Health Insurance and You!

As we have written previously, the White House issued a rule earlier this year that employer-sponsored health insurance plans must offer free birth control services for their employees. Since the policy applies to all employers – including many religious hospitals, charities, universities, and other organizations that oppose contraception – it was met with considerable resistance and has been debated on the legislative floor and all over the media during the past few weeks.

In response to that outrage, wrote Kathleen Hunter of Bloomberg, the Obama administration announced a compromise on February 10 that would require insurance companies, rather than religious organizations, to cover contraception for those organizations.

But many were still unsatisfied. And so, Republican Sen. Roy Blunt of Missouri proposed the Respect for Rights of Conscience Act, also known as the Blunt Amendment, which would have allowed employers to opt out of covering contraception for moral reasons. According to an article by David Morgan and Thomas Ferraro of Reuters, the amendment was tacked on to an unrelated transportation bill, and did not explicitly relate to birth control. Rather, its language would allow employers to choose not to cover a variety of benefits, such as prenatal care, childhood vaccines, and cancer screenings.

The Senate voted 51-48 against the amendment yesterday, with votes falling largely along party lines. One Republican, Sen. Olympia Snowe of Maine, voted against the amendment, and three Democrats voted in favor of it.

According to a recent poll by the Kaiser Family Foundation (KFF), described in a blog post by Julie Rovner and Scott Hensley of NPR, the public generally agrees with the Senate’s decision. Overall, 63% of Americans support health insurance coverage of birth control. KFF parsed the votes along age, gender, and political lines, and found that younger adults, women, and Democrats were most likely to support the requirement. According to an article by Laurie Kellman of the Associated Press, another poll by CBS News and the New York Times had similar results, finding 61% of Americans in favor of contraception coverage and 31% opposed.

So, what happens now? The U.S. House will be deciding on its next steps soon, said House Speaker John Boehner at a news conference yesterday, wrote J. Lester Feder of Politico. During the past month, the House has held several hearings on the issue, but no bills have been introduced so far.

Last summer, the U.S. Department of Health and Human Services (HHS) announced its plan to create a standardized, simplified set of health insurance forms that insurers would be required to use. The goal was for all insurance plans to be comparable, side-by-side, so that customers could have a more streamlined shopping experience – devoid of fine print. After reviewing several versions of the forms, which resemble food nutrition labels, HHS released a draft and opened it for comments from the public.

Now, about two weeks later, the Department has finalized the forms’ design, which you can view here. According to Noam M. Levey of the Los Angeles Times, the forms include basic information such as deductibles and co-payments, for both in-network and out-of-network providers. The plans are illustrated through two examples: diabetes management and pregnancy. In addition to the standardized forms, customers will also receive longer booklets with all of the details of a plan.

Information on premiums, which many consumer advocates had hoped the forms would include, is noticeably missing from the finalized versions. Susan Jaffe of Kaiser Health News writes that the advocates hope to reinstate price information in 2014, when insurers will no longer be allowed to change premium costs based on preexisting conditions.

Originally, insurance companies were supposed to start using the new forms in March of this year. But because of delays in coming up with a final design, the deadline was pushed back to this September. That gives insurers about six months to start complying with the rules, which they say will still be quite a rush, given the large number of plans offered by each company; according to an article by Sam Baker of the Hill, insurers had hoped to have about 18 months.

Late last month, the White House issued a new rule that health insurance plans must offer free birth control services for their employees. The policy, which has many religious leaders and conservatives up in arms, applies to all employers, including Catholic hospitals, charities, universities, and other organizations. With the 2012 presidential election just months away, politicians and analysts on both sides of the issue have been weighing in before the rule takes effect next year.

Yesterday, House of Representatives Speaker John Boehner added his opinion to the mix, calling the policy an “attack…on religious freedom” and promising to overturn it, wrote Thomas Ferraro and Matt Spetalnick of Reuters. Rep. Boehner has taken a first step in that direction by asking the chairman of the House Energy and Commerce Committee to draft a bill to reverse the ruling, adds Jennifer Steinhauer of the New York Times. Such a bill would have an easier time passing the Republican-dominated House than the mostly Democrat Senate.

Catholic bishops support a reversal, according to Mr. Ferraro and Mr. Spetalnick. They say the decision interferes with the religious freedom of groups that are against contraceptives and birth control. Some Democrats agree as well. For example, Sen. Bob Casey of Pennsylvania released a statement last Friday saying that while he strongly backs efforts to increase access to contraception, he doesn’t think religious organizations should be forced to contradict their own beliefs.

President Obama responded to Boehner’s comments by reconfirming the ruling. He and others in favor of the decision say that women should have access to birth control no matter where they work, and to deny them that access is an attack on women’s rights and health.

According to an analysis by Rachel Zoll of the Associated Press, published today, a compromise may be on the horizon. The White House doesn’t plan to reverse the ruling, but may revise how strongly it is enforced.

Last year, we followed AB 52, a California Assembly bill that would allow state officials to regulate health insurance premium increases, similar to the way they regulate car insurance premiums. Introduced by Assemblyman Mike Feuer in December 2010, the bill was debated by the state Senate Appropriations Committee in August 2011, but in September, failed to get enough votes to pass the state Senate and become law. Although the bill has been proposed and then nixed for the past four years, Assemblyman Feuer plans to continue bringing it back to the table.

This year, his effort may get a boost on the national scale. U.S. Senator Dianne Feinstein has been designated the chief spokeswoman on the issue, according to an article by Marc Lifsher of the Los Angeles Times. Sen. Feinstein was the first person to sign a new petition to put state regulation of premium increases on the ballot this November, a campaign that will require 505,000 signatures to succeed. She then spread the word on the issue by emailing the petition to about two million constituents, encouraging them to sign it as well.

Sen. Feinstein’s email focused on you – the individual market – as the main group of consumers who the bill would protect from rising premiums. People enrolled in employer-sponsored plans, she explains, are less affected by rate increases since their premiums are at least partially subsidized. Her website’s healthcare section goes into more detail, citing some of the highest proposed rate hikes of the recent past and the fact that about two-thirds of states and the District of Columbia already have the authority to regulate premium increases.

This isn’t Sen. Feinstein’s first involvement with the issue. Last August, according to a press release on her website, she testified before a Senate Committee on a proposal that would prevent health insurance companies in all states from increasing rates without justifying them.

Readers, do you think that bringing national attention to the issue will help the California proposal? Do you agree that health insurance premium increases should be approved by the state?

Last Thursday, the California state Assembly passed a package of bills that if enacted, would broaden private health insurance coverage, especially as it relates to mental health. According to an article by Judy Lin of the Associated Press, those bills include:

• AB154, which passed 47-18, and would require health insurance companies to cover the diagnosis and treatment of almost all mental illnesses. This includes nearly 400 conditions.
• AB171, which passed 45-13, and would require insurers to cover developmental disorders, such as autism. This is already a requirement, but is not always followed.
• AB137, which passed 67-0, and would require insurers to cover mammograms for all patients who need it, regardless of their age.
• AB1000, which passed 51-15, and would require insurers to cover oral chemotherapy as extensively as they cover intravenous chemotherapy. Similar laws already exist in 13 states and the District of Columbia.

Proponents of the expansions to coverage say that people with mental health conditions are often unable to get treatment, and so they cost taxpayers money through public health programs and when they need emergency care. Assemblyman Jim Beall, who proposed AB154 and AB171, believes that this is a more cost-effective approach because patients will be treated before an emergency takes place, Ms. Lin writes. Plus, supporters say, physical and mental health are equally important to overall well-being, and thus should be covered at similar levels.

Opponents argue that these bills place a large burden on health insurance companies and will drive up their costs, which will be passed on to consumers in the form of higher premiums and fees. They also say that it may encourage abuse of prescription drugs such as medical marijuana.

These four bills are now headed for the state Senate.

In a little under two months, the Supreme Court will begin hearing arguments for and against the constitutionality of 2010’s Affordable Care Act. At the center of the debate is the individual mandate, the requirement that all Americans maintain health insurance coverage. Opponents of the overhaul say the mandate encroaches on people’s right to buy the products and services they want. Supporters believe that without insuring everyone, the rest of the law will be less effective.

But on Friday, the Obama administration announced to the Supreme Court that most of the law can still survive, even if the individual mandate is thrown out. Those portions include cost control measures and public health efforts that are unrelated to insurance coverage, explains James Vicini in an article for Reuters. Plus, they say, the Supreme Court has never before struck down a comprehensive law like health reform because one provision was unconstitutional.

If the individual mandate is invalidated, two parts of the law will have to be eliminated: first, that insurers cannot refuse to cover a person with pre-existing medical conditions, and second, that insurers cannot base a person’s premium cost on his or her medical history. This would protect insurance companies, who need the income from healthy customers’ premiums to pay for the medical costs of the less healthy. Without the individual mandate, those healthy customers may choose not to maintain coverage.

For more information and previous coverage of this debate on our blog, please read:

• Jan. 6, 2012: Cameras in the Courtroom: Will Supreme Court’s Hearing of Health Reform be Televised?
• Nov. 14, 2011: Confirmed: Supreme Court Will Rule on Health Reform
• Nov. 11, 2011: D.C. Appeals Court Rules in Favor of Individual Mandate
• Nov. 4, 2011: Insurers Worried about Potential Repeal of Individual Mandate
• Additional posts about health insurance policy and regulation

Last summer, we blogged about new, standardized forms created by the National Association of Insurance Commissioners that aimed to simplify the health insurance shopping process by allowing insurers and plans to be compared directly. Much like food nutrition labels, the four-page forms included charts listing the costs of common procedures for in-network and out-of-network providers, sample calculations for three scenarios, and definitions of common insurance terms. The new forms would not replace the longer booklets that currently describe plans, but instead, would serve as a supplement.

When the U.S. Department of Health and Human Services (HHS) unveiled these forms in August, the goal was to have them ready by March 23 of this year. But several health insurance companies, who would be the ones developing the forms, wanted more time, according to an article by Susan Jaffe of Kaiser Health News. Insurers argued that the March deadline would force them to duplicate efforts and create both styles of forms for plans available in 2012: once, in the usual format, for continuing enrollment at the end of 2011; and again, in the new format, for those enrolling in March or later. If the deadline were pushed back, they said, they could use the old format for 2012 and begin using the new one in 2013.

Now, writes Ms. Jaffe in a new article, questions still remain about how exactly the forms should be used. HHS is still reviewing public comments on the sample forms. Given that the March deadline is less than two months away, it’s likely to be pushed back. But advocates for consumers and seniors urge HHS and the Obama administration not to weaken it. Several organizations, including the American Cancer Society, Consumers Union, and AARP, have written and signed an open letter to the president asking for the forms to be available by this fall, in time for enrollment for 2013. The letter also asks that the forms include premium and cost information as well as examples, and that they be required for group and individual market plans.

The Supreme Court case pitting 26 states against the health reform law has received a lot of attention in recent weeks. But in the meantime, many of the same states have been making progress in building online health insurance exchanges, a key component of the 2010 overhaul. In fact, the Department of Health and Human Services (HHS) announced on Wednesday that 28 states and the District of Columbia have moved toward creating the exchanges, in spite of the legal challenges to the law and political opposition to it in many states.

According to an article by David Morgan of Reuters, 14 states have established their authority to set up exchanges, whether by a new law or one that previously existed, and 14 have taken steps to show that exchanges are useful. The health reform law set a deadline of January 1, 2013 for states to either move toward a state-based exchange or agree to participate in a national one, with the option of later establishing a state-based system. The exchanges must be up and running by the beginning of 2014. But given the uncertainties and Supreme Court hearings scheduled for this spring, some states have decided to wait and see what happens.

However, all states have made some changes since the law was passed. For example, writes Meghan McCarthy of the National Journal, 44 states have strengthened their review of increases to health insurance premiums. In addition, most states have accepted federal grants to help them plan for the exchanges, says Louise Radnofsky of the Wall Street Journal’s Washington Wire blog. According to Julie Appleby of Kaiser Health News, those grants total more than $729 million in 49 states and D.C. (only Alaska has not sought funding). Some states, however, do not plan to use their grants and will return the money.

During the past few months, we have covered the story of the Community Living Assistance Services and Supports (CLASS) program, health reform’s program for long-term care insurance. While it was being debated and in the months following its enactment, various groups and analysts expressed doubts about whether the program could pay for itself. (Last year’s health overhaul required CLASS to be solvent for at least 75 years, explains Igor Volsky of Think Progress). Last October, echoing those worries, the Obama administration decided to drop the program.

Now, the formal repeal of CLASS is proceeding through the legislature. In November, the House Energy and Commerce Committee voted in favor of repeal. And yesterday, writes Sam Baker of The Hill, the House Ways and Means Committee voted the same way. The next step is a House floor vote, which will take place next month.

While Congressional Republicans are largely against the program and the health reform law in general, Mr. Baker says, Democrats say that CLASS targeted a serious problem – the fact that most Americans are unprepared for the expenses of long-term care – and that while this particular program was not viable, the government should continue to search for an alternative that is more financially sound.

Although CLASS was dropped, not everyone supported its outright repeal, Mr. Volsky elaborates. Many of those who supported the intent of the program were against its repeal, arguing that it could instead be modified and its financial model strengthened. But those in favor of repeal believe that it needed to be removed formally and legally, rather than simply abandoned, Mr. Baker writes.

Neither home care nor nursing home residency are covered by Medicare. While CLASS is no longer an option for those who may need long-term care, a variety of affordable long-term care insurance plans are available on the individual market. If you’re interested, our reference page on long-term care is a good place to get started.

During the past couple of weeks, much public attention (and TV airtime) has been devoted to the Republican Party debates. Kaiser Health News has compiled videos and transcripts of the candidates discussing health care and health insurance issues, and below, we use those resources to summarize what each candidate had to say. In alphabetical order:

Newt Gingrich

• On health cost control: Former Speaker Gingrich supports the Ryan/Wyden health bill, which expands consumers’ options for Medicare. He would also push for improved surveillance of health criminals, citing data that Medicare and Medicaid lose $100 billion per year to theft.

Jon Huntsman

• On health cost control: Gov. Huntsman agrees with Paul Ryan’s budget, which would cut the budget by about $6.2 trillion over ten years and would affect all programs, including Medicare and defense. He also supports means-testing for entitlement programs, including Social Security and Medicare, among the wealthiest Americans.

Ron Paul

• On contraception: Rep. Paul explains that the Fourth Amendment protects’ privacy, which can be extended to contraception, and the Interstate Commerce Clause protects the right to sell contraceptives across state lines.
• On health insurance: Paul believes that seniors should have the same variety of health coverage that other adults have – including a similar range of comprehensiveness and cost. Later in the same debate, Paul distinguishes between entitlements and rights, stating that the only type of right is the one to liberty.

Mitt Romney

• On contraception: Gov. Romney states that no state wants to ban contraception, and that he can’t imagine any state doing so. As to whether states have the right, he does not know and considers the question irrelevant. However, he does believe that the Supreme Court should overturn Roe v. Wade, the landmark 1970s abortion case.
• On health cost control: Romney supports shrinking the size of government and its spending in order to reduce costs. By cutting health reform, he says, the government would save $95 billion per year and businesses would save as well.

Rick Santorum

• On contraception: Sen. Santorum believes that while privacy is protected under the Constitution, Roe v. Wade is not about privacy and should be overturned.
• On health cost control: Santorum supports means-testing for entitlement programs such as and reducing subsidies for the wealthiest Americans. He also believes that in order to reduce dependency, food stamps, Medicare, and housing programs should no longer be entitlements, and should instead be managed by the states as block grants. Beneficiaries should be required to work and should only receive benefits for a limited time.
• On health insurance: Santorum has supported health savings accounts for many years, in order to make the private sector health care system more “bottom-up” and consumer-based. He cites the Medicare Advantage program and Medicare Part D, which have transformed Medicare, as more examples of the premium support model he believes in.

See video and transcript on contraception (ABC News/Yahoo debate).

See video and transcript on other issues (Meet the Press debate).