July 01, 2008
California Health Insurance Companies Spend $10.3 Billion On Administration And Profit
Private health insurance companies regulated by the Department of Managed Health Care (DMHC) spend $6 billion each year on administration, and divert an additional $4.3 billion to profit, according to a report released by the California Medical Association (CMA). Prepared using data obtained under the Knox Keene Act, the report breaks down how private health insurance companies spend their revenues.
"This report paints in stark terms why health care costs are skyrocketing for Californians," said Dr. Richard Frankenstein, M.D., President of CMA. "Health insurance companies in California spend billions of California's health care dollars each year on administration, and for-profit insurers divert billions of dollars more to profit. Californians' health care dollars should be spent on health care, not on bureaucracy."
Currently, private health insurance companies regulated under Knox Keene - representing some 60% of the health insurance market - are required to spend no more than 15% of their revenues on administrative costs. CMA and other health care advocates believe the statute includes profits as administrative costs; health insurance companies exclude profits from the 15%, allowing them to spend as little as they want on actual California health care. SB 1440, a bill authored by Senator Sheila Kuehl and sponsored by CMA, would require insurance companies to spend 85% of their revenues on health care, driving down health care costs for consumers and potentially making coverage more affordable.
"It's not acceptable for us to ignore such massive waste in the California health insurance industry when Californians are being bankrupted by rising health insurance premiums and gutted benefits," stated Senator Kuehl. "California consumers have a right to know that there is a basic formula in the law for how much of their money is actually being spent on medical care. This is the least we should be doing."
If SB 1440 had been in effect in the last reporting year, HMOs would have spent $1.1 billion less on administrative costs and profit - money that would have gone instead to provide health care to their policyholders. Blue Cross policyholders alone would have benefitted from $700 million more in health care that instead went to administrative costs and profit.
The Department of Insurance (DOI) collects the same data as the DMHC, but the DOI refuses to make the data public. CMA strongly supports the DOI and DMHC releasing this information to the public so that consumers can make informed decisions about whether a health plan is spending their premiums on health care.
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Posted by healthinsurance at 01:16 PM | Comments (0)
June 26, 2008
Opposition to Proposed Health Care Cuts Rises in California
Gov. Arnold Schwarzenegger's (R) proposed budget changes to health care programs would increase the number of uninsured residents in California by about one million over the next three years, according to a study released Wednesday by Health Access California, a consumer advocacy group, the Los Angeles Times reports.
The report said the governor's proposed 10% cut to Medi-Cal payments to health care providers and changes to Medi-Cal eligibility rules would create much larger increases in uninsured residents than previous studies have estimated. Medi-Cal is California's Medicaid program (Rau, Los Angeles Times, 6/26).
The report projects that:
* 471,500 children would lose Medi-Cal coverage over the next three years because of Schwarzenegger's proposal to require eligibility verifications quarterly rather than yearly (Rojas, Sacramento Bee, 6/26); an
* 429,000 adults would lose Medi-Cal coverage if the maximum income eligibility level for the program is dropped to 61% of the federal poverty level.
In addition, the California Budget Project estimates that 60,000 children would lose coverage through Healthy Families, California's version of the State Children's Health Insurance Program, if premiums are increased. The governor has proposed increasing monthly premiums by:
* 77% for children from households with incomes between 151% and 200% of the poverty level; and
* 27% for children from households with incomes between 201% and 250% of the poverty level.
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Posted by healthinsurance at 03:32 PM | Comments (0)
June 22, 2008
Huge demonstration for better health coverage in California
Government officials joined thousands of patients, union members and activists from throughout Northern California in front of San Francisco's Moscone Center Thursday afternoon to advocate universal health care and protest insurance-company practices.
Protesters — including an unknown number from the Palo Alto/Stanford area — lined Fourth Street and wrapped around Howard Street, swarming the building where California insurance companies and stakeholders were gathering for an annual convention.
America's Health Insurance Plan, an association representing some 1,300 companies that provide health insurance, hosted Thursday's conference, called Institute 2008.
Outside the conference, advocates held signs with slogans such as "Patients Not Profits" and chanted expressions such as "Californians should beware, insurance companies just don't care."
Speakers included state Sen. Sheila Kuehl, D-Los Angeles, San Francisco Supervisor Tom Ammiano and Los Angeles City Attorney Rocky Delgadillo.
"All of us know the California health care system should be a model for the country," Delgadillo said.
He said the nation's health care system is "broken" and some insurance companies maximize profits at the expense of patients and illegally rescind coverage when a person needs it the most.
Protesters focused on advocating two pieces of legislation. Kuehl's SB 840 would create a single-payer system for California and HR 676, introduced by U.S. Rep. John Conyers, D-Mich., strives to create a national single-payer health insurance program that would be publicly financed and privately delivered.
Donna Cook, a 60-year-old retired teacher, came in from Chico to attend today's event in support of single-payer health insurance.
She said that she has health insurance but that her daughter and 5-year-old grandson do not.
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Posted by healthinsurance at 04:22 PM | Comments (0)
June 16, 2008
United Health Group and PacifiCare announce $6.2 million grants
United Health Group Inc. and Pacificare announced Monday some $6.2 million in grants to a dozen California nonprofits that deliver California health care.
The grants are part of a state-required program to distribute a total $50 million in contributions and make some $200 million in investments over five years to benefit California health care.
United Health Group (NYSE: UNH) agreed to the payments as part of a deal negotiated by former Insurance Commissioner John Garamendi to ensure California consumers wouldn't be saddled with costs of the $9 billion takeover of PacifiCare by United Health Group.
The Northern California recipients of the grants include:
- $250,000 to San Francisco-based North East Medical Services to implement a chronic disease management system.
- $396,057 to Santa Clara-based Community Health Partnership to implement a clinical information management system.
- $276,859 to Stockton-based Child Abuse Prevention Council of San Joaquin County for start up costs for its Therapeutic Services for Children and Families Program.
- $394,470 to Sacramento-based La Cooperativa Campesina de California, to expand patient and physician use of a personal health record system designed for low-income populations with sporadic access to care.
- $841,140 to Fresno-based Kings View Behavioral Health System to implement a telemedical delivery system for mental health services.
- $2.5 million to the Sacramento-based Health Professions Education Foundation to expand its clinician support program that helps place clinical professionals in under-served communities.
- $100,000 for Salinas-based Center for Community Advocacy to help launch its Gang Violence Prevention Initiative.
- $326,357 to Quincy-based Plumas District Hospital to upgrade its telemedical capabilities.
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Posted by healthinsurance at 09:33 PM | Comments (0)
June 13, 2008
States Can't Stop Health Insurance Abuses
People who buy individual health coverage in most states are vulnerable to insurance company tactics that can deny them care, a health care advocacy group warns.
A survey of insurance commissioners across the country shows that all but five states allow insurance companies (including California) to deny coverage to sick or older patients. All but 15 states have no limits on how much companies can raise premiums if individual policy holders get sick, according to the consumer group Families USA.
About 14.5 million Americans bought their own insurance on the individual market in 2006, according to the Henry J. Kaiser Family Foundation. Those numbers would likely grow under the health reform plan being touted by Sen. John McCain, R-Ariz., the presumptive Republican presidential nominee.
McCain's plan would replace existing tax breaks for employer-sponsored coverage with tax credits individuals could use to buy coverage on the individual market. The change would likely shift millions of workers onto individual coverage, where they would be vulnerable to insurance companies' cost-saving tactics, says Ron Pollack, Families USA's executive director.
"To deregulate the market would make a bad situation even worse," Pollack tells WebMD.
The group's report found wide variation in the number of consumer insurance protections in states.
Some states -- such as Maryland, Illinois, and Idaho -- let patients appeal when their individual insurance coverage is revoked; other states -- such as Ohio, Kansas, and Arizona -- don't allow appeals. Most states guarantee that customers can review when companies deny individual claims. But in only a handful of states are those reviews free and conducted by an independent third party, the report says.
Overall, New York, Connecticut, New Hampshire, and California had among the most protections. States including Alaska, Arkansas, and Wisconsin had relatively few, according to the report.
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Posted by healthinsurance at 07:11 PM | Comments (0)
June 11, 2008
HMO Regulator''s Promise To Reinstate Health Coverage For Wrongfully Canceled Patients
HMO regulator's promise to reinstate California health coverage for wrongfully canceled patients; cautions that all health costs during gap must be covered.
Consumer Watchdog said such a step was largely unnecessary because the department's own surveys found a systemic failure at Blue Cross and other companies to review a patient's medical records and/or ask questions about past health conditions a process called "medical underwriting" - before issuing individual policy coverage.
Consumer Watchdog praised a California state regulator's efforts to begin reinstating the insurance coverage of patients left uninsured, uninsurable and often hundreds of thousands of dollars in medical debt when their health insurance policies were illegally canceled after they got sick. The nonprofit consumer group also cautioned that reinstatements must be complete and retroactive, with no gap in coverage from when the policy was issued to the time it was restored.
Last Monday, Consumer Watchdog petitioned the state Department of Managed Health Care to announce its plans regarding reinstatement of thousands of patients affected by the illegal practice.
"This a landmark step on the road to justice for the thousands of innocent patients those health insurance was retroactively canceled. This announcement applies to only 26 people, but the same law used here will provide reinstatement for thousands more. We look forward to working with the department," said Jerry Flanagan, Health Care Policy Director for Consumer Watchdog. "However, we caution that reinstatement must be retroactive to the time of the policy cancellation, and health insurers in California must be liable for all health expenses from the date of issuing the contract through the date of reinstatement. We're also very concerned about the state's plan to subject the remaining thousands of cases to unnecessary and lengthy 'third-party reviews' before restoring their coverage."
A recent survey of Blue Cross of California by the Department of Managed Health Care found that in 90 out of 90 retroactive policy cancellations - - known as "rescissions" - that it examined, Blue Cross failed to show that a patient "willfully misrepresented" a known health condition when applying for coverage. Such "willful misrepresentation" is the only legal grounds for rescission.
In a number of cases made public, policies were canceled for issues not related to the illness at hand, for instance the patient's stated weight on the application, or for omissions or errors that may have been induced by deliberately over-complicated application forms, or for medical issues in the applicant's medical record that the applicant was not aware of or did not understand.
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Posted by healthinsurance at 09:07 PM | Comments (0)
June 05, 2008
Kaiser Permanente Extends California Group Enrollment Deadline
Kaiser Permanente Extends California Group Enrollment Deadline
Deadline extended to Friday, June 6 for new groups to lock in current rates for one year.
Kaiser Permanente California has extended the small group enrollment deadline to this Friday, June 6. Small businesses that apply by Friday can lock in the current rates for one year. After June 6, rates will be increasing on average between 8% and 12%. Some Kaiser medical insurance plans will experience an increase in health insurance premiums as much as 17%.
The plan being hit the hardest by rate increases is the $0/$1500 Deductible Plan with HSA. Kaiser Permanente priced this plan very competitively in 2007 in order to gain market share on the new health savings account plans. Utilization on this plan was higher than expected and forced Kaiser Permanente to implement rate increases around 17% for new groups who begin coverage on July 1, 2008.
For these reasons, many groups are scurrying to get California group health insurance quotes and lock in coverage before the rates go up. Kaiser Permanente underwriters and staff, facing this influx of business and wanting to give groups enough time to submit enrollment forms, made the decision this week to extend the small group enrollment deadline five days beyond the normal June 1st deadline.
About KaiserQuotes.com
KaiserQuotes.com is a leading provider of Kaiser Permanente California Health Insurance Quotes, and has been a trusted name in the health insurance industry for years. The company is a licensed insurance agency that offers competitive prices for a variety of insurance plans. In addition to their informative, interactive website, all customers have access to live support on the phone with the company's experienced benefits specialists.
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Posted by healthinsurance at 09:12 AM | Comments (0)
June 03, 2008
California legislators revive plans to expand healthcare insurance
The California Legislature is moving to curb some of the health insurance industry's most profitable and contested practices as lawmakers resurrect portions of Gov. Arnold Schwarzenegger's unsuccessful proposal to expand medical coverage.
More than a dozen health bills are advancing through the Legislature, many over the objection of insurers. Some of the proposals were transplanted from the plan that passed the Assembly last year, only to be rejected in the state Senate in January. Other measures are newly devised by the Democrats who control the Legislature.
The bills would require insurers to spend at least 85% of their earnings on patient care; block insurers from canceling policies of patients who need extensive care; and force them to cover more procedures, such as maternity services.
Over the objections of the major doctor and hospital lobbies, the Assembly approved a measure backed by Schwarzenegger that would require medical providers to publicly reveal their costs and medical performance.
In a sign that a desire for piecemeal health care changes is strong this election year, some of the Democrats' bills even have picked up votes among Republicans who did not support Schwarzenegger's package.
"In the aggregate, it could be pretty significant," said Sheila Kuehl (D-Santa Monica), chairwoman of the Senate Health Committee, of the legislation. "I think it's just getting to the point where the opposition has just overreached so badly and the insurance companies' actions have been so egregious that both sides of the aisle are getting fed up with them."
The governor's health care proposal was rejected in large part because of its $14.9-billion price tag, which senators considered untenable with the state deep in the red. But the bills that are winning initial approval now put most of their costs on the healthcare industry.
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Posted by healthinsurance at 09:30 PM | Comments (0)
June 01, 2008
States target companies for rescinding health policies
An insurance-industry practice of retroactively dismissing individual health policies and leaving some people with costly medical bills has come under fire from California to Connecticut.
The practice is generating many complaints to government regulators and some lawsuits claiming insurers have improperly dropped coverage. Some states are passing tough measures or pursuing regulatory actions and assessing fines to restrict these retroactive health policy voids.
Insurance companies say such cancellations, which they call "rescissions," are a rare but necessary tool to stop consumer fraud and lower costs for all individual policyholders.
Yet, consumers and lawyers who have challenged such insurance cancellations say there are many examples of insurers targeting patients who have been diagnosed with chronic or life-threatening diseases that require costly medical care.
In Arizona, two women say in separate lawsuits that Health Net of Arizona dropped their policies after they were diagnosed with cancer and that the insurer demanded that their doctors, labs and other medical care providers refund payments. A Phoenix man sued Golden Rule Insurance Co. after his policy was dropped and the insurer refused to cover the costs to remove a brain tumor and other medical procedures.
"The goal is to try to put a stop to this practice because it is hurting a lot of people," said William Shernoff, a Claremont, Calif., attorney who has filed dozens of lawsuits challenging such policy cancellations by insurers. "It is not only a financial burden on the people. When their coverage is pulled, they can't get treatment."
New Mexico Gov. Bill Richardson recently signed a bill that limits insurance companies' ability to rescind a policy. Insurers must show a consumer has been "willfully fraudulent" before rescinding a policy. Before the change, insurers could merely point to a mistake or omission on a health insurance application before dropping a policy.
The insurance industry recognizes how such cancellations are seen as controversial, and has recommended changes that it says will be fair for consumers and insurers alike.
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Posted by healthinsurance at 07:18 PM | Comments (0)
May 29, 2008
Health Insurance Company Paid its Workers Bonuses to Cancel Patient Policies
Health insurance company Health Net Inc. rewarded employees for finding ways to drop customer policies and not pay for their medical expenses, according to an investigation by the California Department of Managed Health Care (DMHC).
Since 2005, the DMHC has been investigating five of the seven insurance companies that provide health care plans to individuals in California. The department is attempting to crack down on the practice among insurers of dropping people's coverage based on often accidental errors in their enrollment applications. In many cases, people's policies have been dropped after they submitted medical claims.
The DMHC has fined Health Net $1 million for failure to disclose a program in which employees received bonuses for meeting or exceeding quotas for health insurance policies to be dropped. The department continues to investigate Health Net and has yet to determine if the dropping of policies or the bonus program are illegal.
The DMHC describes itself as the only stand-alone watchdog agency for managed health care in the country. Since 2005, it has fined Blue Cross $1 million for rescinding its members' health plans and $200,000 for rescinding one person's plan in particular. It has also fined Kaiser Permanente's Kaiser Foundation Health Plans $325,000 for illegally rescinding two policies.
"None of the plans that we are investigating thus far have had an adequately fair process" for dropping policies based on application errors, said DMHC Director Cindy Ehnes.
Health Net's employee bonus program was revealed in the course of a lawsuit by a breast cancer patient who had her health insurance policy dropped by the company after she became sick. The company dropped 1,600 policies between 2000 and 2006, avoiding paying $35.5 million in medical fees.
Ehnes and California Insurance Commissioner Steve Poizner have proposed new regulations that would require health care providers to find that customers deliberately misrepresented information on their applications before dropping their coverage.
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Posted by healthinsurance at 11:31 AM | Comments (0)
May 26, 2008
Polls show health care a growing concern for Californians
A new poll shows concerns over rising health care costs have kept pace with other major economic worries - second only to skyrocketing gas prices and tied with getting a job or raise that pays enough to cover increased living expenses.
The survey by the Kaiser Family Foundation, being released today, found that 44 percent of the more than 2,000 adults interviewed April 3 to 13 ranked paying for gas as a serious problem, compared with 29 percent for jobs and 28 percent for health care.
Difficulties paying for rent or mortgage followed at 19 percent, with food and credit card or personal debt close behind at 18 percent.
Health experts said the Kaiser poll, along with other studies released this week, show that health care remains in the forefront of Americans' concerns despite the mortgage crisis and growing overall economic woes. A Field Poll released Monday showed nearly 75 percent of Californian voters would have approved a health reform package brokered by Gov. Arnold Schwarzenegger and Democratic leaders that failed in the Legislature earlier this year.
"It is surprising to see that problems paying for health care are right up there with the top pocketbook issues that average Americans are facing and are much higher than some of the other problems you'd expect to see at the top of the list," said Drew Altman, president of the Kaiser Family Foundation, a health philanthropy in Menlo Park.
The poll showed that health care also plays a significant role in lifestyle decisions. Twenty-three percent of those surveyed said they or a member of their household either switched or stuck with a job because of health care benefits. Seven percent said that health care was a factor in their or a household member's decision to marry within the past year.
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Posted by healthinsurance at 02:26 PM | Comments (0)
May 22, 2008
California Insurance Department Encouraging Residents to Use Online Personal Health Records
Not enough California residents are using online personal health records offered by insurers and managed care groups in the state, according to a report released on Tuesday by the state Department of Insurance, the Sacramento Bee reports. The report was based on a survey of California's major insurers. The report states that PHRs are secure and efficient and allow people to better manage their health care and handle their health insurance claims. Based on the report, the state is encouraging residents to use PHRs. The department also is expected to announce the creation of a working group that would aim to ensure patients can keep their PHRs when they switch insurance companies.
Some privacy advocates have expressed concern about PHRs. Sue Blevins, founder and president of the Institute for Health Freedom, said, "While providing information is essential when seeking services, one shouldn't be forced to give up privacy and the freedom to withhold consent." Blevins said, "In fact, as the nation moves toward interoperable electronic medical records, it's important for citizens to gain greater privacy and control over their health care information." However, state officials on Monday said that the PHRs available through insurers in the state are securely managed (Glover, Sacramento Bee, 5/20).
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Posted by healthinsurance at 09:33 AM | Comments (0)
May 15, 2008
Kaiser patients to receive health coverage again
Kaiser Permanente today became the first California health plan to reinstate the individual insurance policies of consumers who were improperly dropped, often after running up expensive medical bills.
The California Department of Managed Health Care announced that Kaiser will offer coverage to 1,092 consumers whose policies were rescinded from 2004 until 2006, when Kaiser stopped the practice. The state has been investigating the five largest health plans for retroactively dropping consumers for making minor mistakes about their medical histories on their health insurance applications.
Kaiser will also pay a $300,000 fine.
One of those dropped consumers, Denise Fenton of Lake Forest said she bought an individual Kaiser policy because she’s self-employed. While insured, she was diagnosed with diabetes. Kaiser then dropped her, she says, calling her diabetes a preexisting condition.
“I was suddenly left with no insurance and now knowing I had diabetes I was going to have to disclose it, basically making it impossible for me to get health insurance from anyone else,” she said.
Fenton said she was able to form a corporation and then qualify for Kaiser insurance again, but at double the price.
Cindy Ehnes, director of the agency, said Health Net will be the next insurer to approve a similar plan to reinstate 85 consumers.
In addition to the offer to repurchase their insurance, Kaiser will reimburse those dropped for medical expenses accrued while they were insured, but that were not paid by Kaiser once their policies were canceled. Kaiser will also pay for medical bills incurred after consumers lost their health coverage.
Ehnes estimated that roughly 4,000 more Californians were rescinded by the other major health plans. The state is undertaking a review of patients from other health plans who were rescinded to determine if insurers should be ordered to reinstate them.
William Shernoff, a Claremont attorney representing several Orange County patients who are suing other insurers who dropped them, said though Kaiser wasn’t a big player, he hopes the other health plans will follow suit.
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Posted by healthinsurance at 01:59 PM | Comments (0)
May 13, 2008
California polls show health care a growing concern
A new poll shows concerns over rising health care costs have kept pace with other major economic worries - second only to skyrocketing gas prices and tied with getting a job or raise that pays enough to cover increased living expenses.
The survey by the Kaiser Family Foundation, being released today, found that 44 percent of the more than 2,000 adults interviewed April 3 to 13 ranked paying for gas as a serious problem, compared with 29 percent for jobs and 28 percent for health care.
Difficulties paying for rent or mortgage followed at 19 percent, with food and credit card or personal debt close behind at 18 percent.
Health experts said the Kaiser poll, along with other studies released this week, show that health care in California remains in the forefront of Americans' concerns despite the mortgage crisis and growing overall economic woes. A Field Poll released Monday showed nearly 75 percent of Californian voters would have approved a health reform package brokered by Gov. Arnold Schwarzenegger and Democratic leaders that failed in the Legislature earlier this year.
"It is surprising to see that problems paying for health care are right up there with the top pocketbook issues that average Americans are facing and are much higher than some of the other problems you'd expect to see at the top of the list," said Drew Altman, president of the Kaiser Family Foundation, a health philanthropy in Menlo Park.
The poll showed that health care also plays a significant role in lifestyle decisions. Twenty-three percent of those surveyed said they or a member of their household either switched or stuck with a job because of health benefits. Seven percent said that health care was a factor in their or a household member's decision to marry within the past year.
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Posted by healthinsurance at 11:54 AM | Comments (0)
May 08, 2008
Bush Administration Suggests Leeway on Kids' Health Coverage
The Bush administration on Wednesday sent letters to state health officials to clarify a policy directive issued last year that restricts states' ability to expand eligibility for their versions of the State Children's Health Insurance Program, CQ HealthBeat reports (Carey, CQ HealthBeat, 5/7).
According to guidelines issued in August 2007, before expanding SCHIP eligibility to children in families with incomes greater than 250% of the federal poverty level, states first must demonstrate they have enrolled at least 95% of eligible children with family incomes below 200% of the poverty level (California Healthline, 4/21).
According to the Wall Street Journal, most states do not meet the requirements, which has meant that several states, including New York and Ohio, have had to abandon their SCHIP expansion plans.
The letter sent Wednesday will qualify "many" of the states that did not meet the 95% requirement by using data from the Current Population Survey, according to Herb Kuhn, deputy administrator and acting director for the Center for Medicaid and State Operations at CMS (Zhang, Wall Street Journal, 5/8).
The recent letter says that states can use data on Medicaid, SCHIP or private insurance to demonstrate they had reached the 95% requirement.
"This is an achievable, goal and based on conversations with states, we are convinced that a number of states have already reached this goal," Kuhn wrote in the letter.
The letter also clarifies that the guidelines do not apply to children already enrolled in SCHIP. It also says that state health officials can recommend other ways to prevent families from substituting SCHIP coverage for private insurance, CQ HealthBeat reports (CQ HealthBeat, 5/7).
The guidelines currently say that states seeking to expand SCHIP eligibility must establish a minimum of a one-year period of uninsurance for individuals in families with incomes greater than 250% of the poverty level (California Healthline, 4/21).
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Posted by healthinsurance at 01:59 PM | Comments (0)
May 06, 2008
California health care workers sue state over pay-cut plan
A coalition of health care groups sued the state Monday to prevent pay cuts to doctors, dentists, pharmacists and others who treat the poor, elderly and disabled.
The lawsuit filed in Los Angeles County Superior Court on behalf of California health care providers seeks an injunction to halt 10 percent cuts to Medi-Cal and Denti-Cal reimbursements scheduled to take effect July 1.
"These specific cuts strike at the core of the safety net," said Erica Murray, vice president of the California Association of Public Hospitals and Health Systems. "These are the trauma centers, the burn units, the places where people go not only when they don't have insurance or they have Medi-Cal, but if they have an automobile accident, their house burns down or another tragic event."
The state Legislature approved the cuts in February as part of Gov. Arnold Schwarzenegger's plan to trim a $16 billion budget deficit. Health care providers objected and said reimbursements already fell short of their costs for treating 6.7 million Medi-Cal patients.
The governor's office projected in January that the program would cost $36 billion, including $13.6 billion from the state's general fund, but health care associations expect those numbers to grow by the time a budget is passed. Most of the program is paid for by the federal government.
"The governor fully understands the devastating impact of these cuts which is why he continues to push for comprehensive health care reform and structural budget reform," said Lisa Page, a spokeswoman for Schwarzenegger.
The coalition, which is seeking class-action status, is optimistic it will prevail in its case against the Department of Health Care Services, said attorney Craig Cannizzo. He said lawmakers need to understand that Medi-Cal is not "a pot of money that they can steal from any time."
A similar lawsuit five years ago halted a 5 percent Medi-Cal cut proposed by Gov. Gray Davis.
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Posted by healthinsurance at 12:15 PM | Comments (0)
May 01, 2008
California Can Learn Health Care Lessons From Down Under
The health care reform is still on the table in California, which should consider carefully the achievements and failings of foreign systems. Canada is the usual candidate but Australia’s health care strategies deserve a closer look.
The negative effects of Australia’s government-run health system are predictable and apparent: limited distribution of technology, restrictions on the number of medical students and Medicare providers, and waiting lists. Recognizing this, the country recently reformed private health insurance – which is not mandatory – in order to attract more Australians to sign up.
Australian taxpayers finance almost 70 percent of total health care expenses, including a subsidy for private health insurance, under which almost half of the Australian population is now covered. Taxes fund a 30-percent rebate on private insurance premiums for Australians under the age of 65. Rebates go up to 40 percent for older patients.
Australia phased in a Private Health Insurance Incentives Scheme (PHIIS) to improve citizens’ access to care, which caused the number of privately insured Australians to rise from 31 to 46 percent. The plan incorporated several reforms. Most importantly, it allowed age-rating in private health insurance, which was previously forbidden.
With age-rating, insurers started charging lower premiums for younger people, attracting them to purchase policies. To manage the transition, those above 30 who signed up before a cut-off date in 2000 were also given a discounted premium. Those who did not sign up in time would pay higher premiums equal to the base discounted premium plus 2 percent for every year after age 30.
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Posted by healthinsurance at 02:29 PM | Comments (0)
April 29, 2008
California Above U.S. Average for Health Insurance Cost Increases
The cost of health insurance premiums for coverage through private-sector jobs increased more than 10 times faster than employees' incomes from 2001 to 2005, according to a report released Tuesday by the Robert Wood Johnson Foundation, the Washington Post reports (Washington Post, 4/29).
In California, health insurance costs for the average family increased by about 34%, from $7,898 in 2001 to $10,551 in 2005, according to the study. During that period, salaries increased by about 9% on average for California workers.
California's jump in health insurance costs gives it the 12th-largest increase in the nation. The national average increase in health care costs was 30%, according to the study (Colliver, San Francisco Chronicle, 4/29).
Study Methodology
Researchers from the State Health Access Data Assistance Center at the University of Minnesota analyzed data from the U.S. Census Bureau and the Medical Expenditure Panel Survey conducted by the Agency for Healthcare Research and Quality to compile the report (Forster, St. Paul Pioneer Press, 4/28).
The information was released in conjunction with National Cover the Uninsured Week (Anstett, Detroit Free Press, 4/29).
National Findings
According to the report, monthly premiums for family coverage increased 34.6% from $1,921 in 2001 to $2,585 in 2005, while median family income rose 3.1% from $40,818 to $42,068 during the same period (Washington Post, 4/29).
The report also found that employees nationwide are paying a larger percentage of their insurance premiums -- 24.1% in 2005 compared with 23.2% in 2001 (Park, Arkansas Democrat-Gazette, 4/29).
According to the report, the number of people with private coverage dropped by about 6% nationally, while the number of private-sector employers who offered health insurance declined by 0.8% nationally (St. Paul Pioneer Press, 4/28). Premium increases contributed to 2.4 million fewer U.S. residents with private health coverage in 2005 than in 2001, according to the report (Krouse, Cox/Raleigh News & Observer, 4/29).
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Posted by healthinsurance at 04:16 PM | Comments (0)
April 24, 2008
Insurance reinstatement orders put health plans on edge
Last week’s move by state regulators, opening the door to restoring health insurance to thousands of customers who had their coverage cancelled by health plans, has the health care world waiting to see what will happen next.
The plans say they are still waiting for word from the Department of Managed Health Care about which 26 customers have been ordered to have their health care coverage restored. Thousands of other cases will be reviewed by an arbiter, selected by the department.Representatives from various health plans said they expect the broader review of these cancellations to be challenged in court. Though none would speak for attribution, they said they are waiting to see the details of the process established by the department before commenting on any potential legal action.
The department ordered the reinstatement of 26 patients who had their health coverage cancelled by Blue Cross, Blue Shield and Kaiser. More reinstatements may be ordered as the department winds up its investigation of HealthNet and PacifiCare.
Blue Shield and Kaiser said the department made the public announcement before revealing to the plans which patients were being reinstated. It was unclear whether the plans would fight those specific reinstatements.
“We are in the process of contacting them,” said DMHC spokeswoman Lynne Randolph. She said the DMHC had contacted the health insurance plans for information on cases, and would issue the formal reinstatement orders shortly. “We should have it wrapped up by the end of the week,’” she said.
DMHC Director Cindy Ehnes said her office would review cancellations between 2004 and 2008. “Every single rescission will be reviewed by this department,” Ehnes said, adding that patients would be compensated for their costs in the event the rescission was flawed. “For the first time, we are giving people a second chance to get that health coverage,” she said.
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Posted by healthinsurance at 02:38 PM | Comments (0)
April 22, 2008
California Health Insurers Must Reinstate Policies
Chalk one up for sickly patients. California regulators have ordered insurers there to reinstate the health insurance policies of 26 people who lost their coverage after the insurers claimed they had lied on their applications, according to news reports. The 26 cases represent the most egregious examples of insurers wrongly "rescinding" policies, typically for inadvertent errors. The person gets sick and starts making expensive claims, and the insurer cries "fraud!" The patient says "forgot!" or sometimes "say what?" For example, one woman I spoke with on this topic had answered "no" when asked if she'd been treated for cancer in the past 10 years. Later her policy was yanked because the insurer claimed that regular blood work she had to ensure her earlier cancer hadn't returned constituted cancer treatment.
Now California begins a case-by-case review of thousands of rescissions in the past four years, and it may be that these 26 are the tip of a fairly hefty iceberg. And consumer advocates say there's no reason to believe this issue is confined to California. They expect similar cases to begin emerging elsewhere.
These problems arise in the individual health insurance market, where people buy policies on their own. That market is much more loosely regulated than the group market—and often more problematic for patients—as I discussed a few months ago.
Right now, only about 5 percent of people buy insurance this way. But if Sen. John McCain has his way, many more would very likely start buying insurance on their own. The presumptive Republican nominee has proposed eliminating the tax break that employees currently get on their health insurance benefits and instead giving people a tax credit of $2,500 for individuals and $5,000 for families to put toward buying coverage. I also wrote today about the presidential candidates' healthcare reform proposals.
Many policy analysts see merits to the restructuring that McCain proposes, but they argue that without better regulation of the individual market, people who are older or sick won't be able to get affordable health coverage, or any coverage at all. They point to what's going on in California as an example of the kind of problems that can occur. "Look at the rescission mess in California," said health policy analyst Robert Laszewski, when I interviewed him for the election health reform piece. "The Democratic nominee will stand up and say, 'John McCain will throw you to the market wolves.' " McCain is expected to elaborate on his healthcare reform proposal at the end of April. Maybe at that time he'll offer details about how he plans to protect consumers from predatory insurance practices.
As for this rescission mess, I'd like to hear from people who've experienced problems similar to what's occurring in California. Is this just a left coast phenomenon, or is it happening elsewhere, too?
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Posted by healthinsurance at 02:38 PM | Comments (0)
April 17, 2008
Los Angeles Files Lawsuit Alleging Anthem Blue Cross Illegally Canceled Health Insurance Policies
Los Angeles City Attorney Rocky Delgadillo on Wednesday filed a lawsuit against Anthem Blue Cross alleging the insurer violated more than 25 state and federal laws and "sold people false promises of coverage and concealed a scheme to renege on policies for those diagnosed with serious and often expensive medical conditions," the Los Angeles Times reports. Delgadillo claims the insurer issued false promises of coverage and concealed a plan to rescind the health insurance policies for patients diagnosed with serious and costly medical conditions. The suit seeks restitution for patients left with medical bills and more than $1 billion in penalties.
The lawsuit claims that the company's coverage "is largely illusory." Delgadillo said Anthem "engaged in an egregious scheme not only to delay or deny the payment of thousands of legitimate medical claims but also to jeopardize the health of more than 6,000 customers by retroactively canceling their health insurance when they needed it most." He added, "Countless Californians who believe they have good health insurance actually have policies that aren't worth the paper they're printed on."
The charges cited by the suit include some allegedly illegal activities reported by a Times article highlighting the rescission of policies held by individuals with costly medical conditions. Jerry Flanagan, a patient advocate with Consumer Watchdog, said, "The complaint makes it very clear that a key part of the resolution will be to make sure everyone has coverage."
Cindy Ehnes, director of the state Department of Managed Care, on Thursday is expected to announce that rescinded policies of several individuals would be reinstated by health care plans and to describe a process by which other patients could have rescissions reviewed and reconsidered. State Insurance Commissioner Steve Poizner said he would examine the allegations and decide whether action is needed.
A spokesperson for Anthem's parent company, WellPoint, said the company "strongly disagrees with the allegations" and plans to defend itself. "Anthem has offered on several occasions to meet directly with the city attorney to provide further information on Anthem's rescission procedures," said Shannon Troughton of Wellpoint. "To date, the city attorney rejected each of these offers, and we are disappointed by his actions today because of our attempts to meet with him," she added.
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Posted by healthinsurance at 11:53 AM | Comments (0)
April 11, 2008
Two health-care rescission bills make way through Assembly
The battle over how and when health plans can cancel a patient's insurance policy returned to the Capitol this week as two key pieces of legislation cleared the Assembly Health Committee.
At issue are the rules health insurance companies must abide by before they cancel a patient's health care coverage.
"In the five years that we have records, there have been about 700 rescission per year," says Hector De La Torre, D-South Gate, author of one of the bills passed out of Health Committee this week. "This bill would make it so those rescissions would have to be reviewed by a third party before they can happen."
Under current practice, health plans have the authority to unilaterally rescind a policyholder's insurance if they find there has been a "willful misrepresentation" of the patient's medical history on their initial health care application. De La Torre's bill would force health plans to seek approval from a third-party arbiter before an enrollee's health insurance policy can be revoked.
A number of high-profile cases in recent years have found that health insurance plans have improperly revoked policies from insurance holders for accidental omissions on their health insurance applications.
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Posted by healthinsurance at 05:43 PM | Comments (0)
April 08, 2008
Report links deaths in California to lack of insurance
A report by a national health advocacy group says at least eight Californians die every day because they lack health insurance or have insufficient coverage.
The study, conducted by Families USA, says an estimated 3,100 adults died in California in 2006 because they lacked health insurance, could not afford care or received substandard or late care because of a lack of insurance.
The report follows a three-year study by the National Institute of Medicine that linked roughly 18,000 deaths annually to a lack of insurance in the U.S.
Families USA, based in Washington, D.C., says its report is the first to link deaths to a lack of health insurance on the state level.
The group says the uninsured are less likely to have regular physician visits and more likely to put off the medical care they need. They also receive less health care once they are in hospitals and often cannot afford prescription medication to control chronic illnesses.
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Posted by healthinsurance at 04:32 PM | Comments (0)
April 03, 2008
Many Asian Americans in Sacramento County lack health insurance
Even while her stomach was killing her, Melelea Tausinga remained the heart and soul of Sacramento's Tongan community.
She counseled troubled teens, was the water mom for Tongan rugby teams and danced everything from Tongan classics to her favorite, "The Electric Slide."
But Tausinga never went to a doctor because she didn't know where to go and felt she couldn't afford it anyway, her husband said.
Tausinga, who died Oct. 25 of stomach cancer at age 51, was among tens of thousands of Pacific Islanders, Korean Americans and Southeast Asians without health insurance.
These ethnic groups "are doing much worse than other subgroups in terms of health insurance and access to health care," according to a study of Asian Americans released Tuesday by the Kaiser Family Foundation and the Asian & Pacific Islander American Health Forum.
Korean Americans, Native Hawaiians and Pacific Islanders are less likely to be insured than other Asian American groups such as Japanese or Asian Indians and twice as likely to be uninsured as whites, according to an analysis of national health data from 2004-2006.
The disparity is particularly acute in California, home to a third of the nation's Asian Americans and Pacific Islanders, said Cara James, the foundation's senior policy analyst for race and ethnicity.
"People who do not have health insurance delay much needed medical care, are more likely to forgo care because of costs, and when they do finally show up for care the conditions they have are often far more severe," James said. "They are more likely to show up with late stage cancer."
That's what happened to Tausinga, said her husband, Tevita Tausinga, who won't shave his beard or change his black clothes until his wife has been gone a year.
"She was almost everywhere, and she always followed the kids, who came by the hundreds to see her before she died," he said.
Melelea Tausinga, mother of four and grandmother of seven, not only gave herself to her community, she worked for more than 10 years as motel maid, then as teaching assistant at Susan B. Anthony Elementary, where her granddaughters attend. Neither job provided health insurance.
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Posted by healthinsurance at 01:32 PM | Comments (0)
March 29, 2008
Health insurers to meet with state agency on rescission probe
California's largest health insurers, facing possible fines and other penalties for the way they sometimes cancel policies after patients pile up medical bills, meet today with regulators to discuss ongoing state enforcement efforts.
The meeting was called by the Department of Managed Health Care, which oversees health maintenance organizations and other types of health plans, because it was nearing completion of investigations into the cancellation practices of Health Net Inc., Kaiser Permanente and Blue Shield of California, said spokeswoman Lynne Randolph.
The department plans to discuss the standards to which it is holding the insurers' practices, she said, as well as remedies for problems identified in the probes of policy cancellations, known as rescissions.
"This is our opportunity to move forward and conclude this phase of our investigation into rescissions," Randolph said. "Our goal is to bring a quick resolution to this problem to protect consumers today from illegal rescissions."
Randolph said the results of the remaining three investigations would be announced soon but that the process -- including today's meeting with the health plans -- was confidential until then to protect the insurers' due-process rights.
The closed meeting has alarmed consumer advocates because it comes as the insurance industry is pushing a plan that critics believe could make it easier for sick patients to lose coverage through no fault of their own. But the department said the industry's proposal was not on the agenda.
California health insurers -- battered by newly aggressive regulators, a $9-million court judgment and stinging criticism from lawmakers, judges and consumer advocates -- are fighting on several fronts this spring in Sacramento and elsewhere.
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Posted by healthinsurance at 07:45 PM | Comments (0)
March 25, 2008
PacifiCare Capitulates to Latest California Patient Revolt
In the face of a national campaign on behalf of Nick Colombo, insurance giant PacifiCare has reversed its decisions and agreed to critically needed cancer treatments for the 17-year-old from Placentia, Calif. The decision came after the company was overwhelmed by calls organized by Nick's friends and family, along with RNs from the California Nurses Association/National Nurses Organizing Committee, and netroots activists.
Over 100 of Nick's classmates, friends of the family with their young children, and nurses protested in front of the health insurance company headquarters this morning to demand that the approval be put in writing, which a PacifiCare representative, surrounded by T.V. cameras, and promised to do.
"I am extremely happy about PacifiCare's reversal," said Ricky Colombo, Nick's 19-year old brother. "The goal was to get treatment for Nick, and CNA/NNOC and other allies helped us with that. We decided to go through with the rally in order to get their decision on the record and make sure they back up their words -- and also because there are thousands of others in similar situations who can't get the care they need. We feel blessed to have this community supporting our family."
This is the latest example of a "patient revolt," where friends, family, and healthcare activists demand treatments denied by for-profit insurance corporations. In this case, Nick's physicians pleaded with PacifiCare to approve a cancer treatment, only to be overruled by an insurance company medical reviewer. PacifiCare is owned by United Health, the nation's largest health insurer, and just last year was fined $3.5 million by the state of California for wrongly denying 133,000 cases in a two-year period.
Inspired by the pleas of Nick's 19-year-old brother Ricky -- A national web of friends and family of Nick -- CNA/NNOC registered nurses, doctors, healthcare advocates, and netroot supporters pitched in on a national day of action Monday on Nick's behalf. Hundreds of phone callers clogged the lines of PacifiCare and United Healthcare offices around the country yesterday, at times shutting down the phone system, and leading a spokesman to complain about being "overwhelmed" by healthcare activists.
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Posted by healthinsurance at 01:50 PM | Comments (0)
March 23, 2008
Fighting Health Insurance Cancellations
Imagine spending thousands of dollars a year for health insurance, only to have it canceled after filing claims for treatment of a serious illness. Some retroactive policy "rescissions" appear unfair and arbitrary, raising doubts about the value of insurance and embarrassing the industry.
Insurance companies say they need the right to void policies because some applicants lie about their health. But stung by widespread outrage over some recent cancellations, the industry is proposing a way to resolve rescission disputes between policyholders and companies.
America's Health Insurance Plans, an industry group in Washington, is advocating an appeals process involving independent review by a panel of outside experts. Decisions would be binding on health insurers. Earlier this month, the group presented the plan to representatives of state regulators, insurance commissioners and consumer advocacy groups.
"It's a positive step in the right direction and provides an opportunity for prompt dispute resolution while minimizing the need for litigation," says Ron Pollack, executive director of Families USA, a Washington nonprofit consumer organization.
Direct Buyers Only
This issue affects people who purchase their own policies -- not those who are covered under an employer-sponsored plan. Health insurers in most states can deny coverage based on an applicant's health history. Disclosure of some pre-existing conditions, such as cancer or heart disease, may result in a policy denial. But failure to do so could trigger a retroactive policy cancellation in the midst of treatment.
One challenge for health insurance applicants is that sometimes the medical-history forms they must complete are confusing and difficult to understand. Minor health issues that may not seem worth mentioning, and that were never treated by a physician, may later turn out to have been early warning signs of disease. Brokers or agents eager to complete a sale may urge a naive applicant to fudge an answer.
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Posted by healthinsurance at 08:29 PM | Comments (0)
March 18, 2008
Health care a prime target for states' cutbacks
Financially strapped states are looking to take away government health insurance and benefits from millions of Americans already struggling with a souring economy.
An Associated Press review of the budgets in all 50 states reveals that coverage would be eliminated for hundreds of thousands of poor children, disabled and the elderly. More than 10 million people would lose dental care, access to specialists, name-brand prescription drugs or other benefits. About 20 million could see their care jeopardized by further cuts to doctors' reimbursements.
Health care in California is a choice target as governors and legislators confront the worst deficits they have faced in a decade or more, but that is not their only target: They also are considering cuts in aid to schools and universities, shrinking state work forces and even releasing prisoners before their sentences are completed.
Safety-net programs for the elderly, disabled and out-of-work also could be cut, even as the demand for those services is on the rise.
Despite the dire conditions, only a few states are seriously considering general tax increases or even modest increases on the wealthy to close the gaps. Lawmakers say they fear such actions would only further stress the economy.
Instead of health insurance, states are looking to increase lottery ticket sales, promote Indian gambling or further raise taxes on cigarettes and alcohol. Those taxes disproportionately hit the pocketbooks of the same poor and working-class that would be hurt by the spending cuts, studies show.
Nearly two dozen states are grappling with deep cuts and tax proposals to close shortfalls totaling more than $34 billion. That includes California, where lawmakers have made emergency cuts and authorized billions in bond sales to halve a deficit once projected at $16 billion through June 2009. Another dozen states are bracing for falling revenue.
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Posted by healthinsurance at 01:06 PM | Comments (0)
March 14, 2008
Insurance Drops for Municipal Debt, Undermines MBIA
Demand for municipal bond insurance is shrinking at the fastest pace in the industry's 36-year history.
The backing of an insurer has become a liability for tax- exempt borrowers, sometimes doubling interest rates instead of lowering them. State and local governments bought protection on 26 percent of the $40.8 billion in bonds they sold in January and February, down from 53 percent a year earlier, according to data compiled by Bloomberg. At that rate, 2008 will mark the steepest-ever annual decrease, wiping out almost two decades of growth, Thomson Financial data show.
An extended decline would undermine the two biggest bond insurers, MBIA Inc. and Ambac Financial Group Inc., because they're counting on municipal sales to shore up credit ratings threatened by losses on mortgage-backed debt. Treasurers from California, Pennsylvania and Mississippi told lawmakers yesterday many borrowers would never have relied on insurers' ratings if their own were assessed like corporate debtors.
``This is a watershed moment in the municipal bond industry,'' said Richard Larkin, research director at brokerage Herbert J. Sims & Co. in Iselin, New Jersey, and the former chief municipal rating officer at Standard & Poor's. ``The bond insurers have lost a tremendous amount of credibility.''
Municipalities from California to New York are rejecting insurance as fallout from the collapse of the subprime mortgage market strips some of the biggest guarantors of their top AAA ratings. Even the safest debt that they back is tainted.
AAA Ratings
California, which spent $102 million to insure $9.1 billion of bonds between 2003 and 2007, decided insurance wasn't worth it on its most recent $5.95 billion of debt sales, said Treasurer Bill Lockyer.
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Posted by healthinsurance at 04:17 PM | Comments (0)
March 13, 2008
Legislation Would Set Standards for Individual Health Insurance Market in California
The fight on health reform in the last year put a spotlight on many of the real issues in the health insurance market, and in response, legislators this year have introduced a slew of stand-alone bills designed to set cost and benefit standards for health insurance and otherwise increase oversight of the private insurance industry.
A list of many of these bills is available at the Health Access California website.
SB 1522 (Steinberg), sponsored by Health Access California, would set standards for cost and coverage in the individual insurance market. It would provide immediate help to consumers who have to buy insurenace coverage in the individual market, such as the self-employed and those between jobs, while providing a framework for further health reform.
THE BILL
SB1522 (Steinberg) organizes the individual insurance market and makes it understandable for consumers. It would allow consumers to see and understand their choices in the individual market, and be better informed about a plan's premium, benefits and cost-sharing. By setting a standard for coverage, it would also effectively weed out a lot of "junk" insurance.
Consumers in the individual market would have a better sense of their health coverage choices, since all health plans sold in the individual market would be classified into five "tiers." In this way, consumers would be able to know if a certain plan is a top-tier comprehensive plan, or a bottom-tier catastrophic plan, or something in between, and if one plan from one insurer is roughly comparable with another plan by another insurer. This provides some standardization and simplification of the marketplace, while preserving a wide range of choices for consumers.
To allow real price comparison, Insurers would be required to offer five "benchmark" plans, one in each tier. The bill would enable consumers to do cross-insurer price shopping, to make apples-to-apples comparisons, with the confidence of knowing that benchmark plans in a given tier have similar cost-sharing, benefits, and other plan features. The benchmark plan would help define the tier, by being the lowest-price plan in a given tier.
The bill would eliminate some "junk" insurance, products that are coverage in name only, that provide such limited benefits or leave consumers so financially exposed, that the product is not of value. Such plans, deceptively offer "coverage" but leave consumers facing major gaps in coverage and significant out-of-pocket costs. California health insurers would not be able to sell new plans that do not meet the minimum benefit standards.
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Posted by healthinsurance at 11:18 AM | Comments (0)
March 11, 2008
Scrutiny of California Health Insurers Draws National Attention to the Problem
Dow Jones on Friday examined how a "series of troubling developments" related to rescissions of individual health insurance policies in California "is bringing national attention to the problem of patients having their coverage taken away when they need it most." According to Dow Jones, health insurers maintain that they "have a responsibility to ensure applicants are truthful about any pre-existing conditions they may have so companies can accurately price insurance policies and hold down costs for all their members," but consumer advocacy groups "warn that tactics such as tying financial incentives to the number of rescissions an employee makes or involving doctors in investigations after policies have been issued aren't working and may be illegal in some states."
California Department of Managed Health Care spokesperson Lynne Randolph said, "We don't think it is only happening in California ... but California's farther ahead in terms of enforcement," adding, "We had a statute in place that companies must do underwriting up front and a consumer must willfully misrepresent their health condition on an application in order for a company to rescind. We feel that means it can't just be an inadvertent omission."
America's Health Insurance Plans, which has begun to draft a proposal that would allow individual health insurance policyholders to appeal rescissions, said that the practice affected only 0.15% of individual health insurance policyholders in 2006. AHIP President Karen Ignagni said, "We recognize the process needs to be very transparent and people need to have peace of mind that they will have an independent review," adding, "As states adopt this proposal, they'll have a place where they can have these cases vetted external to the health plan." Meanwhile, some health insurers, such as Health Net, have begun to establish their own independent review programs.
Sandy Praeger, president of the National Association of Insurance Commissioners, said that health insurers are "making a lot of money collecting premiums" on individual coverage policies and "need to honor those contracts." She said, "I don't dispute (their) ability to drop someone who's intentionally lied," adding, "But to have policy language and application forms that are hard to understand and rely on a third party to explain them to you, it opens the door to people making unintentional mistakes. They shouldn't be held accountable for those." NAIC has begun to develop a standardized application for individual health insurance policies that could help prevent unintentional errors (Gerencher, Dow Jones, 3/7).
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Posted by healthinsurance at 12:06 PM | Comments (0)
March 08, 2008
How to Spot a Health Insurance Scam
The law offers Medicare beneficiaries a bewildering array of new health-insurance options. They can now choose from dozens of Part D prescription-drug plans to supplement Medicare, or they can opt out of traditional Medicare and enroll in a Medicare Advantage plan to get both medical and drug coverage from a private insurer.
All of the new choices have resulted in "an immense amount of confusion," says Micah Roderick, of the Illinois attorney general's office. They've also led to an epidemic of fraudulent sales practices, ranging from sales abuses to criminal activity:
*
To reap big commissions, some insurance agents sell seniors Medicare Advantage plans without explaining the limitations, and even sign people up without their knowledge.
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Posing as Medicare representatives, unscrupulous agents use Part D to get a foot in the door -- or even into a whole senior high-rise building. Then they tout a slew of high-priced insurance policies, including annuities, life insurance, gap coverage for Medicare Advantage and other products that people may not need.
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Once they have personal information about their victims, some of these renegade agents steal their identities.
In other cases, regulators have uncovered fraud rings selling fake drug-discount cards and bogus coverage for home health care. It's a huge racket, says Paul Greenwood, head of the elder-abuse prosecution unit for the San Diego district attorney's office. "These crooks realize there's money to be taken from elderly victims looking for a way to save on health-care costs."
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Posted by healthinsurance at 08:11 PM | Comments (0)
March 06, 2008
California Senate Kills $15 Billion Health Insurance Plan
A California Senate committee has rejected Gov. Arnold Schwarzenegger's plan to provide government-controlled health insurance to millions more of California's citizens.
The January vote of the Senate Health Committee against the $14.9 billion plan came after nearly a year of tense negotiations between Schwarzenegger (R) and Assembly Speaker Fabian Nuñez (D). Last December the two announced a bipartisan compromise on a plan to add 3.6 million of California's five million citizens without health insurance to the rolls of the insured by 2010.
Called "an incredible plan" by Nuñez, the proposal--which would have appeared on the California ballot in November if lawmakers had approved it--included a mandate requiring nearly all Californians to buy private health insurance or enroll in a government program that would have been expanded to meet the additional demand.
Analysts called the plan unworkable, saying the revenue sources were too unsure and the mandate too difficult to enforce.
The committee voted 7-1 against the plan. Much of the opposition was based on the projected impact on the cash-strapped state's economy.
The estimated price tag had climbed from $14 billion at the time the plan was announced to $14.9 billion by the time of the committee vote. State budget officials are projecting a $14.5 billion overall budget deficit.
Tax Increases
The Health Care Security and Cost Reduction Act, Assembly Bill X1 1, was to receive funding from four sources: a $2.3 billion increase in the state hospital tax, a new payroll tax on businesses of 1 to 6.5 percent, an additional $1.50 to $2 per pack tax on cigarettes, and another $2.3 billion in funding from the federal government.
The measure also would have prohibited insurers from denying coverage to people because of existing medical ailments and would have required them to spend at least 85 percent of insurance premiums exclusively on medical care.
The plan was scheduled to move through California's state legislature in two parts.
The first, which laid out the changes and expansions being made to the state health care system, passed the General Assembly by a party-line vote at the end of 2007.
The second piece of legislation, dealing with program funding, was expected to take more time to pass than the first part because California requires a two-thirds majority vote to approve tax increases. Tax hikes therefore need bipartisan support.
Job Loss Fears
"The biggest problem for the state was the proposal to force employers to spend between 1 percent and 6.5 percent of payroll on health coverage," said Devon Herrick, a senior fellow at the National Center for Policy Analysis. "This tax on labor would have stalled job growth and increased costs on employers whose workers aren't willing to forgo sufficient cash wages to cover health benefits."
Stephen J. Entin, president of the Institute for Research on the Economics of Taxation, called the health plan "a tax on the poor, who smoke disproportionately, as well as on young workers and small businesses. Low-income workers would have been forced to use a large part of their limited compensation for insurance and taxes."
California Senate Health Committee Chair Sheila Kuehl (D-Santa Monica) said, "It doesn't matter how many good things are in the bill if there isn't money to pay for them."
State Sen. Leland Yee (D-San Francisco) concurred, saying, "Nothing that came out of [the committee] hearing gives me the comfort level that working people of California won't be left holding the bag."
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Posted by healthinsurance at 11:14 PM | Comments (0)
March 02, 2008
Insurance company: Doctors' Social Security numbers went on Web
A health insurance company in California has notified more than 100,000 doctors in Michigan and 10 other states that their personal information was posted on the Internet.
Health Net Federal Services spokeswoman Molly Tuttle says the doctors' Social Security numbers were accidentally posted on a Web site for about two months, beginning in November.
Tuttle says the company has no indication that anyone's doctor's personal information has been misused.
HNFS is a government contractor providing health insurance for nearly 3 million military families and veterans in 23 states.
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Posted by healthinsurance at 12:50 PM | Comments (0)
February 28, 2008
Bills aim at insurers after health care reform in California collapses
With health care reform dead in California - at least on the grand scale that Gov. Arnold Schwarzenegger envisioned - lawmakers are stepping in with a series of measures they say would help consumers and ban some egregious practices by insurance companies.
The bills fall far short of the governor's vision of sweeping reform, which collapsed last month under the weight of a nearly $15 billion price tag. And they would do little, if anything, to reduce the ranks of the roughly 6.5 million uninsured.
But short of that, supporters say the state can use its regulatory heft to aid consumers and possibly rein in rising health care costs. The measures, they say, would lay the groundwork for the next major reform push, possibly in 2010.
Lawmakers are "looking for an easy path to do something positive that won't cost money that the state doesn't have," said E. Richard Brown, director of the University of California-Los Angeles Center for Health Policy Research. The state has a projected budget shortfall of roughly $8 billion.
One bill is meant to help guide anyone trying to make sense of the dizzying combinations of deductibles, co-pays and premiums in choosing a health plan. The measure, SB 1522, sponsored by Sen. Darrell Steinberg, D-Sacramento, would simplify the process. Insurers would have to offer five "benchmark" plans, with easy-to-follow benefits and costs, so a person could make "apples-to-apples" comparisons from one insurance company to the next.
In a similar vein, Assemblyman Felipe Fuentes, D-Arleta, has a bill to help people measure what they're getting in return for hefty hospital and doctor bills. The bill, AB 2967, would create a "transparency" committee that would collect medical data to gauge the performance of hospitals and doctors treating certain illnesses, relative to what they charge.
At least three bills target a practice that's received widespread attention in recent months - insurance companies that retroactively cancel a patient's insurance coverage, often only after the person gets sick. Some insurers have defended so-called "rescissions" by claiming that patients lied about their health condition in their applications.
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Posted by healthinsurance at 02:41 PM | Comments (0)
February 26, 2008
California Health Plans Pay $65 Million to Improve Performance in Patient Care
Physician Groups Rewarded for Achieving Pay for Performance Measurements with Payments That Exceed Prior Year by More Than $10 Million.
Pay for performance (P4P) bonus payouts from health plans to California physician groups to reward quality of patient care totaled $65 million in 2007, according to the Integrated Healthcare Association (IHA). The payments were distributed during the third and fourth quarters of 2007 based upon the 2006 performance of physician groups serving HMO members. Aetna, Blue Cross of California, Blue Shield of California, CIGNA HealthCare, Health Net, PacifiCare, and Western Health Advantage participated in the performance payments with each health plan determining its own budget and methodology for calculating bonus payments to the physician groups.
These health plans have distributed over $210 million in payments to physician groups as a result of meeting P4P quality measures in the first four years of the program. The total financial payout equates to about 2 percent of the overall reimbursement to physician groups annually. Payments to individual groups vary from no payments to payments equaling up to 5 percent of overall reimbursement based upon performance.
Payments are typically paid on how well a physician group performs versus its peers, but emphasis is also placed on groups that show significant improvement over prior years. Participating health plans have been encouraged to allocate 20 percent of 2008 bonus payments for physician groups that make the most significant improvements.
Another incentive to promote improved physician group performance involves public reporting of results. Annually the results for each performance measure are reported by physician group on a website managed by the California Office of the Patient Advocate (OPA).
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Posted by healthinsurance at 09:50 PM | Comments (0)
February 24, 2008
Blue Cross of California Responds to Recent Media Coverage of Rescission
-- Blue Cross of California is committed to being the industry leader when it comes to protecting those seeking health insurance. That's why in September of 2006, Blue Cross was the first health care insurer in California to implement a series of steps to strengthen and make more transparent our process for rescinding policies in order to further minimize the possibility of errors.
These initiatives included:
-- Creating a new simplified application for individual benefits policies
-- Revising policies to clarify the initial underwriting process
-- Forming a new committee structure for the rescission review process
-- Adding dedicated liaisons for members undergoing retrospective review
or who have had their policies rescinded
-- Revising documentation to improve the accuracy and consistency of
review processes
-- Enhancing training programs for the underwriting and the retrospective
review process
In addition to these steps, for the past several weeks Blue Cross of California has been in the process of developing an outside third-party review process for all rescission cases. This means an independent, outside agent will help us validate whether rescission of a member's benefits is warranted. Blue Cross will be bound by the decision of the third-party reviewer. As the market leader in California, this practice is intended to further our efforts to protect all health care consumers.
Rescission, a tool designed to protect the system from abuse, affects a very small percentage of new enrollments -- roughly one-half of one-percent out of 300,000 new applicants a year. Blue Cross takes the issue of rescission very seriously, and we are leading the industry in working with legislators, regulators, providers and our members to help improve the access to health care for all Californians.
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Posted by healthinsurance at 07:00 PM | Comments (0)
February 23, 2008
California act to protect individual health insurance coverage
Lawmakers in several states are limiting insurers' ability to cancel health policies for consumers who buy their own coverage.
The state actions come as more people buy individual insurance policies because they are self-employed, unemployed or don't get coverage at work. More than 18 million people have individual coverage.
Unlike group health insurance policies offered by employers, individual plans require applicants to submit many years' worth of detailed medical information. The insurers use that information in deciding whether to offer coverage and how much to charge.
Most states allow insurers to revoke an individual policy — generally within two years of granting it — if they find an applicant lied or inadvertently omitted information on an application.
Cancellation of a policy is retroactive. Patients must pay for all their past medical care, even if the insurer previously approved and paid for the care. There is little nationwide data on the extent of cancellations. Blue Cross of California has said it cancels fewer than one-half of 1% of all new policies, an average of 1,000 a year.
Prompted by numerous consumer complaints and lawsuits against insurers, state lawmakers are taking action. Among their efforts:
•New Mexico. The Legislature this month passed bills requiring insurers to show that applicants deliberately gave incorrect information on an application. Current law allows cancellation if the error or omission was inadvertent. The governor has not said whether he will sign the bills, says spokeswoman Caitlin Kelleher. Without the law, "the consumer has no ability to defend" against a cancellation, says Melinda Silver, attorney with the state's Managed Health Care Bureau.
•Connecticut. In October, a new law took effect requiring approval from the state insurance commissioner before an insurer can cancel an existing policy.
•California. Legislation introduced last week would require insurers who want to cancel a policy to first win approval from the state's Department of Managed Health Care. Last year, legislators adopted a law requiring insurers to pay for any medical treatment they approve, even if they later cancel the policy.
California state regulators have announced cancellation-related fines against some insurers, including Blue Cross, Kaiser Permanente and Blue Shield of California.
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Posted by healthinsurance at 06:37 PM | Comments (0)
February 21, 2008
Los Angeles Launches Action Against California Health Insurer
The Los Angeles city attorney launched a wide-ranging legal action on Thursday against one of California’s biggest health insurance providers, accusing it of illegally selling policies to customers and then denying them coverage when they fell ill.
The action is being launched as health insurers face closer scrutiny from US regulators and legislators. Health insurance has become one of the dominant themes of the presidential election, with Democratic challengers Hillary Clinton and Barack Obama promising to reform what they contend is a broken system.
Rocky Delgadillo, the Los Angeles city attorney, accused Health Net of defrauding customers by setting illegal policy cancellation targets for its sales agents, who rarely possessed any medical training.
Mr Delgadillo said 1,600 Health Net customers had policies cancelled illegally. Damages of $2,500 (€1,700, £1,275) per customer are being sought. But the final damages tally could be much higher as Health Net is also held responsible for illegally advertising its products to thousands more customers.
The company is accused of “unlawful, unfair and fraudulent business acts and practices and deceptive advertising”. In addition, Mr Delgadillo said the company created a “secret unit” responsible for cancelling policies.
More than $35m of claims for medical treatment had been denied, he said, adding that customers were often in a vulnerable position when they discovered they were not covered with health insurance. “Just imagine . . . you’re in a hospital bed awaiting treatment and you find that Health Net will not provide the coverage you have paid for,” he said.
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Posted by healthinsurance at 02:37 PM | Comments (0)
February 19, 2008
Candidates' health plans duck some key questions
Democratic presidential candidates Hillary Clinton and Barack Obama are sparring over which of them is more electable, whether change is better than experience, and how the party's "super delegates" should vote.
What they are not doing as much of is debating issues. That's because on most policy matters, beyond the backward-looking debate over invading Iraq, there's little daylight between them.
The notable exception is health care. Both candidates say they favor universal coverage, a worthy goal in a country where 44 million people are uninsured. Their big difference is whether uncovered individuals should be required to buy health insurance. Clinton says yes, that anything less is unsatisfactory. Obama would require only that all children be covered. Adults will buy health insurance, he says, if given incentives, a questionable assertion.
Clinton's broader mandate (with government subsidies for the poor) would get the nation closer to the goal of universal health care coverage and would spread the cost over a larger pool of individuals, both good objectives. Further, it would do more to reduce the hidden tax on insured people, estimated at more than $1,000 a family, to pay for the health care of those who don't have insurance and show up at hospital emergency rooms.
But for voters, this narrow policy difference provides little basis for a judgment. That is because both plans are sketchy and incomplete, making the mandate on individual coverage kind of like a loose piece on a giant puzzle. Without seeing how it would fit with all the other pieces, it is difficult to make an informed decision.
Both Democrats' health care plans are more ambitious than that of presumptive Republican presidential nominee John McCain, who proposes much more modest adjustments to the health care system, centered on tax changes to encourage consumers to take a more active role in choosing, and paying for, their health coverage. Even so, Clinton and Obama are heavy on promises about making insurance affordable and available, and light on the more painful details. Neither says, for example, how he or she would enforce the individual mandates (Clinton's for everyone, Obama's just for those 18 and under). Would they garnish people's wages? Deny them access to health care? Shrug and look the other way?
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Posted by healthinsurance at 11:20 AM | Comments (0)
February 17, 2008
Bill Targets California Health Insurance Cancellations
Spurred by complaints that Blue Cross of California and other health insurers cancel patients' policies after they get sick, a Southland lawmaker has introduced legislation that would require state regulators to sign off before carriers drop policyholders for allegedly failing to disclose preexisting medical conditions.
Assemblyman Hector De La Torre (D-South Gate) said his bill was prompted by recent letters from Blue Cross to physicians asking them about new patients' health issues that could be used as a reason for canceling insurance coverage.
De La Torre said his bill was needed because insurance companies "were not intending to abide by the spirit" of a law he wrote last year prohibiting carriers from refusing to pay medical bills for previously authorized services.
"We all agree that if someone is lying and doing willful misrepresentation, then they should not be insured," the assemblyman said. "But the insurance companies should not be taking premium dollars from someone and dumping them."
Health insurance companies contend that weeding out people who may not have been forthright when they applied for coverage is an essential part of keeping treatment costs under control.
"We need to make sure that the process for application, rescission and cancellation is fair," said Christopher Ohman, chief executive of the California Assn. of Health Plans. "But we also want to make sure that the millions of people who do the right thing aren't left paying for the relatively few who don't."
Ohman's association represents 40 health maintenance organizations and preferred provider organizations covering 21 million enrollees in California.
Ohman said his group's members were "analyzing the implications" of De La Torre's bill.
The assemblyman's bill is the latest in a series of legislative, regulatory and legal actions in California in response to aggressive efforts by insurers and health maintenance organizations to drop patients who hold individual policies after they've filed claims.
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Posted by healthinsurance at 06:41 PM | Comments (0)
February 14, 2008
Study shows Latinos willing to pay for cross-border California health insurance
Research out of UC Berkeley points to cross-border health insurance as a way to expand health coverage to Mexican immigrants living in the United States, and a county health staffer plans to learn more about it.
The study, by Arturo Vargas Bustamante, a doctoral candidate at UC Berkeley, found:
• 62 percent of Mexican immigrants surveyed said they would support a cross-border insurance plan.
• 57 percent said they'd pay $75-$125 per month if services in Mexico were provided in public hospitals.
• Mexican immigrants in the U.S. sent $20 billion to their relatives back home in 2005, primarily to help cover family health care expenses.
• Those who sent money for family health care expenses strongly supported cross-border insurance.
The study was released as the Pew Research Center unveiled projections that Latino population in America would more than double from 14 percent in 2005 to 29 percent by 2050.
"The Mexican-born population in the U.S. has the lowest share of health insurance coverage than any other foreign-born group," said Gil Ojeda, director of UC Berkeley's California Program on Access to Care and Health Initiative of the Americas, which co-funded the study.
California is the only state to offer cross-border health insurance.
About 50,000 Mexican immigrants living between Los Angeles and San Diego are enrolled, a small percentage of the estimated 11 million Mexican immigrants who live or work in the U.S.
Carmen Robles, a senior health analyst for Santa Cruz County, said she plans to attend a conference Feb. 28-29 in Berkeley where the cross-border approach will be discussed.
Dr. Jose Chibras of Salud Para la Gente, which treats many Latino families in Watsonville, said he was not familiar with the existing cross-border health insurance program. He had a lot of questions.
"Who's going to pay for it?" he asked. "What would the reimbursements be for the physicians? What does it cover? What could a person actually get for that amount of money? Are the patients able to afford $150 a month? That is a lot of money to put out, $1,500-$1,600 a year. And who would be eligible?"
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Posted by healthinsurance at 08:23 PM | Comments (0)
February 13, 2008
California Health-care solution
Since many conservative politicians oppose universal health care because they feel it takes away patients’ right to choose where to get their health insurance, wouldn’t it make sense for the government to adopt a system that promotes public-private competition?
In his book The Conscience of a Liberal, Paul Krugman, opinion columnist for The New York Times and economic teacher at Princeton University, advocates for a health-care system that gives people the choice to either buy into a Medicare-type government insurance plan or stick with their private insurance companies.
Wouldn’t this be a logical compromise that could be made between conservatives and liberals?
It would provide health care to all Americans without taking away a person’s right to choose where to get their health insurance.
Health care reform plans similar to the one envisioned by Krugman have been proposed at the national level by Sen. Barack Obama and at the state level by California Gov. Arnold Schwarzenegger.
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Posted by healthinsurance at 07:19 PM | Comments (0)
February 12, 2008
New Study on Individual California Health Insurance Mandates
Behind the escalating debate on the health care between Senators Hillary Clinton and Barack Obama on individual mandate – she’s for it, he’s against it – is a critical policy battle that not only cuts across healthcare reform but also the neo-liberal privatization dreams, the home mortgage crisis, and the recession that is no longer looming, it’s here.
Sound farfetched? Take a closer look, starting with the millions of Americans staring at the loss of their homes due to the subprime loan debacle. It’s not a loan or a mortgage crisis for those families; it’s a debt crisis being forced upon them by the banks, hedge funds, and some California insurers who are desperate to shift their own mammoth debt onto someone else.
Banking, other financial institutions, insurance and real estate which make up the finance sector, now account for about half of U.S. corporate profits. And, they are in trouble with more than $2.5 trillion in outstanding consumer credit, $800 billion of that in credit card debt, and another $10.1 trillion in domestic mortgage debt.
Being thrifty won’t solve that problem. The financial planners have identified two lucrative pots of money. Trading carbon credits for industries and employers that want to brand themselves as green while continuing to pollute. And, making a killing in healthcare premiums, currently 16 percent of our national economic pie and rapidly growing.
The banks are already into healthcare in a big way, serving as a repository for health savings accounts and other tax credit schemes so beloved by the Bush administration and the Republican presidential candidates. But the financiers would like more.
Enter the neo-liberal think tanks and policy wonks and plans they hawk to expand the reach of the market, especially the financial market, in health care. Central to that approach is shotgun insurance, forcing everyone not currently covered to buy health insurance policies.
Compelling people to buy insurance, however, is not the easiest sell. Big insurers and HMOs have a well deserved bad reputation for heartless denials of care – that’s how they make money. And, it’s pricey. Premiums the past decade have gone up 87 percent, not to mention the ever climbing bills for insurance deductibles, co-pays, and a host of other transaction fees.
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Posted by healthinsurance at 02:08 PM | Comments (0)
February 11, 2008
Challenges Loom for Childrens' Health Insurance in California
Since President Bush did not renew the State Children's Health Insurance Program, or S-CHIP, California is grappling with the future of its version of the program that covers more than 900,000 kids. But many people don't realize the other looming challenge of getting health insurance for low-income children. From Sacramento Kelley Weiss explains.
This time California health officials are bracing for a federal law that will take effect in August. The law will cut back how much money a family can make to qualify. Bonnie Ferreira is with Cover the Kids. Her program, based in Sacramento, picks up children who don't qualify for Medicaid or Health Families, the state version of SCHIP. Right now there are 10,000 enrolled in Cover the Kids. Ferreira says she's worried that the new law will further strain the health care system.
Ferreira: Our local communities cannot afford to have all these kids uninsured. Where do they show up? They show up in high cost care, they show up in emergency rooms.
Dr. Patricia Samuelson works at the Norwood Clinic in Sacramento. In her practice, she sees a lot of kids without health insurance. She says the national veto and upcoming law could affect more than emergency rooms.
Samuelson: When your children don't have any medical insurance there are parents who don't let them play, don't let them ride their bikes for fear of injury.
But, some health officials say it could be worse.
Spingarn: I don't think anyone really believes at this point that there's going to be no federal funds and no state funds for this program in the future.
That's Ronald Spingarn with California's Managed Risk Medical Insurance Board that oversees Healthy Families. The good news, he says, is even with the national uncertainties California plans to add more than 65,000 kids to the program.
He also says the feds will give California money until September. But, from September to March 2009, when SCHIP is slated to end, he says there are no funding guarantees. So, while there are different predictions on just how SCHIP changes will impact California, officials agree it's a 'wait and see' scenario.
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Posted by healthinsurance at 12:51 PM | Comments (0)
February 09, 2008
Growing Pains of Universal Coverage for Californians
It has not been a good few weeks for state efforts to provide universal health insurance. A pioneering program in Massachusetts to cover hundreds of thousands of uninsured has cost a lot more in its opening phases than originally projected, raising fears about its sustainability. An even more ambitious proposal to cover millions of uninsured in California collapsed in the State Senate over fears that it would prove unaffordable.
Neither setback means that states should stop trying to cover the uninsured — especially since the federal government is AWOL. The problems do suggest that officials need to make the most realistic possible cost estimates and be prepared to provide resources to subsidize coverage for those who can’t afford it.
The Massachusetts plan was the result of compromises between a former Republican governor — Mitt Romney, who lost his enthusiasm just in time for the presidential primaries — and a Democratic Legislature. It required all residents to buy health insurance or suffer financial penalties, subsidized those unable to afford it, imposed a small fee on businesses that failed to provide employee coverage and set up a marketplace where people can buy portable insurance with pretax dollars.
The financial problems are mostly because of underestimating the number of uninsured and the rate at which they would sign up for subsidized coverage. As a result, the state, which had originally expected to spend $472 million on subsidized insurance this fiscal year, now expects to spend about $150 million more than that. It anticipates spending almost $870 million next year.
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Posted by healthinsurance at 07:20 PM | Comments (0)
February 07, 2008
Schwarzenegger vows to pursue health insurance
California Gov. Arnold Schwarzenegger on Tuesday vowed to press on with legislation to provide health insurance to his state's uninsured, a day after a universal health care bill he backed died in a Senate committee.
"I'm as determined as ever," Schwarzenegger said.
Lawmakers who voted against the bill missed a golden opportunity for California to demonstrate to the rest of the United States how to establish a universal health care system, Schwarzenegger said in a speech to the press club of the state capital of Sacramento.
"The issue is not going to go away," he said.
The Republican governor and Assembly Speaker Fabian Nunez had brokered a bill that would have provided Californians without medical insurance some level of coverage by requiring they obtain it individually or through employers or a state program.
The Democrat-led Assembly had endorsed the legislation but on Monday the health committee of the Democrat-led Senate voted it down 7-1.
Top Democrats in the Senate had joined with the chamber's minority Republicans in opposition to the legislation's complexity and projected cost, expected to be more than $14 billion to help establish a fund to subsidize medical insurance for more than 5 million uninsured Californians.
The fund would have relied on tobacco taxes and fees on employers and hospitals. Opposition to the bill grew after a report last week by the state's budget watchdog warned the insurance scheme could cost the already cash-strapped state much more than supporters claimed.
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Posted by healthinsurance at 08:27 PM | Comments (0)