead of allowable charges for services.

WYOMING: The legislature recently adjourned after enacting a cancer clinical trial mandate. The legislation requires a policy or contract that provides coverage for the treatment of cancer to also provide coverage for the routine patient care costs that are part of a clinical trial.

 

Courtesy of Aetna

Statement from Allianz regarding Dateline NBC story

On April 13, 2008, Dateline NBC aired a story called "Tricks of the Trade" that focused on the sale of fixed indexed annuities to seniors. In particular, the story alleged that several agents failed to clearly disclose surrender charges associated with certain annuity products.

Dateline acknowledged one of the safeguards Allianz Life has implemented to prevent inappropriate sales practices – the calls we make to all new fixed annuity policyholders age 75 and older. These calls specifically address surrender charges to ensure that policyholders clearly understand their annuity purchase. The 75+ calls are just one of the programs that are part of our Partnership for Consumer Trust (PACT).

As part of PACT, Allianz:

• Requires all agents to accept our Code of Best Practices, which focuses on suitability, replacements, and disclosure.
• Has a list of professional designations approved for use when marketing Allianz products.
• Surveys all new policyholders through a third-party (LIMRA) and calls all new fixed annuity policyholders age 75+.
• Has an agent training program recognized as among the best in the industry (Agent Sales Journal, April 2008).
• Does not tolerate agent misrepresentation. Allianz terminates agents if and when we become aware of serious misconduct of any kind.

Dateline requested an on-camera interview, which we declined. We did provide a detailed written statement, which highlights our industry-leading consumer initiatives. The statement is posted on Dateline’s web site and also attached below for your reference.

The statement echoes what I’ve said on many occasions – including in my testimony to the U.S. Senate: Allianz is committed to ensuring that our products meet the needs of the people who entrust their hard-earned savings to us. We’ve taken significant steps to make sure consumers are fully informed and only purchase products that are suitable for their needs. It is important to remember that our products can play a unique role as an important part of a balanced financial plan. Fixed indexed annuities also offer consumers the opportunity for growth along with a guarantee that they will never lose a nickel of principal regardless of stock market performance.

We are committed to maintaining a world-class organization, and will not deviate from this objective. We remain focused on meeting the needs of both our consumers and producers. We have never wavered in our commitment to the highest ethical standards and absolute accountability.

Texas needs more homeowner insurance competition

Great article from the San Antonio Express News about why homeowner rates are so high in Texas. Insurance carriers currently have a 30% profit margin according to the article, so they seem not be suffering. The article also mentions another reason for the high rates – lack of competition. Read more….

Texas needs more homeowner insurance competition

A Few Things to Think About Before Filing a Claim on Your Homeowners or Auto Policy

Good article about something almost all of us do from time to time – actually use our insurance – and what the consequences could be.

Claims-That-Boost-Your-Insurance-Rates from Yahoo! Finance

Healthcare Legislation Update Week of March 24, 2008

Commentary courtesy of Aetna:

Soaring costs and the slowing economy have put a damper on comprehensive health care reform efforts across the country, most notably in California earlier this year. More limited health care reforms continue unabated, of course, but the cost of comprehensive reform appears more daunting than ever. New Jersey, however, appears to be bucking the trend with a new comprehensive reform package that would cost an estimated $28.8 million in its first phase and $1 billion in its second phase. The plan (see below) includes an individual coverage requirement and creation of a new state-sponsored health plan. Supporters of the package vow the plan would be implemented without raising taxes. But an important player in the process, Governor Jon Corzine, provided the proverbial splash of cold water when he said that current budget circumstances will greatly impair the state’s ability to achieve universal coverage. The governor, however, may announce support for a portion of the proposal. Whether New Jersey is able to join the small number of states with universal health care plans remains to be seen. But State Sen. Joseph Vitale, one of the architects of the plan, has a lot in common with many state legislators across the country in believing that the state has to try. “We can’t wait for national reform,” he said.

Health care-related developments in Washington, D.C. and state legislatures across the country:

Federal
Congress was in recess last week. No report this week.

States
CONNECTICUT: Many of the health care measures approved by the Insurance Committee last week are focused on the high cost of health care. One of the committee-approved proposals would establish a wellness tax credit for small businesses; another would allow more flexibility to offer lower-cost health plans. Another proposal would allow municipalities to collaborate together to purchase health insurance. The House put forth the Healthy Steps Program, which permits the sale of reduced-mandate products, requires a cost-benefit analysis of mandates and establishes business tax credits for providing employees with health insurance. The Insurance Committee did not act on the “pay or play” health care tax bill, nor did it act on legislation that would dictate the provisions and terms included in the contracts between health insurers and physicians. Disposing of these proposals early in the session provides a boost to the business climate in Connecticut.

FLORIDA: Governor Charlie Crist’s “Cover Florida” plan for the uninsured passed out of its first committee last week and continues to move forward. Aetna has worked with the Governor’s office for several months on this proposal and has been successful in seeing a number of suggestions incorporated into this version. Health plan participation in the plan would be voluntary. Though Cover Florida still contains guaranteed issue language affecting participating plans, the plan would allow pre-existing condition exclusions as well as benefit limits.

GEORGIA: Action on the Georgia Medical Association’s prompt-pay proposal was postponed last week, but it may be acted on in committee this week. While it still contains language applying the prompt-pay requirements to self-insured plans, Aetna has been able to help reduce the bill’s impact by assuring health plans are not assessed penalties regarding prompt payment of claims unless they are below a 95 percent compliance standard. Also, the interest penalty has been reduced from 18 percent to 12 percent.

INDIANA: The Legislature adjourned the 2008 session on March 14. In recent weeks, an Assignment of Benefits bill died in the Senate. However, a “Silent PPO” bill made it through the process. After much negotiation, the industry supported the bill, which requires greater disclosure of information regarding the rental of PPO networks. The provider community attempted to include much more far-reaching, costly, and unnecessary items to the bill, but those were ultimately defeated.

MAINE: Although the legislative session does not adjourn until April 7, an agreement on Dirigo funding and individual market reform looks unlikely. It appears that three versions of a Dirigo bill will be reported out of the Insurance Committee, with none having enough support to pass. That will leave the industry with the current savings offset payment (SOP) mechanism to fund Dirigo’s Year 4. Although the Dirigo Health Agency will no doubt seek to double the SOP to the full 4 percent, it will be hard to defend. Dirigo’s enrollment has been frozen for the better part of a year, so a substantial increase in savings to the health care system based on new enrollment will be hard to justify. However, the Dirigo Health Agency still may find a way to increase the current 1.7 percent SOP, perhaps significantly.

MASSACHUSETTS: Commonwealth Choice health insurance premiums projected for this summer will average 5 percent more than last July’s rates. A state panel last week approved a contract to pay insurers about 10 percent more for each person enrolled in the subsidized insurance program starting July 1, making the lowest premiums in Commonwealth Care $39 a month to $116 a month. Insurers had asked for an increase of about 15 percent but agreed to less after weeks of negotiations. Under the contract, the state also would assume more of the financial risk if the enrollees were to use more medical care than expected. The Connector’s Executive Director John Kingsdale recently reported that more than 300,000 Massachusetts residents have enrolled who were previously uninsured. This large number suggests that the state’s official estimate of the number of uninsured (372,000) was low, so the cost of solving this bigger problem is going to be significantly more than originally thought (an estimated $869 million in FY ‘09 instead of $725 million).

NEW JERSEY: Senators Joseph Vitale and Robert Singer and Assemblymen Neil Cohen and Lou Greenwald joined David Knowlton, President of the New Jersey Health Care Quality Institute, last week in announcing a comprehensive health care reform initiative – the Vitale Plan – with the goal of achieving universal coverage in New Jersey. Phase One would feature a Kids First mandate requiring coverage of all children under 18; expansion of New Jersey Family Care to 200 percent of the federal poverty level; and small group and individual market reforms, including prior approval by the Department of Banking and Insurance for premium increases of more than 15 percent, an increase in MLR from 75 percent to 80 percent, and a requirement that insurers selling small group market products also sell in the individual market. Phase 2 would feature an individual coverage requirement, and establishment of a state-operated health insurance plan administered (ASO) by two insurance carriers. Projected costs for the first year total $28.8 million (of which $20.5 is for the children’s component), and funding is purportedly available at present in the form of surpluses totaling $180 million in the state’s Family Care and Medicaid Programs.

NEW YORK: New Governor David Paterson has asked all Commissioners and agency heads to submit their resignations. While he says this is a formality, it is unclear who will be asked to stay. There is widespread belief at the Capitol that Commissioner of Health Richard Daines will be asked to stay along with Deputy Director Dennis Whelan, but the fate of Superintendent of Insurance Eric Dinallo is less clear. Budget talks remain stalled. As expected, the Assembly is proposing the richest spending package, the Senate the leanest. Governor Paterson already has reduced the Spitzer spending proposal by $800 million. But faced with a $4.5 billion dollar deficit, the state has a deep hole to fill. Getting a state budget adopted by the April 1 deadline does not look likely.

SOUTH DAKOTA: The Legislature adjourned its 2008 session on March 17. Recent legislative action includes passage of a transparency bill, which requires licensed hospitals to report charges for any procedure for which the hospital had at least 10 cases. The data will be reported to the South Dakota Association of Healthcare Organizations, which is required to develop a web-based system for making the information available to the public via a link from the Department of Health’s website. In addition, the law requires the dissemination of information about physicians’ charges for certain outpatient procedures.

TENNESSEE: The Tennessee Medical Association this week announced it now officially supports the “Silent PPO” legislation originally introduced by some individual providers. The bill closely follows the AMA model on this issue and contains significant restrictions on insurers’ ability to operate rental networks. Aetna is working with the industry to defeat this legislation.

WASHINGTON: The Legislature last week sent to the Governor a measure to mandate a minimum level of reimbursement for contracting chiropractors. The bill would damage the ability of insurers to contract with needed health care professionals and severely limit the ability of insurers to use competitive market forces to lower health care costs. Specifically, this bill requires insurers to reimburse chiropractors no less than other providers who bill under the same billing code as chiropractors. In other words, carriers must reimburse an orthopedic surgeon no more than a chiropractor for an office visit, in spite of the differences in training, education and costs of maintaining a practice. Aetna has submitted a veto request letter to Governor Chris Gregoire. The Governor has until April 5 to sign or veto the bill.

MedQuot.com

MedQuot.com is a great place to find health insurance plans and rates. Along with information about the plans, you can find which doctors, hospitals and other medical providers accept the plans to make sure that you are able to use your insurance.