Health Care 2013: April 2013

Friday, April 12, 2013

Wait For Obamacare Price Tags Could Last Months

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Wednesday, April 10, 2013

The FY2014 Budget: Strengthening Health and Opportunity for all Americans

Today, the President released a budget that strengthens the middle class, creates jobs and reduces the deficit in a balanced way. �The budget for the Department of Health and Human Services (HHS) provides critical investments in health care, disease prevention, social services and scientific research to create healthier and safer families, stronger communities and a thriving America.�

First, our budget makes sure we can continue to implement the Affordable Care Act to give more Americans the security of affordable health coverage.� The health care law is already making a huge difference in Americans� lives, and more options for health insurance coverage are just around the corner.� Open enrollment for the new Health Insurance Marketplaces begins on October 1st of this year, and coverage will start on January 1, 2014.� This budget supports investments in the Health Insurance Marketplace and will ensure Americans in every state have somewhere they can go to get quality health insurance to fit their budget.

We�re also proposing a major new investment in programs to help identify mental health concerns early, improve access to mental health services and support safer school environments.�While we know that the vast majority of Americans who struggle with mental illness are not violent, recent tragedies have reminded us of the staggering toll that untreated mental illness takes on our society.�

Today�s budget supports the President�s call to provide every American child with access to high quality early learning services, so that our children gain the skills they need to do the jobs of tomorrow.� And it helps make America a magnet for jobs by securing America�s place as the world leader in science and technology, and supporting the groundbreaking research that will generate the treatments, vaccines, and cures of tomorrow.� The significant new investments this budget contains for the NIH reflect our commitment to furthering the biomedical research that will help create good new jobs and advance the cause of medical science.� That work will include projects like the human brain mapping initiative the President announced earlier this month

At the same time, the budget contributes to the President�s balanced plan to significantly reduce the deficit in the long term.� Due in part to the successful implementation of the Affordable Care Act, Medicare spending per beneficiary grew at a historically low rate of 0.4% in 2012.� The President's 2014 budget would achieve even more savings.� In total, the budget would build on the Affordable Care Act by generating an additional $370 billion in Medicare savings over the next decade, reducing the deficit and putting Medicare on sounder financial footing.

The FY 2014 Budget reflects our efforts to make cutting fraud, waste and abuse a top Administration priority.� We�re proposing an increase in mandatory funding for our Health Care Fraud and Abuse Control program�an initiative that last year saved the taxpayers nearly eight dollars for every dollar spent on it.� And we�re investing in additional efforts, including reducing improper Medicare, Medicaid, and CHIP payments, enhancing the investigative efforts of our Office of Inspector General.

What this all adds up to is a budget that will help HHS to pursue this Administration�s North Star of a thriving middle class.� It�s a budget that promotes job growth and bolsters the programs and investments American families count on to live healthy lives.� And it will keep our economy strong in the years to come, while also helping to bring down the deficit.

Sweeping Anti-Abortion Bill Expected To Become Kan. Law

Kansas legislators gave final passage to a sweeping anti-abortion measure Friday night, sending Gov. Sam Brownback a bill that declares life begins "at fertilization" while blocking tax breaks for abortion providers and banning abortions performed solely because of the baby's sex.

The House voted 90-30 for a compromise version of the bill reconciling differences between the two chambers, only hours after the Senate approved it, 28-10. The Republican governor is a strong abortion opponent, and supporters of the measure expect him to sign it into law so that the new restrictions take effect July 1.

In addition to the bans on tax breaks and sex-selection abortions, the bill prohibits abortion providers from being involved in public school sex education classes and spells out in more detail what information doctors must provide to patients seeking abortions.

The measure's language that life begins "at fertilization" had some abortion-rights supporters worrying that it could be used to legally harass providers. Abortion opponents call it a statement of principle and not an outright ban on terminating pregnancies.

"The human is a magnificent piece of work at all stages of development, wondrous in every regard, from the microscopic until full development," said Sen. Steve Fitzgerald, a Leavenworth Republican who supported the bill.

Abortion opponents argue the full measure lessens the state's entanglement with terminating pregnancies, but abortion-rights advocates say it threatens access to abortion services.

The declaration that life begins at fertilization is embodied in "personhood" measures in other states. Such measures are aimed at revising their constitutions to ban all abortions, and none have been enacted, though North Dakota voters will have one on the ballot in 2014.

But Kansas lawmakers aren't trying to change the state constitution, and the measure notes that any rights suggested by the language are limited by decisions of the U.S. Supreme Court. It declared in its historic Roe v. Wade decision in 1973 that women have a right to obtain abortions in some circumstances, and has upheld that decision while allowing increasing restrictions by states.

Thirteen states, including Missouri, have such language in their laws, according to the National Right to Life Committee.

Sen. David Haley, a Kansas Democrat who opposed the bill, zeroed in on the statement, saying that supporters of the bill were pursuing a "Taliban-esque" course of letting religious views dictate policy limiting women's ability to make decisions about health care and whether they'll have children.

And in the House, Rep. John Wilson, a Lawrence Democrat, complained that the bill was "about politics, not medicine."

"It's the very definition of government intrusion in a woman's personal medical decisions," he said.

Brownback has signed multiple anti-abortion measures into law, and the number of pregnancies terminated in the state has declined 11 percent since he took office in January 2011.

The governor said he still has to review this year's bill thoroughly but added, "I am pro-life."

This year's legislation is less restrictive than a new North Dakota law that bans abortions as early as the sixth week of pregnancy and a new Arkansas law prohibiting most abortions after the 12th week. But many abortion opponents still see it as a significant step.

"There is a clear statement from Kansas with respect to the judgment on the inherent value of human life," said Senate Public Health and Welfare Committee Chairwoman Mary Pilcher-Cook, a Shawnee Republican and leading advocate for the measure.

The bill passed despite any solid data on how many sex-selection abortions are performed in Kansas. A 2008 study by two Columbia University economists suggested the practice of aborting female fetuses � widespread in some nations where parents traditionally prefer sons � is done in the U.S. on a limited basis.

But legislators on both sides of the issue said the practice should be banned, however frequent it is.

The bill also would require physicians to give women information that addresses breast cancer as a potential risk of abortion. Advocates on both sides acknowledge there's medical evidence that carrying a fetus to term can lower a woman's risk for breast cancer, but doctors convened by the National Cancer Institute a decade ago concluded that abortion does not raise the risk for developing the disease.

The provisions dealing with tax breaks are designed to prevent the state from subsidizing abortions, even indirectly. For example, health care providers don't have the pay the state sales tax on items they purchase, but the bill would deny that break to abortion providers. Also, a woman could not include abortion costs if she deducts medical expenses on her income taxes.

"Every taxpayer will be able to know with certainty that their money is not being used for abortion," Pilcher-Cook said.

But Jordan Goldberg, state advocacy counsel for the New York City-based Center for Reproductive Rights, called the tax provisions "appalling and discriminatory."

"It's probably, if not definitely unconstitutional, and it's incredibly mean-spirited," she said.

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The anti-abortion legislation is HB 2253.

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Associated Press Writer Maria Fisher in Kansas City, Mo., also contributed to this report. Follow John Hanna on Twitter at www.twitter.com/apjdhanna

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Wednesday, April 3, 2013

Insurers see way to dodge federal healthcare law next year

A little-known loophole in President Obama’s landmark legislation enables health insurers to extend existing policies for nearly all of 2014.

A new fight is brewing over health insurance companies letting millions of Americans renew their current coverage for another year � and thereby avoid changes under the federal healthcare law.

That may offer a short-term benefit for certain consumers and shield some of those individual policyholders from potentially steep rate increases. But critics say this maneuver could undermine government efforts to remake the insurance market next year and keep premiums affordable overall.

At issue is a little-known loophole in President Obama’s landmark legislation that enables health insurers to extend existing policies for nearly all of 2014. This runs contrary to the widespread belief that all health insurance must immediately comply with new federal rules starting Jan. 1, when most provisions of the law take effect.

“Insurers are onto this, and the big question is how many will try to game the system,” said Timothy Stoltzfus Jost, a law professor and health policy expert at Washington and Lee University.

Some of the nation’s biggest health insurers are looking to take advantage of this delay, and Arkansas officials are encouraging companies to do this by resetting customers’ renewal dates for the end of December. There’s also concern that some insurers and agents could rush to sell more individual policies before year-end so they could be extended in 2014.

Some policy experts are expressing concern about this practice for fear that insurers will focus on renewing younger and healthier policyholders and hold them out of the broader insurance pool next year. Their absence could leave a sicker and older population in new government insurance exchanges, driving up medical costs and premiums there.

“This could undermine the Affordable Care Act, and it opens the door for exacerbating potential rate shock in the exchanges,” said Christine Monahan, a senior analyst at Georgetown University’s Health Policy Institute. “The health insurers can cherry-pick some healthy people and it raises prices for everyone else.”

This issue could affect some of the 15 million people nationwide who purchase their own coverage and millions more of the uninsured who are expected to join government exchanges next year. It would not pertain to the 150 million Americans who get health benefits through their employers.

Many health insurers are still mulling over their options on how to handle these individual renewals.

“Some carriers will require everyone to switch plans Jan. 1, and other carriers will allow customers to stay on their existing plan as long as possible,” said Bob Hurley, senior vice president of carrier relations at online site eHealthInsurance. “We are trying to nail this down with the carriers. I think it would be better for consumers to have that choice to carry their policy forward.”

The nation’s largest health insurer, UnitedHealth Group Inc. of Minnetonka, Minn., said, “We are currently looking at the best way to serve our customers’ best interests while continuing to comply with the Affordable Care Act going into 2014.”

WellPoint Inc., the Indianapolis insurance giant that runs Blue Cross plans in California and 13 other states, said its renewal practices will vary by state. In California, the company said its Anthem Blue Cross unit may allow individual policyholders to renew through March 31.

Kaiser Permanente, a major nonprofit health plan based in Oakland, said it doesn’t plan to renew policies beyond Jan. 1 in California and most of the other states where it sells coverage.

Richard Kern and his wife, a retired couple in Los Angeles, say they would welcome the flexibility to keep their individual policy from Aetna Inc. for another year amid so much uncertainty over next year’s rates.

“We don’t even know what the prices and alternatives are under Obamacare,” Kern said. “We are waiting for the other shoe to drop.”

If an insurer offers this option, it would then be up to consumers to decide whether they want to renew an existing policy into 2014. The length of any renewal may depend on what month their annual plan year begins.

Many lower-income people will qualify for federal premium subsidies, which will be available only when purchasing new coverage available in state- or federal-run insurance exchanges. It would make financial sense to take advantage of that government aid. Individuals earning less than $46,000 or families below $94,000 annually would be eligible for subsidies.

However, many people who are middle income or above could face significantly higher premiums next year with no subsidies. Those premium increases are tied to federal requirements that insurers accept all applicants regardless of their medical condition and the inclusion of more comprehensive benefits.

Renewing an older policy could mean forgoing some of those richer benefits and new limits on out-of-pocket medical expenses.

Last week, California officials estimated that premiums may rise 30% on average for about 1.3 million existing policyholders primarily because of those changes in the federal law. Insurers have warned that some customers could see their premiums double depending on their age and other factors.

Citing that threat of higher rates, Arkansas officials issued a bulletin to insurers last month describing how they could extend individual policies until Dec. 30, 2013, and then renew them for another year.

These health plans “would not be required to comply with the [Affordable Care Act] market reforms until 12/31/2014,” according to the Arkansas bulletin.

“For those folks who don’t qualify for subsidies, this is a consumer-friendly thing because the premium rates for 2014 will be substantially higher,” said Dan Honey, deputy commissioner of compliance for the Arkansas Insurance Department. “You will be exposed to rate shock.”

Other states may oppose that approach, further underscoring the uneven implementation of the federal healthcare law across the country. Oregon Insurance Commissioner Louis Savage said these renewals could be problematic and his office issued a rule barring any extension beyond March 31, 2014.

“We want to get as many people as possible into the exchange,” Savage said. “I think having renewals go deep into 2014 is counterproductive to the goals of the federal healthcare law.”

In California, state lawmakers are working on legislation that could address this renewal issue and other details about how individual policies comply with the federal overhaul.

These questions over renewals are separate from “grandfathered” health policies that existed before the federal law passed in March 2010. Those plans don’t have to meet all the requirements of the healthcare law as long as insurers or employers don’t make significant changes to them.