Back To The States?

President Barack Obama has called a televised summit for Democrats and Republicans on Feb. 25 to discuss health reform, and some Republicans already are deriding the idea as “political theater.”

With federal prospects for reform dimming, for the moment at least, it might be instructive to take a peek at what the states are doing about health care.

California. The state senate has approved creating a government-run health care system for the state, ignoring a veto threat from Gov. Arnold Schwarzenegger. The plan would cost an anticipated $200 billion per year. Also, the California Department of Managed Health Care has released rules that limit HMO wait times. The rules require that patients be treated by HMO doctors within ten business days of requesting an appointment and by specialists within 15 days. In addition, patients seeking urgent care that does not require prior authorization must be seen within 48 hours. California is the first state to set time standards for HMOs, which serve approximately 21 million state residents.

Connecticut. Insurance regulators in the state have given three of the top five insurers approval to raise rates for 2010 by double-digit percentages. Anthem Blue Cross and Blue Shield, Health Net of Connecticut, and ConnectiCare asked for group health plan rate increases of 15.78%, 19.09%, and 14.5%, respectively, for 2010. According to the health insurers and the Connecticut Insurance Department, the increased premiums will keep premiums in line with medical costs.

Florida. Major health insurers in the state have agreed to pay for care for members diagnosed with cancer who participate in clinical trials to avoid a legislative mandate on the issue. The “Clinical Trials Compact” ensures that cancer patients will receive continued benefits while being treated with experimental drugs and other therapies. Participating insurers are: Blue Cross and Blue Shield of Florida, Humana, Aetna, Cigna, UnitedHealthcare, Vista Healthplans, and AvMed Health Plans. In recent months, there had been a move toward legislation to eventually cover all phases of these cancer clinical trials, but these health insurers wanted to avoid a legislative mandate. Florida is the fifth state to use a compact for cancer trials, after Georgia, Michigan, Nebraska, and New Jersey.

Georgia. Georgia Health Commissioner Rhonda Medows has urged state lawmakers to adopt a tax hike on hospitals and health care plans to help with the state’s Medicaid deficit problem. Beginning on July 1, the state will face a $506 million shortfall in Medicaid funds. The recession has caused enrollment in Medicaid to soar: enrollment has increased 7.7% from June 2009 to 2010 to more than 1 million people.

Illinois. The Illinois Supreme Court has struck down a medical malpractice law enacted in 2005 that limited monetary damages to $1 million from hospitals and $500,000 from doctors for pain and suffering. The court said the law violates the state’s separation-of-powers clause between the branches of government by allowing lawmakers to interfere with a jury’s right to determine damages. According to the American Medical Association, courts in 16 states have upheld these types of laws, while those in 11 states have overturned them.

Maryland. A bill pending in the state would allow young adults to continue enrollment in their parents’ health care plan until age 30. Current law allows dependent individuals to remain on a parent’s plan until they are 25 years old. By expanding this to age 30, graduate students, veterans returning to school, and young adults who have been laid off and are seeking employment would be helped. Similar laws exist in New Jersey, New York, and Pennsylvania.

Minnesota. The state plans to charge counties extra to cover health care for their neediest residents beginning March 1. Previously, a $400 million General Assistance Medical Care program was available to help provide coverage for the poorest in the state, but the program is ending in an attempt to balance the budget. State legislators have proposed funding the program through surcharges on hospitals and health groups to draw down federal dollars and would levy a 10% match by counties to share the program’s cost.

Pennsylvania. Premiums for the state’s adultBasic health insurance plan will double in March from $330 per month to $600 per month. In addition, more than 40,000 participants will face new higher out-of-pocket costs, with higher copayments for doctor and emergency room visits and more expensive coinsurance requirements for services including chemotherapy, dialysis, and outpatient surgery. The Pennsylvania Insurance Department cited higher medical service use and escalating health care costs, combined with limited state funding, as the reason for the coverage changes.

Utah. The state has proposed legislation that would establish a state risk adjuster board to ensure consumer health risks are spread evenly among private insurers as they increase access to health insurance for 350,000 uninsured Utahns. The bill, HB294, also would permit businesses in Utah with more than 50 employees to be part of the Web-based exchange for medical insurance and information.

Washington. The state’s domestic partnership law went into effect on Dec. 3, 2009, and has some implications for employers in the state. The law provides that for all purposes, registered domestic partners must be treated the same as married spouses. This means that employment-related benefits must be extended to the registered domestic partner of employees on the same basis as spouses.