Health law implementation: Insurance, coverage and Medicare payment questions

Kaiser Health News reports that the insurance industry — traditionally a state-regulated industry — is facing new federal scrutiny by four officials in the new Office of Consumer Information and Insurance Oversight. "On this year's to-do list: writing rules to define when premium increases are 'unreasonable,' creating new coverage for people who can't get it because of health conditions and making sure insurers comply with consumer protections. The new director of the office is Jay Angoff, a former Missouri insurance commissioner. … Joining him are former Maryland insurance commissioner Steve Larsen, who in 2003 rejected the sale of nonprofit insurer CareFirst Blue Cross Blue Shield; former Georgetown University professor Karen Pollitz, a longtime critic of the individual insurance market; and Richard Popper, who runs Maryland's insurance program for people who can't get coverage because they have health problems" (Appleby, 6/1).

The New York Times: Young adults — particularly those graduating from college — could see a gap in health insurance despite employer and insurer assurances they would implement early a provision in the new law allowing young adults to stay on their parents plan until the age of 26. "But when parents ask for details from their employers about how to keep their children on a family plan, many are learning that their employers have said 'no thank you' to their insurer's offer to make the change early. Instead of modifying health plans now, they plan to wait to provide the extended coverage until they are legally required to do so. For many employers, that means January 2011." Premiums under COBRA, which allow recent graduates to retain their coverage, are often cost-prohibitive (Andrews, 5/31).

Politico, on a possible conflict over birth control: "As health reform regulations begin to take shape, Planned Parenthood has begun a quiet campaign to ensure that birth control is counted among the free preventive services that health insurers must cover under the Affordable Care Act." The issue was barely breached in the reform debate, but it is likely to spur debate since many religious groups are opposed to contraceptive use.

"Beginning Sept. 23, six months after the reform law passed, many health insurance plans will be required to provide free preventive services coverage, with no co-pays or out-of-pocket costs. During the reform debate, Sen. Barbara Mikulski (D-Md.) added an amendment that specified guaranteed 'additional preventive care and screenings' specific to women's health would also receive coverage. What remains to be determined is what will make the 'preventive services' list" (Kliff, 6/1).

The (Jacksonville) Florida Times-Union: Members of Congress are not exempt from the new health reform law. "They must have insurance and, according to FactCheck.org, those plans must meet the same minimum benefit standards that other insurance plans will have to meet." 

"Members of Congress and their staff currently buy private insurance offered through the Federal Employees Health Benefits Program, which has more than 350 plans that charge different premiums, according to the FEHBP handbook. ... But under the health-care act, Congress and its staff members must join a plan created by the law, or offered through a health exchange"  (Fader, 5/30).

Finally, The New York Times, in a separate story: "Members of Congress from Iowa, Minnesota, Washington and Wisconsin secured extra money in the new health care law to reward low-cost hospitals in their states, which they said had long been underpaid by Medicare. But it now turns out that New York will get more of the money than any other state, and some of the chief proponents of the bonus payments will not receive any."  

 "The Obama administration recently disclosed how it planned to distribute the money, $400 million over the next two years, and the result was not exactly what Congress or hospital lobbyists had expected. …The money is going to 415 hospitals in 273 counties around the country. The counties were selected because their average Medicare spending per beneficiary — adjusted for the age, sex and race of patients — was low." The New York Times analyzed the data after the recent disclosure of the Obama administration on how it planned to divide the money and found that New York will get more than $46 million of the $400 million appropriated for the entire nation (Pear, 5/30).