Healthcare Reform Round UpJuly 2010

What are the major stories?

• Rate hikes

• Electronic Health Records and “meaningful use”

• High-risk pool: is it enough?

• Public sentiment: Bleak.

Rate hikes are on. They’re off. Oh no wait, they’re back on again.

May 2010Feb 2009

June 2010

July 2010

http://consumerist.com/2010/06/1-out-of-5-medical-claims-processed-incorrectly-says-ama.html

Anthem and Aetna brought feelings of mistrust and anger to a boil as they first threatened customers with massive rate hikes, rescinded, then returned with same bad news. Add to that the embarrassment of mathematical errors as the initial cause of the rate hikes and a sea of news reports about bloated health insurance CEO salaries and medical claims processing errors.

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/02/11/BU2F15I06K.DTL&tsp=1 http://bscindustryupdates.blogspot.com/search/label/Anthem%20Blue%20Cross

Measure of transparency puts customer in control

“The state Department of Insurance has begun alerting customers by e-mail whenever health insurance providers submit planned rate hikes to the agency.” The hope is that the program will provide more transparency to the escalating premiums. "We want as many people as possible scouring these rate filings to ensure they are mistake-free," Insurance Commissioner Steve Poizner said in a statement.

http://www.insurance.ca.gov/0250-insurers/IndHlthRateFilings/

http://www.sacbee.com/2010/07/27/2916357/california-to-send-e-mail-notice.html

Electronic health records & “Meaningful use”

http://www.itchannelplanet.com/technology_news/article.php/3892161/Hospitals+Scrambling+to+Qualify+for+EHR+Incentives,+Study+Says

• Information Technology: On Tuesday, there will be a hearing of the health subcommittee of the House Energy & Commerce Committee on putting in place the Health Information Technology for Economic and Clinical Health Act, known as the HITECH Act. The law was adopted last year as part of the economic stimulus legislation to encourage the use of health information technology and electronic health records by hospitals and doctors. The committee provides a Webcast at http://energycommerce.house.gov/

Last year a law was adopted as a part of the economic stimulus to encourage the use of health information technology and electronic health records by hospitals and doctors. In order to qualify, hospitals must meet “meaningful use” criteria to get a piece of the $17.2 billion pie set aside for EHR adoption under the new law.

However, many hospitals don’t think they will get a piece of the funding to implement EHR use. According to a PricewaterhouseCoopers LLP report, there is a lack of clarity on the criteria to get funding, “a shortage of skilled IT workers, unpreparedness of external vendors and lack of networking capabilities and bandwidth to handle massive data flow associated with EHR implementation.” - ITChannelPlanet

Add to that the worries over data privacy and security that come with electronic records.

http://www.huffingtonpost.com/rita-k-bowen/the-next-big-healthcare-d_b_646456.html

Sink or swim?

http://www.bizjournals.com/sacramento/stories/2010/07/26/story8.html?b=1280116800^3697791&s=industry&i=insurance

• An Anthem spokesperson said the company declined to participate in the federally supported high-risk pool because the program is "temporary in nature (pools would operate until 2014) and ... would require significant changes to our existing systems in order to implement."

• Many worry that the funds could be exhausted by 2011

Will the high-risk insurance pool plan work?

Resources Some are opting out

• The government is providing California $760 million to create the high-risk pool for those with pre-existing conditions. That gives the state a budget of “well over the $200 million a year. Beneficiaries will pay premiums, too, but no more than 35 percent of the cost of benefits. The money is expected to cover almost 25,000 people a year, though estimates suggest there are more than 200,000 Californians unable to get insurance because of pre-existing conditions.” -Sacramento Business Journal

A bleak outlook• People are feeling disappointed with their president and with his policies

including reform. Morale is slowly sinking and the media is serving up a plate-full of negative outlook on our economic future.

• 48% said they were “in favor” of the reform as of June, 41% unfavorable and 10% undecided. Across political party lines, people are generally in agreement about the reform. But many see politicians as pushing reform only for votes and not for the good of citizens.

• Anthem’s rate hike squabble has only generated greater distrust of insurance companies and fed the general sentiment that they make too much money.

“Public Opinion on Health Care Issues,” by The Henry J. Kaiser Family Foundation, June 2010

Thank you for your time.