Blues Plans and Reform

In an earlier post I mentioned that the Blues Plan in NC had to refund $156 M to its members that have individual coverage based on the new MER requirements for such coverage. What about other Plans and reform? Here is a summary:

• Meanwhile, some Blues plans and other insurers have withdrawn from child-only coverage, citing issues with reform provisions related to pre-existing condition exclusions. The insurers said they no long would sell such policies as of Sept. 23, when they may no longer reject applicants up to age 19 based on pre-existing conditions. In Colorado, for example, WellPoint, Inc.’s Anthem unit and several other carriers, including Aetna Inc., CIGNA Corp., Humana Inc. and UnitedHealth Group’s Golden Rule Insurance Co. subsidiary, said they would drop new sales of child-only policies while continuing to cover current child-only enrollees and to accept children with pre-existing conditions in new family policies. Insurers in several other states also reported that they would withdraw child-only products.Under rules issued in June that take effect for plan years beginning on or after Sept. 23, 2010, insurers may no longer exclude pre-existing conditions from coverage for enrollees under the age of 19. In an effort to address concerns regarding adverse selection, HHS issued guidance July 27 authorizing insurers to restrict enrollment of children under age 19 “to specific open-enrollment periods,” if permitted by state law. But the open-enrollment period must apply to healthy as well as sick children, while the insurers — and some state insurance commissioners, preferred to allow acceptance of healthy children year-round. HHS signaled that it would try to adjust open-enrollment periods to address the risk of adverse selection, but no deal had been reached by press time.
  

• Meanwhile, insurers in several states blamed reform for premium rate hikes. The Rhode Island Blues plan, for example, reportedly told customers it would raise premiums by a few percentage points on top of already approved rate hikes to account for additional benefits mandated by the reform law. BCBSRI and other Rhode Island insurers that planned to impose similar rate hikes came under fire from Insurance Commissioner Christopher Koller. In a Sept. 9 letter to chief executives at the state’s three largest insurers, Koller said that any changes to approved premium rates “as a result of PPACA [i.e., the reform law] will be considered material and an exception to the OHIC’s previous decision….They may not to be applied in quotes to customers unless and until approved by this office.” The insurers also must submit “analysis supporting the additional premium rate charge anticipated for each contemplated change and why it should cause average rates to increase by more than the amount approved.” BCBSRI spokesperson Kimberly Reingold told The AIS Report that “the guidelines under federal health care reform will add cost to employers and we currently are working with them to understand the specific impact to premiums, which will vary based upon benefits selected by each employer. Every time an employer changes their coverage, or we are mandated to cover new services…rates are adjusted.” She added that “those rates could be anywhere from 1.8% to 3% more depending upon plan design.”

NY VNA Study: Home Visits Reduce Hospitilaztion Rates

Well you have to consider the source here but this study(http://www.healthleadersmedia.com/page-2/TEC-257573/Predictive-Modeling-May-Reduce-Hospitalizations) seems very positive. Key article takeaway:

Preliminary analyses from their investigation revealed that patients who received physical therapy were 37% less likely to be hospitalized compared with patients who did not receive physical therapy services."

What Employees Will Find at OE This Year

This is a good article (http://www.kaiserhealthnews.org/Features/Insuring-Your-Health/open-insurance-season.aspx) on open enrollment issues this year. It notes that family coverage has increase 12% over last year and with employees picking up more and more of the cost of their coverage, paychecks will be smaller for many next year.

It also notes how more and more employers will offer incentives for healthy activities such as an health assessment.

Despite Patient Interest Few Doctors Use Email

The Center for Studying Health System Change released a report (http://www.hschange.org/CONTENT/1159/)that showed less than 7% of physicians use email to communicate with their patients. Why is this figure so low? Lack of reimbursement was cited as one of the issues. What a surprise

Aetna Study: Account Funded Plans Save Money

Aetna just released a five year study that showed customers who replaced their previous plan options with an Aetna HealthFund (AHF) Health Reimbursement Arrangement (HRA) or Health Savings Account (HSA) experienced lower annual cost trends over five years, producing savings of nearly $18 million per 10,000 members.

While this obviously is positive news for supporters of this kind of coverage, this article (http://www.sacbee.com/2010/10/04/3077647/price-comparisons-nearly-impossible.html) does a good job of showing how difficult it still is for consumers to obtain medical procedure cost information. Until easy to understand and easy to obtain medical cost and quality information is available, it will be hard for these types of plan to dominate the marketplace.

Good Article on Mini Med Plans

The NY Times (http://www.nytimes.com/2010/10/06/business/economy/06leonhardt.html?_r=1&ref=business) has a good overview of mini-med plans and how they do not fit in the future of health insurance once the Affordable Care Act kicks. Last week it was major news that McDonald's was ready to drop such coverage for their employees. The benefit limits for these plans was either $2,000 or $10,000/yr. The article noted this really was not coverage since a major procedure would easily pass either amount.

Mini med plans really are not a good alternative to standard HC insurance. However as the article notes, standard HC coverage is too expensive for most people to afford. In 2014 both the mandate for HC coverage and subsidies to help pay for the premiums kick in. Until then, people will have to muddle through with either no coverage or mini med coverage which is really not a good scenario.

More Updates on Health Insurance Exchanges.

From various sources:

NAIC publishes draft legislation for comment
Monday, the National Association of Insurance Commissioners (NAIC) published its draft model legislation to assist states in establishing insurance exchanges by January, 2014. Under PPACA and the NAIC draft legislation, a state may establish an exchange within or outside of state government or a combination of the two. NAIC will accept comments until October 6.

HHS awards grants to assess data requirements
Thursday, HHS awarded $1 million grants to 48 states and DC to assist in preparation for health exchanges infrastructure. The initial funds will be used to assess information and data requirements in each state.

California accelerates exchange timetable
Thursday, Gov. Arnold Schwarzenegger (R) signed two bills that will make California the first state to establish a health insurance exchange per PPACA (Utah, Massachusetts had exchanges pre-PPACA). The exchange will create a web-based insurance plan marketplace for residents, offering standardized and detailed information about available plans, as well as a toll-free hotline to help consumers understand their options. Approximately 8.3 million Californians are expected to be eligible for coverage through the exchange. The program is expected to bring as much as $10 billion in subsidies for the state over ten years. An independent, five-member board will oversee the California exchange with responsibility for naming insurers that will participate, eligibility, and enrollment processes.

Congressional Research Service report: Can state exchanges prohibit plan participation?
According to the Congressional Research Service (CRS) analysis of PPACA, a state exchange could deny participation by every plan submitting certification if the exchange were to determine that every plan is not in the “interest of plan participation.” However, CRS analysts concluded the HHS Secretary could use her authority to prevent such a scenario.