Health Insurance and You!

As you’ve probably noticed on this blog, 2011 has been a big year for health policy developments at the national, state, and local levels. In the health insurance world, we saw progress by the states in crafting online health insurance exchanges and steps toward implementation of last year’s health care overhaul. Journalist Ezra Klein, in his Washington Post blog Wonkblog, posted a good roundup yesterday of 2011’s health policy highlights, which we supplement below with milestones that we’ve blogged about.

Health Reform and Nationwide Changes. The Affordable Care Act included several provisions scheduled to take place between 2010 and 2014, many of which began this year.

• In January, Republicans in the U.S. House voted to repeal the health reform law (Washington Post, Jan. 19).
• In February, the Department of Health and Human Services (HHS) ruled that college health insurance plans had to comply with health reform’s requirements. Previously, they were exempt (GetInsured.com blog, Feb. 15).
• To commemorate Mother’s Day in May, HHS secretary Kathleen Sibelius highlighted four parts of the overhaul that aim to improve women’s health (May 13). In August, health insurers were required to begin covering women’s preventive care, such as contraception and screenings, by the following August (Aug. 1).
• Also in May, HHS decreased premiums and eased enrollment processes for federally-administered preexisting condition health insurance plans (June 6).
• In June, HHS moved toward phasing out ‘mini-med’ health insurance plans, which are inexpensive but have very limited benefits, by setting a September deadline for waiver applications (June 21).
• In July, HHS awarded low-interest loans to non-governmental groups to help them introduce Consumer Oriented and Operated Plans, also known as co-ops (July 20).
• Health reform originally included a long-term care insurance program known as CLASS. In October, however, officials deemed the program financially unviable, and decided to drop it (Oct. 21).
• Courts and experts continued to debate the constitutionality of the individual health insurance mandate. In November, a D.C. appeals court ruled in favor of the mandate (Nov. 12) and the Supreme Court announced that it will rule on the case in early 2012 (Nov. 14).

Health Insurance Exchanges. The federal government and states came closer to shaping online health insurance exchanges in 2011. The exchanges are set to launch in 2014.

• In August, HHS unveiled standardized health insurance forms to simplify the insurance shopping and selection process (Aug. 17).
• The Institute of Medicine and HHS worked to define what health benefits are considered ‘essential’ (Oct. 11), but ultimately, HHS decided to leave that decision to the states (@GetInsuredCom, Dec. 29)
• In December, Minnesota launched demos of several health insurance exchange modules for public comment (including one developed by us!) (Dec. 12).
• States voted on whether to use the federal exchange or establish their own, set up exchange committees, and took other steps forward during the past year. Many of these are noted on our Twitter feed.

Medicare and Medicaid. These programs for the elderly and poor were often threatened due to a tough economic climate, but they made some innovative and interesting changes.

• In April, Medicaid announced a new grant program for states to incentivize healthy behaviors, like losing weight and quitting smoking, that reduce health costs (Apr. 13).
• In December, Rep. Paul Ryan and Sen. Ron Wyden proposed a Medicare reform plan that would provide seniors with subsidies to enroll in a public or private insurance plan (Washington Post, Dec. 14).

State Changes. At the state level, lawmakers enacted a variety of policies designed to improve health, including many related to health insurance.

• In January, Michigan voted to provide health benefits to domestic partners of its state employees (Feb. 9).
• During the first few months of the year, states established open enrollment periods for child-only health insurance plans (Mar. 8).
• In April, Massachusetts proposed a method of dealing with the rising cost of healthcare by replacing the traditional fee-for-service model with integrated care (Apr. 19).
• States began implementing the medical loss ratio rule, which required insurers to spend at least 80% of premiums on care or quality improvement. In July, five states got more time to put this new rule into effect (July 25). In December, despite lobbying by insurance brokers, HHS defined broker fees as an administrative cost, not falling under that 80% (Dec. 5).
• In September, after several months of debate, California voted against state regulation of health insurance premium increases (Sep. 1).
• Also in California, in October, lawmakers passed a bill to require individual-market plans to cover maternity care starting in July 2012 (Oct. 7).
• In November, New York mandated health insurance coverage of autism screening, diagnosis, and treatment starting in November 2012 (Nov. 2).
• Health insurance companies continued to propose premium increases, many of which were met with criticism. In November, HHS ruled for the first time that one Pennsylvania insurer’s proposed increase was unreasonable and asked the company to justify the increase (Nov. 22).

Mr. Klein writes that “in health policy, 2011 might be best viewed as the year of getting ready.” Looking at the policy topics we’ve covered during the past year, he may be right: several bills were passed and committees convened, but their implementation and action won’t get rolling until 2012 and later.

Readers, as 2011 draws to a close, what are your thoughts on this year in health? Did we make the kind of progress you hoped to see?