Healthcare Roundup: One step closer to medical-loss ratio rules

The National Association of Insurance Commissioners (NAIC) voted unanimously Thursday to finalize new rules requiring insurance companies to dedicate more revenues directly to healthcare costs. 

A few technicalities aside, the NAIC kept their "medical-loss ratio" guidelines largely identical to the draft proposal the group approved in September. 

The insurance lobby had fought hard to convince commissioners that the draft would harm consumers' access to coverage, but NAIC members disagreed.

Kansas Insurance Commissioner Sandy Praeger told reporters Thursday that, while there were many amendments on the table, it "wasn't clear" that any one of them would have improved the initial proposal.

HHS likes what it sees

Health and Human Services (HHS) Secretary Kathleen Sebelius was quick to issue a statement saying the rules are "reasonable, achievable for insurers and will help to ensure insurance premiums are, for the most part, supporting health benefits for consumers." 

The recommendations now move to HHS, which still has to certify them. The agency plans to draft their MLR guidelines "in the coming weeks," Sebelius said.

The insurance lobby doesn't like what it sees

Karen Ignagni, head of America’s Health Insurance Plans, issued a one-sentence statement saying the current rules, if allowed to stand, "will reduce competition, disrupt coverage, and threaten patients’ access to health plans’ quality improvement services."

Consumer groups cautiously optimistic

Carmen Balber, Washington director for the advocacy group Consumer Watchdog, said the NAIC deserves a great deal of credit for resisting the pressure from insurers to alter the guidelines. Still, Balber said the final language allows plenty of opportunities for the industry to evade the consumer protections.

“Making these rules work will require tough scrutiny of insurance companies’ spending to make sure they don’t use loopholes in the law to pass off overhead costs as health care,” she said in a statement. 

Brokers weigh in as well

The insurance brokers lobby had pushed NAIC to consider brokers' fees a healthcare expense for the purpose of calculating medical-loss ratios. It didn't happen, but the National Association of Insurance and Financial Advisors (NAIFA) is hoping that could change down the line.

"While disappointed the NAIC did not believe it has the authority to modify the MLR definition to accommodate agent commissions," the group's president, Terry Headley, said in a statement, "NAIFA is hopeful that the NAIC and HHS will side with consumers by recognizing that agents need to be compensated for the vital assistance they provide consumers in managing day-to-day healthcare issues." http://bit.ly/9y7Njw

Liberal group launches effort to combat misleading healthcare reform ads

A coalition of liberal health and labor advocates launched a phone campaign this week designed to combat conservative claims that the healthcare law will steal benefits from seniors — claims Health Care for America Now (HCAN) says are false.

“These ads are smearing the records of people who stood up to the insurance companies and ended the worst abuses of consumers,” HCAN Executive Director Ethan Rome said in a statement. “The health care law improves health care for families, seniors and businesses.”

The phone campaign, Rome said, "is about warning people they shouldn’t be fooled by the onslaught of insurance company-sponsored propaganda.”

Goal to reach 500,000 seniors in 10 states

The group is making calls in support of Sens. Harry Reid (Nev.), Barbara Boxer (Calif.), Russ Feingold (Wis.) and Senate candidate Joe Sestak (Pa.). 

On the House side, HCAN is targeting districts represented by Illinois Reps. Melissa Bean, Bill Foster and Deborah Halvorson; Michigan Reps. Mark Schauer and Gary Peters; New York Reps. Scott Murphy, Bill Owens and Daniel Maffei; Ohio Reps. John Boccieri and Mary Jo Kilroy; Pennsylvania Reps. Chris Carney, Kathy Dahlkemper, Paul Kanjorski and Patrick Murphy; and Florida Reps. Suzanne Kosmas and Alan Grayson.

Included as well are districts represented by Reps. Dina Titus (Nev.), Steve Kagen (Wis.) and Tom Perriello (Va.).

Grassley wants HHS to investigate high-prescribing docs

Sen. Chuck Grassley, ranking member of the Senate Finance Committee, urged HHS on Wednesday to launch an investigation into doctors with itchy prescription fingers. 

The Iowa Republican says his own inquiry into the subject turned up:

• A Miami physician who wrote nearly 97,000 prescriptions for mental-health drugs for Medicaid patients — in less than two years; 

• An Ohio doctor who wrote 102,000 prescriptions in two years; 

• And a Texas doctor who, last year alone, wrote 14,170 prescriptions for Xanax.

"The federal government has an obligation to figure out what's going on here," Grassley said in a statement. "The taxpayers are footing the bill, and Medicare and Medicaid are already strained to the limit.  

"These programs can't spare a dollar for prescription drugs that aren't properly prescribed. The conclusion might be that there isn't any fraud, but it's important to reach a conclusion one way or the other and fix whatever is broken."

Former senators promote malpractice courts as balanced-budget solution

Over the summer, Esquire magazine put together a committee of former lawmakers to come up with ways to fix the country's spending crisis. On Thursday, former Sens. Bill Bradley, Gary Hart, John Danforth and Bob Packwood announced one element of their plan: the creation of medical malpractice courts.

"As an alternative to the current trial-by-jury system for medical-malpractice lawsuits, this proposal would decrease the number of frivolous lawsuits that reach trial, increase the speed with which meritorious lawsuits reach trial, and reduce administrative costs for the federal judiciary," the group said in a statement. 

"It would also discourage the practice of defensive medicine, whereby health-care providers, under the constant threat of litigation, often order unnecessary (and costly) tests and procedures to hedge against potential lawsuits."

A longer version of the recommendation appears in the November issue of Esquire.

Food fight!

Congress might be focused on November's midterms, but food safety advocates haven't forgotten about that amendment to the Democrats' food safety bill that would exempt small farmers from the new restrictions. http://bit.ly/cjGEpy

In a Thursday letter to Senate lawmakers, the Make Our Food Safe coalition is urging lawmakers to reject the amendment, which is sponsored by Sens. Jon Tester (D-Mont.) and Kay Hagan (D-N.C.). Carving out small farmers, the advocates say, ignores "the risk to human health posed by a particular food item." 

"As a result, high-risk foods would be exempt from safety regulations."

Not to be outdone, the small-farmers lobby weighed in as well. 

"Our strong hope is once [critics] look at the actual details of the amendment they will change their position," Ferd Hoefner, policy director of the National Sustainable Agriculture Coalition, said in a statement. 

"The sooner they remove this damaging new roadblock to passage of the Food Safety Modernization Act in the short time left in this session of Congress the better."