03/2001: State Legislative Update
Arizona Senator Sue Grace has introduced legislation that would create a high-risk health insurance pool in the state. The pool would be financed by an assessment on health insurance carriers and would allow carriers a premium tax credit to help offset costs. The measure passed the Senate Health Committee on February 8, 2000.
Arizona voters approved Proposition 200 on election day, November 7, 2000. The measure will authorize use of the state’s share of monies from the federal tobacco settlement to fund a variety of health related-causes, including increasing access to health insurance coverage for uninsured children and adults.
House Bill 1021 would extend a state Medical Savings Account tax exemption to all state citizens regardless of whether they qualify for the federal tax exemption.
In further action, the Arkansas attorney general intended to introduce privacy legislation more onerous than anything found in HIPAA or HCFA regulations. CAHI member companies and others were successful in persuading the attorney general to hold off during this session. The proposal may, however, emerge as a topic for an interim study after the current session ends.
A key change to the Insurance and Real Estate Committee: Rep. James Amann has been replaced by Rep. Michael Jarjura as House Chairman of this joint committee. Both are strong supporters of MSA passage in the state. Amann is now in a leadership role and will be offering an MSA bill again this year.
The most popular issue this year concerns the cost of mandated benefits. There appears to be bipartisan support to allow insurance carriers to offer some health care coverage exempt from state mandates. Specifically, the maternity mandate for small group health insurance, the prostate screening/mammography mandate, and the child health supervision mandates that require first-dollar coverage have been singled out for repeal.
Insurance Commissioner Tom Gallagher has signaled a desire to end the out-of-state group exemption provided by the state insurance code. He also wishes to delete one-person groups from the scope of small-group laws and repeal the small group-rate bands in favor of returning to modified community rating. Gallagher also would like to reopen the state’s high-risk insurance pool, which has be closed to new applicants for many years due to lack of funding.
Rep. Lou Lang has a bill to mandate rate filings and approval by the Department of Insurance. Many oppose the bill, including the Department of Insurance.
Rep. Jack Franks introduced H.B. 4764, an amendment to the Senior Citizens and Disabled Persons Property Tax Relief and Pharmaceutical Assistance Act. The amendment would mandate insurance coverage of prescription drugs used to treat the chronic and acute effects of cancer, lung disease, or smoking-related illnesses, as well as any drugs used for treatment of osteoporosis.
The House side of the Assembly has been busy with hearings on proposed health care legislation, with health insurance mandates making up a large portion of the agenda. CAHI member companies have been busy offering alternative language in an effort to make the bills less harmful to private insurance consumers.
An initiative to change the Indiana Rules of Evidence has met with strong opposition from the private insurance sector. The change would declare that medical bills under $15,000 are presumptively reasonable and necessary.
H.B. 5869, sponsored by Rep. Mary Middaugh, passed the House and was sent to the Senate. The measure, known as the Elder Prescription Insurance Coverage Act (EPIC), would create a state pharmaceutical purchasing assistance program to help state residents over the age of 65, with incomes below 200 percent of the poverty level and ineligible for Medicaid.
Rep. Luanne Koskinen introduced legislation (H.F. 405) to prohibit state government access to most patient data without consent. The bill was set to be heard February 20 in the House Health and Human Services Committee--until Rep. Fran Bradley, chair of the committee, received a barrage of requests to testify against it.
Koskinen has withdrawn the bill, and Bradley has asked for testimony on the topic of patient consent and medical record access in order to better understand the issue before legislation is considered.
For the first time since 1948, Republicans gained control of the Senate, with an 18-16majority. It’s too early to tell, but the liberals of the past may not wield as much influence over health insurance regulation as in the days of Governor Mel Carnahan and former Insurance Commissioner Jay Angoff.
However, the ever-present Rep. Tim Harlan has introduced his usual omnibus bill of health insurance mandates. Inasmuch as Harlan recently lost his race for Speaker, it’s considered unlikely he will be able to muster support for his proposal.
The state Department of Insurance (DOI) is presenting a problem in the interpretation of HIPAA language regarding “guaranteed renewability” by saying it would use the Oklahoma and HIPAA renewal agreements alternately, based on whichever benefits the insured the most.
It appears the DOI thinks an insurer must offer guaranteed renewable policies without the right to exit the market by non-renewal. This interpretation create a problem with current in-force coverage, and could spill over to other states who might choose to similarly re-interpret HIPAA.
The same bills and the same disagreements that characterized the last session have resurfaced in the 2001 legislature. Remaining on the table are numerous issues surrounding the state’s troubled government-run health plan, TennCare.
The issue gaining a great deal of attention in the legislature is the state-sponsored health benefits plan for public school teachers. Several legislators want to include a Medical Savings Account (MSA) option.
CAHI members are working with other businesses and health insurance coalitions in an effort to create a “clean claim.” The Texas Medical Association may be prepared to offer amendments to reduce the amount of time of payment from 45 days to 30 days and to broaden the rule to include doctors outside a network.
Virginia recently completed its “crossover” day: the date when a bill must have passed its chamber of origin. Of the various health care measures under consideration—including guaranteed issue, community rating, increased tort liability, and a shopping cart full of mandates—the only survivor of “crossover” day is H.B. 2768, a bill providing mandated coverage for hearing aids. Seniors caught on to this one and, even though they are largely insured by Medicare, are lobbying to include a hearing aid entitlement of $1,200 every two years.
Sources: The Council for Affordable Health Insurance (CAHI) and their member companies provide much of the information for this State Legislative Update. Contact CAHI at firstname.lastname@example.org, phone 703/836-6200, or visit its Web site at www.cahi.org. Additional material was provided by The National Association of Health Underwriters, http://nahu.org/government, http://bizjournals.com, and http://stateline.org.