WeeklyFinancingNewsPulseNationalEditionfinal20091109.pdf (PDF | 294.24 kb)
SAMHSA222s Weekly Financing News Pulse: National Edition November 9, 2009 11/9/09 1 SAMHSA222s Weekly Financing News Pulse: National Edition National News House Passes Democrat222s Health Care Reform Bill; Rejects GOP Proposal Sens. Brown and Casey Propose Legislation Extending ARRA COBRA Subsidy Sen. Harkin Requests Rate- Setting Information from Insurers Senate Commerce Committee Analysis Suggests Insurers Overstated Their Medical Expenses CMS Letter Provides CHIPRA M/SU Parity Implementation Guidance CMS Eases Planned Medicare Rate Cuts for Some Specialists, Still Increases Primary Care Rei mbursements DOJ Settles Medicaid False Claims Suit for $112 Million 15 States Sue Amgen for Medicaid Fraud Update: WellPoint to Resume Enrolling Medicare Part D and MA Beneficiaries Update: Aetna Completes Acquisition of Horizon Behavioral Health Studies Released Drug Policy Alliance Brief Advocates Changes to Veterans222 Substance Abuse Treatment Health Care Leaders Think Medicare Provides Easy Access to Care, Ineffective Cost Controls RWJF Report Considers Lessons for Wisconsin222s BadgerCare Plus Coverage Expansion KFF Brief Examines the CLASS Act NPAF Whitepaper Examines Health Care Reform222s Effect on Access to Care Polling Analysis Finds Current Attitudes Towards Health Care Reform Similar to 1994 Attitudes Study Links Child Uninsurance and Mortality Research Finds Gaps in Public Health Insurance Coverage Uninsurance and Public Insurance Associated with Greater Mortality After Trauma in Children Around the Hill: Hearing s on Health Financing Although general coverage for this issue ended November 6, it was published November 9 to allow for coverage of the House222s Affordable Health Care for America Act vote on November 7. To Subscribe to SAMHSA222s Weekly Financing New s Pulse, please go to the following link and choose 223Health Care Financing224: https://service.govdelivery.com/service/multi_subscribe.html?code=USSAMHSA&origin=http://www.samhsa.go v/enetwork/success.aspx For quest ions or comments, please contact Kevin Hennessy ( kevin.hennessy@samhsa.hhs.gov ). SAMHSA222s Weekly Financing News Pulse: National Edition November 9, 2009 11/9/09 2 National News House Passes Democrat222s Health Care Reform Bill; Rejects GOP Proposal : With a 220 - 215 vote, the House approved the Democrats222 health care reform bill, The Affordable Health Care for America Act ( HR 3962), just before midnight on November 7. The bill, estimated to cost $1.1 trillion over ten years, had been endorsed by the AARP and the American Medical Association (AMA) and received 219 Democratic votes and one Republican vote from Rep. Joseph Cao (R- LA) . Prior to passage, the bill was amended to include a ban on using federal health insurance subsidies to purchase insurance plans that cover abortions ( Kaiser Health News, 11/7 ; Kaiser Health News, 11/7 ; Kaiser Health News, 11/5 ). However, plans purchased with government subsidies may still offer abortions in cases of rape, incest, or danger to the mother222s life ( New York Times, 11/8 ). Also on November 7, the House rejected a GOP health care reform proposal on a 176 - 258 vote ( Roll Call, 11/7 ). The GOP bill would have limited damages in medical malpractice lawsuits, allowed small businesses to purchase health plans across state lines, and rewarded states for reducing their uninsured population. The Congressional Budget Office (CBO) estimated that the bill would insure an additional 3 million people by 2019 and lower average premium costs for those with coverage ( Kaiser Health News, 11/4 ; Kaiser Health News, 11/5 ). Meanwhile, Senate Majority Leader Harry Reid (D - NV) has yet to release the Senate222s health care reform bill, saying that he is waiting for CBO cost estimates on several variations of the legislation before deciding which to introduce ( Kaiser Health News, 11/4 ). Sen s . Brown and Casey Propose Legislation Extending ARRA COBRA Subsidy: On November 4, Senators Sherrod Brown (D - OH) and Robert Casey (D - PA) introduced legislation ( SB 2730 ) to extend and increase COBRA subsidies under the American Recovery and Reinvestment Act (ARRA). Under the original ARRA provisions, workers laid off before the end of 2009 receive a 65 percent COBRA subsidy for up to nine months. SB 2730 would extend the subsidy by 6 months; extend the eligibility cut off from the end of 2009 to June 30, 2010; and increase the subsidy from 65 percent to 75 percent of the COBRA premium. In addition, the bill would extend eligibility to employees whose reduction in working hours cause them to lose eligibility for their employer- sponsored plan. The bill was referred to the Senate Health, Education, Labor and Pensions (HELP) Committee ( WKYK, 11/5 ; THOMAS). Similar legislation ( HR 3930 ) was introduced in the House on October 26. Se n. Harkin Requests Rate -Setting Informat ion from Insurers: After small business owners testified at a November 3 Senate HELP Committee hearing that rising health care costs are hurting their businesses, Senate HELP Committee Chair Tom Harkin (D - IA) sent detailed requests to Aetna Inc. , Humana Inc. , WellPoint Inc. , and UnitedHealth Group Inc. , asking the insurers to explain their premium - setting procedures. In the letters, Sen. Harkin also asked the companies to provide information about any employee earning over $5 million annually. Sen. Harkin requested the insurers222 responses by November 17; however, the letters are not subpoenas and carry no legal mandate ( Des Moines Register, 11/4 ; Kaiser Health News, 11/4 ). S enate Commerce Committee Analysis Suggests Insurers Overstated Their Medical Expenses: A Senate Commerce Committee analysis suggests that insurers have overstated the percentage of insurance premium collections spent on medical expenses. Americans Health Insurance Plans (AHIP) claims that insurers spend an average of 87 percent of insurance premium collections on medical expenses; however, a letter from Senate Commerce Committee Chair Jay Rockefeller (D - WV) to Cigna Corp. revealed a Senate analysis that showed that some insurance companies spend as little as 66 cents per premium dollar on medical expenses. Under the Senate analysis, top insurers spent an average of SAMHSA222s Weekly Financing News Pulse: National Edition November 9, 2009 11/9/09 3 74 percent of individual policy premiums and 80 percent of small business premiums on medical expenses. The Senate analysis is based on data from the National Association of Insurance Commissioners (NAIC) and excludes California data because the state does not file with the NAIC ( New York Times, 11/2 ; Bloomberg, 11/3 ; Kaiser Health News, 11/3 ). CMS Letter Provides CHIPRA M/SU Parity Implementation Guidance: On November 4, the Centers for Medicare & Medicaid Services 222 (CMS) Center for Medicaid and State Operations (CMSO) Director Cindy Mann sent a letter to state health care officials providing implementation guidance for the Children222s Health Insurance Program Reauthorization Act of 2009222s (CHIPRA) mental health and substance u se disorder parity requirements. The letter covers the law222s effect on Children222s Health Insurance Program (CHIP) programs and provides preliminary guidance for Medicaid programs on the extent to which M/SU parity requirements apply to them . CMS Eases Planned Medicare Rate Cuts for Some Specialists, Still Increases Primary Care Reimbursements: CMS announced October 30 that it will not implement its planned 10 percent Medicare rate cut for cancer and heart specialists designed to generate savings for primary care reimbursement increases. Instead, CMS will reduce such specialist payments less than 10 percent and do so incrementally over four years, beginning in 2010. CMS will still use the savings to increase Medicare reimbursement rates for family physicians and nurse practitioners, raising those rates by 4 and 3 perc ent respectively. The cuts, along with the traditionally delayed 21.5 percent payment reduction for all physicians, are scheduled to take effect January 1, 2010; however, Congress can still intervene to alter the rates ( Bloomberg, 10/31 ; Kaiser Health News, 11/2 ). In related news, CMS also issued a rule adjusting Medicare ho me health care reimbursement rates, increasing base rates by 2.5 percent, effective January 1 ( Healthcare Finance News, 11/2 ). D OJ Settles Medicaid False Claims Suit for $112 Million: On November 3, the U.S Department of Justice (DOJ) announced an agreement with nursing home pharmacy Omnicare Inc. and IVAX Pharmaceutical s under which the companies will pay a combined $112 million to settle charges that they engaged in an illegal kickback scheme to defraud Medicaid and increase the use of their drugs. Neither company admits wrongdoing under the deal; however, Omnicare will pay $98 million and IVAX will pay $14 million. Roughly $68.5 million will go to the federal government for its share of the Medicaid costs and $43.5 million will be returned to the affected states. In addition, both companies agreed to enter into corporate integrity agreements with the HHS Office of the Inspector General . The DOJ continues to investigate Johnson & Johnson222s potential involvement in the case ( DOJ via PRNewswire, 11/3 ; Kaiser Health News, 11/5 ). 1 5 States Sue Amgen for Medicaid Fraud: Fifteen (15) states filed suit against Amgen Inc. on October 30, alleging that the company222s marketing and distribution of the anemia drug Aranesp defraude d their Medicaid programs. The states claim that Amgen offered kickbacks to medical professionals to boost product sales and distributed free drugs while encouraging providers to bill Medicaid for the free doses ( AP via Los Angeles Times, 10/31 ). U pdate: WellPoint to Resume Enrolling Medicare Part D and MA Beneficiaries: On November 4, WellPoint Inc. announced that it w ill resume marketing Medicare Prescription Drug Benefit Program (Part D) plans and Medicare Advantage (MA) plans in the coming days, enrolling new members for coverage beginning January 1, 2010. In January 2009, CMS banned the company from marketing its SAMHSA222s Weekly Financing News Pulse: National Edition November 9, 2009 11/9/09 4 p roducts or enrolling new beneficiaries as a result of fraud investigations, but has since lifted those restrictions effective October 1 ( AP via Forbes, 11/4 ; Kaiser Health News, 11/5 ). U pdate: Aetna Completes Acquisition of Horizon Behavioral Health: On November 3, Aetna Inc. completed it s acquisition of Horizon Behavioral Health Services LLC. for $70 million. Under the deal announced in July, Horizon will become part of Aetna Behavioral Health ( AP, 11/3 ). Studies Released Drug Policy Alliance Brief Advocates Changes to Veterans222 Substance Abuse Treatment: A brief released by the Drug Policy Alliance (DPA) examines substance abuse and incarceration among veterans returning form the wars in Iraq and Afghanistan, issuing recommendations for improving treatment. Among other policy recommendations, the DPA recommends that the Departme nts of Defense (DOD) and Veterans Affairs (VA) expand veteran treatment programs to include medication - assisted treatment and adopt overdose prevention programs that target illicit drugs, alcohol, and prescription opioid. The DPA also recommends that stat e and federal governments improve and expand drug court programs to keep veterans out of prisons and jails ( Navy Times, 11/5 ). Health Care Leaders Think Medica re Provides Easy Access to Care, Ineffective Cost Controls : A Commonwealth Fund/Modern Healthcare Opinion Leaders survey, conducted September 9 to October 13, found that 83 percent of the 215 health care leaders polled believe that Medicare is 223extremely224 or 223very224 successful providing basic medical care to seniors. However, only 6 percent of respondents believe that the program has been successful leveraging its purchasing power to improve quality and 4 percent believe it has been successful controlling c osts. In addition, 81 percent of respondents support using Medicare222s purchasing power to drive down pharmaceutical costs and 75 percent support an independent Medicare advisory council ( Modern Healthcare, 11/2 ). RWJF Report Considers Lessons for Wisconsin222s BadgerCare Plus Coverage Expansion: The Robert Wood Johnson Foundation (RWJF) released a report analyzin g the successful expansion of Wisconsin222s BadgerCare Plus Medicaid program. Because of the expansion, Wisconsin was forced to cap enrollment, reaching maximum capacity three months after launching the program. The report notes that Wisconsin222s experience highlights a number of successful components for state and national health care expansions including, whole - family coverage, targeted auto - enrollment, expanded income eligibility limits, administrative responsibility for insurance verification, and aggre ssive outreach strategies pursued in partnership with community leaders ( RWJF, 10/16 ; Kaiser Health News, 10/30 ). KFF Brief Examines the CLASS Act: The Kaiser Family Foundation (KFF) released a brief examining the Community Living Assistance Services and Supports (CLASS) Act . The brief provides an overview of the long- term care insurance provision included in Congress222 major health care reform legislation, discussing the programs222 financing mechanisms and target audience ( KFF, 10/20 ; Kaiser Health News, 10/30 ). N PAF Whitepaper Examines Health Care Reform222s Effect on Access to Care: A whitepaper released by the National Patient Advocate Foundation (NPAF) examines the provisions of the major health care reform bills ( HR 3962 , SB 1679, and SB 1796 ) expanding coverage of pre - existing conditions, reducing out - of - pocket expense reductions, and eliminating annual and lifetime coverage limits ( PRNewswire, 11/2 ). SAMHSA222s Weekly Financing News Pulse: National Edition November 9, 2009 11/9/09 5 P olling Analysis Finds Current Attitudes Towards Health Care Reform Similar to 1994 Attitudes : An analysis of national health care reform opinion polls from fall 2009 and spring 1994, found that Ame ricans222 attitudes towards health care reform remain largely unchanged. Both sets of polls found that respondents believed that the health care system requires change and that many respondents approve of specific Democratic proposals. However, the polls also show that respondents do not believe that the proposed provisions would help them personally and fear increased costs and decreased quality under reform. The analysis is published in the New England Journal of Medicine ( Boston Globe, 11/5 ; Kaiser Health N ews, 11/5 ). S tudy Links Child Uninsurance and Mortality: Analyzing data from 23 million U.S. pediatric hospitals admissions, a study published in the Journal of Public Health found that uninsured children had a higher mortality rate than insured children (.75 percent versus .47 percent). The study found that uninsured children were 1.6 times more likely to die as a result of hospital admission than insured children and calculated that the uninsurance contributed to 16,787 deaths over the 18 year study period ( Kaiser Health News, 10/30 ; U.S. News & World Report, 10/29 ). Research Finds Gaps in Public Health Insurance Coverage: A study published in Health Affairs examined data from the Medical Expenditure Panel Survey (MEPS), finding that, despite public insurance programs, uninsurance rates remained high for low - income adults with chronic conditions (25 percent) and disabilities (15 percent). The study found two major gaps in public health coverage: residents who did not meet federally - mandated Medicaid eligibility criteria were roughly twice as likely to be uninsured as those who did; and low - income residents with chronic conditions living in southern states were more likely to be uninsured than similar residents living in other regions. The authors consider the implications of these findings for health care reform ( Kaiser Health News, 10/30 ). U ninsurance and Public Insurance Associated with Greater Mortality After Trauma in Children : A study published in the Journal of Pediatric Surgery found that uninsured children are three times more likely to die from trauma injuries than insured children. The study also found that publicly insured children, covered under Medicaid or CHIP, have twice the mortality risk of privately insured children after trauma hospitalizations. The authors speculate that, among other causes, treatment delay, receipt of fewer diagnostic tests, and decreased health literacy contribute to the disparity ( Kaiser Health News, 11/4 ; U.S. News & World Report, 11/3 ). Around the Hill: Hearings on Health Financing Senate HELP Committee : Increasing Small Business Health Care Costs November 3, 2:30 p.m., 430 Dirksen House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies : H1N1 Influenza Pandemic November 4, 10:00 a.m., 2359 Rayburn House Energy and Commerce Subcommittee on Health: H1N1 Preparedness November 4, 2:00 p.m., 2322 R ayburn SAMHSA222s Weekly Financing News Pulse: National Edition November 9, 2009 11/9/09 6 Senate Banking, Housing and Urban Affairs Committee : Commerce and HHS Nominations November 5, 10:00 a.m., 538 Dirksen Senate Veterans Affairs Committee : VA - Indian Health Service Cooperation November 5, 10:00 a.m., 418 Russell Senate Judiciary C ommittee : Reducing Recidivism at the Local Level November 5, 2:00 p.m., 226 Dirksen Senate Veterans222 Affairs Subcommittee on Health: Project HERO November 19, 10:00 a.m., 334 Cannon
