health reform weekly aetna 2009-12-10

Federal    The process to begin debate of the merged health care reform bill in the Senate began when Majority Leader Reid moved to proceed to a "shell" bill and then scheduled a cloture vote for Saturday night to cut off debate on the motion. The Democratic leadership needed 60 votes on this issue, and they got just that as the Senate voted 60 to 39 on Saturday night to move forward with all four hold-outs (Lincoln (AR), Landrieu (LA), Nelson (NE) and Lieberman (CT)) voting yes. The Senate will go home for Thanksgiving and return on the 30th to start the debate in earnest. While Senator Reid and the rest of the Democrats are thrilled with the vote, they know well that the road to passage is paved with chards and potholes. This vote was the first of dozens of votes on health reform, many of which will be of the 60-vote variety, and the debate itself is expected to consume all of December and could even run into 2010. And when the Senate is done, the House and Senate have to sort out just how to get together and pass the identical bill in order to send it to the President. It must be remembered that the Senate bill to be debated after Thanksgiving is at odds with the House on several key fronts: the public plan option, and individual and employer requirements on coverage, abortion, funding sources, taxes and immigration. Late last week the House passed (243 to 183) a bill to eliminate the year-to-year cut in Medicare payments to physicians, including elimination of the pending 2010 cut of 21 percent. The bad news is that the bill does not have a funding source, which means the cost ($210 billion over 10 years) would be added to the deficit. The Senate has already rejected this approach, and that means House Democrats will have to bargain hard to either persuade the Senate to address the House bill or to include the issue in health care reform. States    CALIFORNIA: Insurance Commissioner Steve Poizner officially released the CA Department of Insurance’s first PPO Report Card. The Report Card will allow consumers to compare PPOs in a number of key areas such as diabetes, treating conditions in children, heart disease and others. Each PPO insurer has been given an overall grade. Aetna’s PPO plans received a 3 out of 4 star rating on the report card. In other news, California’s nonpartisan Legislative Analyst's Office released a report projecting that California faces a $20.7 billion deficit through June 2010. This includes a $6.3 billion problem in the current fiscal year, largely because the budget approved by lawmakers and the governor contained risky assumptions that are unlikely to come to pass.   GEORGIA: Commissioner Oxendine held a meeting with representatives from the Georgia Health Plan Association, including Aetna, to discuss his 2010 legislative agenda. The Commissioner is focused on availability and affordability in the individual market and is interested in creating guaranteed-issue products for individuals that would be available to the uninsured. The GAHP agreed to form a workgroup to give input to the Commissioner.     MARYLAND: The Maryland Health Care Commission (MHCC) has adopted amendments to the eligibility requirements for small employers and their employees under the state's Health Insurance Partnership (HIP) program. Effective October 19 under the HIP program, small businesses with 2 to 9 full-time employees that have not offered health insurance to their employees during the previous 12 months and who meet wage and salary requirements are eligible for subsidies of up to 50 percent of the cost of employee health premiums. Also, the Maryland Health Care Commission (MHCC) and the Maryland Insurance Administration adopted amendments to the state's small employer wellness benefit regulations to require "prominent" carriers to offer a wellness benefit to a small employer for a health benefit plan offered in Maryland. The amendments also redefine "wellness benefit" to mean "a benefit that includes a bona fide wellness program and complies with regulations adopted by the Commission."   MISSOURI: The proponents of an "any willing provider" ballot initiative have hit a stumbling block. The process has been at least temporarily delayed by the filing of a lawsuit challenging the publication of a financial impact estimate that was approved by the Secretary of the State for circulation. The suit halts the proponents' ability to move forward until a ruling is issued regarding whether the financial estimate is accurate. The proponents have not filed or reported any funds collected or expenditures made as of the last reported deadline with the Missouri Ethics Commission. Aetna will continue to monitor the petition effort. OHIO: On behalf of the Healthy Choices for Healthy Children Coalition, of which Aetna is a member, Senators Kevin Coughlin and Eric Kearney have introduced legislation that focuses on school-based solutions to combat childhood obesity in Ohio. The legislation would establish nutritional standards for certain foods and beverages sold in public and chartered non-public schools; require students to have periodic body mass index measurements; require daily physical activity for students and make other physical education changes; and establish the Healthy Choices for Healthy Children Council. The Healthy Choices for Healthy Children Coalition includes Ohio providers, associations and other businesses that are proponents of efforts to curb childhood obesity in the state.