HCPro Health Plan Insider - April 1, 2009 | Recharging the Individual Mandate as Part of Health Reform View as a Webpage | Subscribe for Free
Recharging the Individual Mandate
As Part of Health Reform

Les Masterson, Senior Editor-Managed Care

The Health Reform Dialogue's report breathed new life in the individual mandate, but it couldn't find consensus on other pressing healthcare issues. Expect more of this in the healthcare reform debate. [Read More]
  April 1, 2009

 
Editor's Picks
Obama favors building on current healthcare plan
President Barack Obama said at an online town hall meeting that the country's employer-based healthcare system has filled the needs of most Americans and suggested that transforming healthcare under a different system would not be easy. The president said lawmakers should build universal healthcare on the current employer-based healthcare system rather than create a new system, such as single-payer healthcare. [Read More]
Democrats clear hurdle; now comes the hard part
Democratic chairmen of five Congressional committees have reached a consensus on the main ingredients for major healthcare reform: an individual mandate that requires all Americans to have health insurance and a public insurance option to compete against private insurers. Now comes the hard part—figuring out the details. They will need to decide how to pay to cover the uninsured Americans who can't afford coverage and how to handle state coverage mandates. Congressional leaders hope to have a bill ready for Congress by the end of July. Last month, Democratic leaders told Republicans that they have until September to come up with a compromise healthcare reform plan or they will barrel ahead with their own proposal through budget reconciliation, which is a shortcut that allows lawmakers to push a filibuster-proof bill through Congress. [Read More]
U.S. acts to ease costs of private Medicare plans
The Obama administration's new terms for private insurers involved in Medicare made one thing clear: insurers will face greater scrutiny under the Democrats. The changes will limit Medicare Advantage out-of-pocket costs, eliminate more than 25% of those plans, and make sure that Medicare Advantage plans don't charge patients more than traditional Medicare for dialysis, home healthcare, and other services. The president earlier announced Medicare Advantage payment cuts to private insurers. The new regulations and lower payment levels may push some private insurers out of the program, but so far no insurer has announced that it is withdrawing from Medicare Advantage. [Read More]
Sebelius confirmation hearings start
Kansas Gov. Kathleen Sebelius, nominee to lead Health and Human Services, was greeted warmly by the Senate Health, Education, Labor and Pensions Committee for the first of two confirmation hearings this week. Former Republican Sen. Bob Dole, who supported former Sen. Tom Daschle in his earlier bid to lead HHS, spoke on her behalf, trumpeting Sebelius' experience with health issues in her state. The similarities between Sebelius and Daschle don't end merely with Dole's support. Sebelius announced this week that she needed to amend three years' worth of tax returns to correct "unintentional errors" and paid back taxes and interest totaling about $8,000. She is the fifth Obama nominee to run into tax problems, which helped derail Daschle. Sebelius will next appear before the Senate Finance Committee, which votes on her suitability as a Cabinet member. That committee is expected to question her on the tax issue as well as her stance on abortion. [Read More]
Lawmakers consider taxes on healthcare benefits
A large healthcare reform package could include taxing medical insurance benefits, which opponents say could jeopardize the employer-based health system. Capitol Hill leaders from both parties are discussing the idea, which is opposed by many in Congress and organized labor. President Barack Obama opposed the idea during his successful campaign, but his administration has since told Congress that he won't block the plan as part of a large healthcare package. Taxing health benefits probably won't happen this year, but I think it's inevitable. [Read More]
UnitedHealth executives face skeptical Senate panel
The Ingenix story is the gift that keeps on giving for policymakers and elected officials. Senators sharpened their knives this week for two UnitedHealth Group executives, who spoke about UnitedHealth's Ingenix databases and whether insurers are fairly paid for out-of-network services. Sen. John D. Rockefeller IV, who is leading the hearings for the Senate Commerce Committee, describes the out-of-network payment process as "data laundering." New York Attorney General Andrew W. Cuomo already investigated Ingenix and reached a settlement with UnitedHealth that will lead to a new, independent database. UnitedHealth also agreed to pay $350 million to settle class-action lawsuits, and the American Medical Association is suing other insurers because of the database issue. During the hearing Tuesday, the two UnitedHealth executives acknowledged a potential conflict of interest with the insurer owning the databases, but denied any wrongdoing and dismissed concerns that the information was skewed to underpay doctors and lawyers. [Read More]
Are You a Top Leadership Team?
HealthLeaders Media is gearing up for its fifth year of the Top Leadership Teams in Healthcare program. Health insurers with varied specialties have won the Health Plan portion of the contest over the past three years, including Harvard Pilgrim Health Care, Erickson Advantage, and CareSource Management Group. If you think your organization has an outstanding teamwork story to share, submit your entry today. The deadline for submissions is April 30.
Managed Care Headlines
Health czar has deep ties to industry
Chicago Tribune - March 30, 2009
Walgreens' clinics to offer free care to jobless
Chicago Tribune - April 1, 2009
A lesson on healthcare from Massachusetts
New York Times - March 30, 2009
Doctors who prescribe more activity want insurers to offer more coverage
St. Louis Post-Dispatch - March 26, 2009
Physicians push for clean slate on Medicare reimbursement rates
Wall Street Journal Health Blog - March 31, 2009
For Geisinger Health System, less is more
Washington Post - March 31, 2009
Blue Cross, Connecticut hospital talks break down
Hartford Courant - March 31, 2009

Webcasts/Audio conferences
April 20: Service Lines Strategies Workshop 2009: Joint Replacement
April 28: Compensation Packages to Recruit and Retain Physicians in Today's Economy
April 29: Marketing Neurosciences: Service Line Strategies for Marketers
May 12: Service Lines Strategies Workshop: Cardiovascular Physician Alignment
On Demand: 5 Ways to Improve the Patient Experience at Your Hospital
From HealthLeaders Magazine
A Shifting Burden
High deductibles are spreading beyond the consumer-driven health plan niche—and helping change the way patients relate to providers. Consumer-driven health plans remain a relatively small percentage of the health plan market—but the premise behind CDHPs is spreading. [Read More]
The Big Switch
Many health plans are struggling to retain members who retire or lose group coverage, but there are steps that payers can take to improve conversion. [
Read More]
Listen Up
Standing Out During Difficult Times

Jeff Levin-Scherz, MD, assistant professor at Harvard Medical School and Harvard School of Public Health, talks about how health plans can add value in this difficult time. [Listen Now]
Guest Commentary
Three Types of Alignment for Better Payer-Provider Relations

The fundamental need in today's healthcare system is for the two largest constituents?payers and providers?to work together in alignment. It's time to shift the thinking and actions to the dynamic of how payers and providers work and interact with each other, writes Emad Rizk, MD, president of McKesson Health Solutions, in his new book, The New Era of Healthcare: Practical Strategies for Providers and Payer. [Read More]
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