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October 29, 2007

California Agencies Release Proposed Regulations To Prevent Improper Cancellations Of Health Insurance Policies

The California Department of Managed Health Care and Department of Insurance on Tuesday proposed new regulations intended to prevent insurers from improperly canceling individual health insurance policies, the Sacramento Bee reports (Chan, Sacramento Bee, 10/24). The agencies said the new rules reinforce existing laws prohibiting insurers from rescinding coverage unless they can prove policyholders intentionally omitted information or lied on a medical questionnaire (Girion, Los Angeles Times, 10/24).

Under the proposed regulations, advance notice would be required before any policy cancellations; coverage could not be suspended during an investigation of a policyholder; coverage could not be canceled for an entire group if only one person is responsible for submitting false information on a medical questionnaire; and the DMHC director could review policy cancellations (Sacramento Bee, 10/24). In addition, insurers would be required to simplify their applications to avoid confusing questions about medical history (Colliver, San Francisco Chronicle, 10/24).

The proposal will be reviewed during a public hearing sometime after mid-November (Sacramento Bee, 10/24). DMHC has fined Blue Cross of California and Kaiser Permanente for improper cancellations, and the agency is continuing investigations of Blue Shield of California, Health Net, Kaiser Permanente and PacifiCare (San Francisco Chronicle, 10/24).

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Posted by healthinsurance at 02:04 PM | Comments (0)

October 21, 2007

State Watch | California Health Care Reform Debate 'Divisive,' USA Today Reports

A proposal by California Gov. Arnold Schwarzenegger (R) that would require all state residents to obtain health insurance has become "increasingly divisive, possibly jeopardizing major health legislation this year and highlighting the difficulties other state or national reform efforts might face," USA Today reports (Appleby, USA Today, 10/17). Schwarzenegger last week introduced a revised $14 billion proposal that would require all state residents to obtain health insurance, through employers, the individual coverage market or public programs.

Under the proposal, the state would subsidize health insurance for individuals with annual incomes less than $25,525 and for families with annual incomes less than $51,625. Lower-income state residents who do not qualify for the subsidies but whose health insurance costs exceed 5% of their household incomes would receive a tax credit. Schwarzenegger said that he would finance the proposal in part through the lease of the state lottery program to a private company (Kaiser Daily Health Policy Report, 10/16).

On Friday, Schwarzenegger vetoed a bill (AB 8) proposed by state Democratic lawmakers that would have required employers to contribute as much as 7.5% of their payroll to cover the cost of health insurance for employees or pay into a state fund that would provide coverage. The legislation would not have required all state residents to obtain health insurance (Kaiser Daily Health Policy Report, 10/15).

Debate Details:

Enactment of the Schwarzenegger proposal would make California the second state after Massachusetts to require residents to obtain health insurance. However, "unlike Massachusetts, where a broad coalition of interest groups won a hard-fought battle for consensus, California lawmakers, the governor, consumer groups and labor unions have not agreed on two key issues: how much employers must pay if they don't offer health insurance to workers; and how much individuals should pay to buy their own coverage," USA Today reports.

Adam Mendelsohn, communications director for Schwarzenegger, said, "Everyone is very disappointed that labor unions have decided to poison the health care debate," adding, "No one is clear why labor unions have gone from sitting at the table and having an honest debate to opposition."

Betsy Imholz, special projects director for Consumers Union, said that the group has concerns about whether the Schwarzenegger proposal is "sustainable for the long term with a low employer contribution." Art Pulaski, head of the California Labor Federation, said, "The governor's proposal says that if you make more than 350% of poverty (about $35,735), there is no support for you whatsoever" (USA Today, 10/17).

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Posted by healthinsurance at 09:12 PM | Comments (0)

October 18, 2007

California health reform gets sticky

Health reform efforts in California have become increasingly divisive, possibly jeopardizing major health legislation this year and highlighting the difficulties other state or national reform efforts may face.

Launched in January by Republican Gov. Arnold Schwarzenegger, the state's efforts aimed to be a model for others contemplating how to cut the number of uninsured. If the governor's plan is adopted, it would be the second state, after Massachusetts, to require all individuals to have health insurance.

But, unlike Massachusetts, where a broad coalition of interest groups won a hard-fought battle for consensus, California lawmakers, the governor, consumer groups and labor unions have not agreed on two key issues: how much employers must pay if they don't offer health insurance to workers; and how much individuals should pay to buy their own coverage.

Last week, Schwarzenegger vetoed a Democratic plan he said didn't go far enough toward covering all the state's estimated 4.8 million uninsured, partly because it did not require individuals to buy insurance.

In response to the expected veto, a coalition of consumer and labor groups said the governor's plan, which did not receive any sponsors in the Democrat-controlled legislature, doesn't do enough to help people who earn too much to qualify for his proposed low-income subsidies. They don't favor a requirement that individuals buy insurance without more cost control and affordability requirements, such as a 5% cap on how much of an individual's income must be paid toward insurance premiums.

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Posted by healthinsurance at 03:22 PM | Comments (0)

October 16, 2007

California voters would support tax to fund health insurance

A slim majority of California voters would support a one-cent sales tax increase to help fund health insurance, according to a survey by the Survey and Policy Research Institute at San Jose State University.

That might bode well for Gov. Arnold Schwarzenegger - if he decides to ask voters for such an increase to help pay for universal health care.

It's no secret that such a move was being considered - pushed by the California Restaurant Association and the California Small Business Association - but it appears the governor has decided instead to try and lease the state lottery and use money from that to help pay for his plan.

The survey showed that 52 percent of voters would approve, while 38 percent would vote against it.

The restaurant and small business associations like the sales tax proposal as a way to protect employers from payroll taxes, which will almost certainly be included in any proposal to provide universal health care.

The poll also showed that a majority of voters - 51 percent - would go along with a ballot measure that seeks to loosen term limits. But that's probably because the emphasis in the ballot summary is on shortening the amount of overall time a lawmaker can spend in office from 14 years to 12 years.

What's more difficult to explain is that the measure actually increases the overall time many lawmakers would spend in office, by allowing them to serve longer in either the Assembly or the Senate.

Perhaps the best evidence that voters believe the measure will reduce time in office is that it is supported most strongly by Republicans - 54 percent, compared to 49 percent of Democrats. Republicans traditionally advocate for limiting terms.

But the support for the measure also is slipping - across all party lines - down from 56 percent approval in a previous San Jose State poll.

The institute polled a random sample of 652 California adults Oct. 1-8 by telephone. Interviews were conducted in English and Spanish. The margin of error was plus or minus 4.9 percentage points among voters.

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Posted by healthinsurance at 12:31 AM | Comments (0)

October 14, 2007

Children only get about half the recommended treatment for common medical problems such as asthma and obesity, potentially leading them toward an unhealthy adulthood, researchers have found in the largest and most comprehensive study of its kind.

The problems with poor-quality health care for children holds true even when they have good health insurance, according to the study to be published Thursday in New England Journal of Medicine.

Babies aren't getting regular height and weight checks to make sure they're growing properly. Toddlers don't get all their recommended immunizations. Schoolchildren aren't getting all medication they need to control chronic asthma. Teenagers aren't screened for chlamydia, a common sexually transmitted disease.

"That almost all of the kids in the study had health insurance yet still failed to get good care is pretty disturbing," said lead author and pediatrician Dr. Rita Mangione-Smith of the University of Washington-Seattle. "This study shows that health care quality for kids is an issue in itself; it's not just about health coverage."

The study comes at a politically fraught time for children's health, as Congressional Democratic leaders work to overturn President Bush's recent veto of a major expansion of SCHIP, a popular national children's health insurance program. Without compromise legislation, the entire program, which insures 4 million children, could shut down in November. The expansion also included new provisions for monitoring and improving health care quality, Mangione-Smith said.

With parents' permission, the researchers reviewed medical records for more than 1,500 children randomly selected from 12 urban areas who would, in theory, have good access to doctors and hospitals. Nearly all the children had some form of health insurance, and 82 percent of the insured children had private health coverage. They tended to be less diverse than children in the general population, researchers noted.

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Posted by healthinsurance at 04:46 PM | Comments (0)

October 12, 2007

Governor Schwarzenegger's Health Insurance Plan 2.0

ne of the things I've learned through the years as a negotiator is that regressive bargaining, besides being illegal in many cases, will always come back to bite you. That assumes, of course, that you have built up some trust with your adversary and can be depended on to at least honestly try to reach agreement. When regressive bargaining begins, the ability to reach an agreement is severely compromised and trust is on vacation.

Unfortunately, regressive bargaining is what I see from Governor Schwarzenegger on health care. He has "introduced" Health Insurance Plan 2.0, but instead of being better than the previous version 1.0, it takes at least a small step backward, though Art Pulaski of the California Labor Federation calls version 2.0 "an enormous step backward."

For instance; under the first plan employers would be required to contribute 4% towards employee health care, far short of the 7.5% that Democrats want. In the new plan Schwarzenegger moved backward, allowing employers to pay on a sliding scale, ranging from nothing to 4%, letting some employers off the hook. What happened to "shared responsibility?"

The individual share just got bigger. Everyone will still be required to "obtain" coverage, but the plan doesn't adequately protect middle-class individuals who may not be able to afford high premiums. "Middle-class families would be left on their own to figure out how to pay thousands of dollars in deductibles, premiums, co-pays, prescriptions and other out-of-pocket expenses," Pulaski said. Some may not see this as a step backward, but it sure isn't moving forward.

Doctors are taken off the hook for their 2%. This isn't necessarily a negative, though it had little opposition, even from doctors, but is a step backward from Health Insurance 1.0. To make up for lost revenue Schwarzenegger wants to lease the state lottery.

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Posted by healthinsurance at 03:49 PM | Comments (0)

October 07, 2007

President Bush is sending signals that he won't back down from his veto of the children's health insurance program. But Health Secretary Mike Leavitt said Sunday the president is willing to go above the extra $5 billion he pledged to the program.

Despite the $5 billion increase, the program would actually cover fewer children because of rising health care costs.

The bill President Bush vetoed last week would have increased funding to the program by $35 billion, mainly by increasing the tax on cigarettes.

The president called it a path to socialized medicine and he doesn't like the increased tax.

California is one of 8 states now suing the Bush Administration, claiming the President's proposal means 800 California kids will lose their insurance every day.

Thousands of kids in the valley are already without insurance. Now the Fresno County Board of Supervisors will vote on a resolution encouraging valley Congress Members to override the President's veto.

The resolution would only be symbolic, but supervisor Henry Perea says it would be a powerful message. Other supervisors say they're still undecided about the resolution, but at least one says the county shouldn't get involved in the Federal Government's business.

Democrats say they'll take the next couple weeks to convince some Republicans to switch their votes before they take an official vote to override the veto.

The valley's Congress Members were split on the health insurance bill. Democrat Jim Costa co-sponsored the bill and voted yes, as did Democrat Dennis Cardoza.

But Republicans George Radanovich and Devin Nunes voted against it.

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Posted by healthinsurance at 10:12 PM | Comments (0)

October 01, 2007

To reform the health care system

Responding to Americans' desire for health care reform, a near-desperate desire in some quarters, almost all of the presidential candidates have put forth a plan to increase access to medical insurance. The resulting options range from market-based solutions to national health insurance. The most intriguing proposals, and possibly the most pragmatic, would build on the successes of the private health insurance market and mend the cracks of its failures.

All eyes are on Hillary Clinton's plan, which John Edwards' campaign claims is nearly identical to its own. These plans and several state reform efforts hinge upon requiring individuals to purchase health insurance. In the case of Clinton's plan this is coupled with a mandate to insurers to offer insurance to all who apply, regardless of health status or other qualifiers.

It is a clever plan. If realized, it would accomplish a return to an insurance market that does not discriminate by age, health status or other factors. By definition, it would eliminate the problem of the 47 million uninsured Americans.

Its implementation depends upon a realistic method for making the premiums affordable for the uninsured, most of whom certainly can't pay the going rate, which the Kaiser Family Foundation sets at $12,000 a year for a family of four. The Clinton plan promises people tax credits tied to a premium guaranteed not to exceed an "affordable" percentage of their incomes.

A reform so monumental will require the buy-in of both parties. The focus on private insurance reform raises interesting issues on both sides of the aisle. Conservatives are less likely to balk at a plan that maintains the choice and flexibility of the private market but will be less enthusiastic about the federal involvement in financing the purchase. Liberals will appreciate the progressive tax credits to subsidize the purchase, but will question the public-private venture. Libertarians will chafe at the requirement that individuals purchase insurance. There is a push-pull phenomenon at work in the plan's mechanism.

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Posted by healthinsurance at 11:40 AM | Comments (0)