Obama Administration struggles to soothe health reform concerns; Insurance Commissioners issue rules

The Associated Press reports that the new health reform law "hasn't helped Americans feel any more secure about their own medical care." That's according to a survey,  to be released today by the Robert Wood Johnson Foundation, which says "consumer confidence spiked in April after Obama signed landmark legislation to expand coverage and start trying to control costs. But confidence levels have since fallen back to what they were last year at the beginning of an epic congressional debate. It's another sign of ambivalence over Obama's historic accomplishment as Democrats campaign to preserve their congressional majorities in the midterm elections."

Many reforms don't take effect until 2014,. "Those who stand to benefit most from the new health care law — the uninsured, those in poor health and low-income people — also had the most pessimistic outlook about the health care system, the surveys found" (Alonso-Zaldivar and Tompson, 8/18).

In the meantime, President Obama visited Ohio to talk about economic and health care concerns, The Wall Street Journal reports. "The 30 or so Ohio residents who gathered in the backyard of the Weithman family asked Mr. Obama about a host of economic and controversial topics, such as the stability of Social Security, effects of the health-care legislation and consequences of Wall Street overhaul. It was a mostly friendly crowd. One man, who didn't identify himself, asked Mr. Obama what the health-care legislation would do to help his brother, who washes dishes for a living, is mentally disabled and suffers from other illnesses." Obama answered that the legislation "will provide his [brother's] employer with tax incentives for health insurance, allow him to join a large insurance pool if his boss doesn't offer coverage and, if those two items don't help enough, the government will subsidize part of his care, Mr. Obama said" (Favole, 8/18).

The Hill: "Top White House health officials on Wednesday used the lull of August to highlight the insurance reforms found in the Democrats' new healthcare law," with a live online chat, "sponsored by the Health and Human Services Department (HHS) ...   Faced with polls indicating consumers — particularly seniors — remain bewildered by what the reform law actually does, Democrats have persistently touted every new benefit that's come along" (Lillis, 8/18).

"The discussion came a day after the National Association of Insurance Commissioners approved a document that will eventually be used by state insurance commissioners to ensure that companies are spending 80 percent to 85 percent of costs on medical claims, depending on the group size of the plan," CongressDaily reports. The recommendations on the "medical-loss ratio," which must be approved by HHS, "garnered criticism from the insurance industry for not including fraud prevention efforts, updates to the disease coding system, and innovation in quality improvement programs in potential medical costs" (McCarthy, 8/18).

Meanwhile, despite insurer concerns, the NAIC's "medical-loss" document "includes some flexibility," Modern Healthcare reports. "The approved forms — called 'blanks' — include categories for spending. For instance, under the law, insurers are allowed to count 'quality-improvement activities' as part of their medical-loss ratios. Some provider groups have urged the NAIC to restrict this category to activities that directly help individual patients. But, based on the blanks document, the NAIC has offered some leeway." Activities that could be counted by health plans as quality improvement efforts "include case management, care coordination, chronic-disease management and wellness programs, hospital discharge planning, some call lines and public health education campaigns conducted with local health authorities" (Vesely, 8/18).

Business Insurance quoted AHIP President and CEO Karen Ignagni in a statement released after Tuesday's NAIC vote "The current proposal could have the unintended consequence of turning back the clock on efforts to improve patient safety, enhance the quality of care and fight fraud,' said " (Wojcik, 8/18).

NAIC's guidelines for medical loss ratio could also affect others, including insurance agents. "One of the biggest losers in the transition may be insurance agents," The Palm Beach (Fla.) Post reports. "For now, the job typically pays agents commissions of 5 percent a year per health premium, although it varies according to group size and type of plan." The NAIC opted "not to allow agents' sales commissions to count as 'medical care' ... The insurance commissioners did, however, call on federal policy makers to 'protect the indispensable role that licensed insurance professionals play in serving consumers' as insurance exchanges are rolled out after 2014" (Singer, 8/18).

The NAIC proposal can be found on its website.