Monday, December 21, 2009

Blue Cross and Blue Shield of Georgia Statement on For-Profit Health Insurance Tax Amendment

On December 19, Senator Reid released his Manager's amendment to the health care reform legislation currently being discussed in the U.S. Senate. One provision in the amendment involved the $6.7 billion annual tax that will be levied on the health insurance industry. As the Congressional Budget Office has stated, this tax will get passed on to consumers through higher premiums. In his amendment, Senator Reid put forth that non-profit health insurance companies will be exempt from this tax -- in essence leaving for-profit plans, and their members, to shoulder the entire tax burden.

What does this mean to the nearly 91 percent (5,285,472) of Georgians that have health insurance provided by for-profit companies?

It means Georgia's share of the $6.7 billion tax will increase. It will directly impact Georgia's insured population and will cause premium amounts to increase even more under this legislation. Because a greater percentage of Georgians are insured by for-profit companies (91 percent) than the national average (55 percent), Georgia taxpayers will subsidize states like Michigan, which has a very low enrollment in for-profit health insurers (23 percent).

Any proposal to tax only for-profit health plans will further exacerbate the un-level playing field for not-for-profit plans, without improving access to health benefits coverage or enhanced health services. While some plans are not-for-profit, that does not mean they are not "profitable." Insurers are required to generate a "net income" in order to help ensure they can pay future claims by members. Not-for-profit simply reflects a tax status under the Internal Revenue Service Code. In many states, the net income on a per-member, per-month (PMPM) basis for not-for-profit health plans is actually higher than that of the for-profit health plans.

Over time, un-equal taxation will lead to the erosion and potential insolvency of for-profit plans, as a progressively smaller share of the overall market would bear the burden of sustaining the entire amount of the tax. Ultimately the government would receive no revenue from the tax when there are no for-profit entities remaining subject to the tax.

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Sunday, December 20, 2009

AHIP Statement On Senate Health Care Reform Legislation

/PRNewswire/ -- Karen Ignagni, President and CEO of America's Health Insurance Plans (AHIP), released the following statement today on the Senate health care reform legislation:

"The debate before us today is not whether insurance market reforms are needed. In fact, health plans proposed and support a complete overhaul of insurance market rules and new consumer protections to ensure all Americans have guaranteed access to affordable, portable coverage. The critical policy questions are whether the current legislation can bend the cost curve and result in a sustainable system. While the bill makes important improvements in access and takes steps towards cost-containment, it lacks accountability to ensure that costs are brought under control. Moreover, this bill includes provisions that will increase costs for families and small businesses and disrupt the quality coverage on which millions of Americans rely today."

Barriers to affordability:

-- A new $70 billion premium tax that will increase the cost of health
care coverage for millions of Americans and fall primarily on small
businesses and those who purchase coverage in the individual market.
-- More cost shifting to patients with private coverage as providers are
forced to make up for hundreds of billions in reduced Medicare
-- New market and rating rules that will increase premiums for
individuals and small businesses with coverage today.

Disruptions for current policyholders:

-- New regulatory requirements and benefit mandates that go into effect
beginning next year - before access provisions go into effect - that
will cause major disruption for millions who have already enrolled in
their plan for next year.
-- A new federal plan that would preclude many high-quality plans from
participating and increase complexity in the exchanges.
-- Arbitrary caps on administrative costs that will undermine essential
health care services, such as disease management and care coordination
programs, investments in health information technology, programs to
root out fraud and abuse in the health care system, and new
administrative simplification requirements.
-- Major cuts in Medicare Advantage benefits beginning next year that
will ultimately result in millions of seniors losing their current

"These issues need to be resolved if the country is to make health care coverage more affordable and put the system on a sustainable path. Health plans will continue to work to solve the problems that have been identified."

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Thursday, December 17, 2009

States Get Bonuses for Boosting Enrollment in Children's Health Coverage‏

HHS Secretary Kathleen Sebelius today announced the award of more than $72 million to nine states for making significant progress in enrolling children in health coverage through Medicaid and improving access to children's coverage through Medicaid and the state children's health insurance program.

Funding for the "performance bonuses" was included in the Children's Health Insurance Program Reauthorization (CHIPRA) law. CHIPRA also set performance goals that states must meet to qualify for a bonus.

"Today, we're happy to reward states that have taken important steps to help insure more children and made a real difference in the lives of families across the country," said Secretary Sebelius. "These awards will provide crucial support and help states continue to serve children and families."

States receiving funds today include: Alaska, Alabama, Illinois, Louisiana, Michigan, New Jersey, New Mexico, Oregon, and Washington. (See below for a complete list of state awards.) Awards vary by state according to a formula set out in CHIPRA but total $72.6 million this fiscal year.

To receive these performance bonuses, states had to meet two types of performance goals set forth in the CHIPRA statute. States had to qualify by adopting at least five of eight listed program features-like providing 12 months of continuous eligibility, using a joint application for both Medicaid and the Children's Health Insurance Program (CHIP) and streamlining eligibility renewal processes-that are known to encourage enrollment and retention of eligible children. States also had to document significant increases in Medicaid enrollment among children over the course of the year.

Performance bonuses are not the only federal incentive for states to maintain and expand their Medicaid programs. A short-term boost in Medicaid reimbursement rates authorized by the American Recovery and Reinvestment Act (ARRA) also provided relief to states with suffering economies, enabling them to extend care to eligible children.

"In the midst of the worst economic downturn since the Great Depression, decisive action in ARRA and CHIPRA, along with focused state activity, helped ensure that children got the health care they need," said Cindy Mann, director of the Center for Medicaid and State Operations within the Center for Medicare and Medicaid Services (CMS). "We are pleased to see the success these states have achieved as well as the actions to enroll eligible children taken by other states that we expect may qualify for the bonus next year."

Today's announcement closely follows the release of a study by the Kaiser Family Foundation's Commission on Medicaid and the Uninsured which also credited ARRA and CHIPRA with enabling States to expand access to care for low-income, uninsured children. In a 50-state survey, the Commission concluded that 26 states expanded and/or simplified their Medicaid and CHIP programs in 2009. A copy of the complete report can be found at

State award amounts today are:
Alabama $39.1 million
Alaska $789,000
Illinois $9.1 million
Louisiana $1.5 million
Michigan $3.7 million
New Jersey $4.2 million
New Mexico $5.1 million
Oregon $1.6 million
Washington $7.5 million

Total: $72.6 million

CMS today also released a letter to state health officials providing more detailed guidance on the criteria for qualifying for a bonus payment for 2009 and in future years. That letter will be available on the CMS web site at and also on the Insure Kids Now website at

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Monday, December 14, 2009

NORD Calls for Immediate End to Lifetime Insurance Caps

/PRNewswire/ -- The National Organization for Rare Disorders (NORD) today called upon Congress to put an immediate end to lifetime and annual health insurance caps. In a full-page ad in The Politico, a newspaper distributed widely on Capitol Hill, NORD said the current Senate health reform bill includes loopholes that would allow caps to continue for most Americans, contrary to what many people believe.

"NORD supports health care reform and welcomes the promises made by President Obama and Congress to eliminate lifetime and annual caps," said NORD President Peter L. Saltonstall. "However, under the current version of the Senate bill, caps would continue for several years for many people and would never be eliminated for others."

Private insurers often set lifetime or annual caps on the amount of health care coverage an individual may have. For Americans with chronic diseases, rare disorders, or major medical crises, this can lead to financial crisis or bankruptcy when insurance benefits are exhausted.

The health care reform debate has focused a spotlight on this problem. President Obama promised this fall that the caps would be eliminated under health reform, noting that insurance companies would "no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or a lifetime." Originally, the Senate health reform debate also advocated eliminating the caps.

However, the current version of the Senate bill provides for "grandfathering" existing insurance plans so that existing plans would be subject to annual lifetime caps indefinitely. The bill also allows self-insured plans to impose annual or lifetime caps indefinitely, which means that many people with employer-provided insurance would still be subject to caps. Even when the bill would require eliminating caps, it would not require doing so for several years.

Earlier this fall, NORD sent a letter to all members of Congress and President Obama outlining four measures that it considers essential to any health reform plan: prohibiting discrimination based on pre-existing conditions; protecting patients against catastrophic out-of-pocket costs and lifetime or annual caps; prohibiting insurers from canceling policies as a result of medical diagnoses; and including tax credits and other direct financing support to assure that all Americans can afford coverage.

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Insurance Now Subject to Federal Jurisdiction

/PRNewswire/ -- On December 9, 2009, the United States Court of Appeals, Tenth Circuit, affirmed the federal government's position that private insurance companies are "plans" and therefore subject to federal jurisdiction. (US vs. Frost)

Although other federal courts have held that contracts issued by insurance companies may be subject to federal jurisdiction under Title 18 Section 1347, US vs. Frost is the first case an insurance company itself has been held to be a "plan," because, as the government claimed in this case, all insurance companies are "plans." At trial and initially on appeal in this case, the government maintained the position that insurance contracts are "plans," but to avoid a constructive amendment, changed their theory claiming that all insurance companies are "plans" as a "matter of law" and the 10th Circuit agreed.

Ironically, the term "plan" was first adopted by ERISA in 1974. Although ERISA generally excluded insurance companies as "plans," the federal government now claims that health insurance companies are the private equivalent of Medicare and Medicaid which are "plans." Therefore, all insurance companies that make payments for the cost of medical services are "plans" under federal law. The 10th Circuit agreed and upheld the district court's finding that simply paying a medical claim qualifies an insurance company as a "plan."

Not only does this ruling open the door for the federal government to hold all insurance companies subject to ERISA, but it automatically and retroactively subjects all insurance companies to federal jurisdiction under Title 18, 669, 1035 and 1347 by qualifying them as "Health Care Benefit Programs" under 24(b).

If upheld by the Supreme Court, a quantum leap toward federal regulation of health insurance companies will be complete. Redcorn and Frost, the defendants in the case, stated they would ask the Tenth Circuit to reconsider the matter 'en banc' before they appeal to the Supreme Court.

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Tuesday, December 08, 2009

Save Flexible Spending Plans Applauds Amendment to Protect Flexible Spending Accounts

/PRNewswire/ -- Save Flexible Spending Plans, a national grassroots organization dedicated to protecting flexible spending accounts (FSAs), praised Sen. Charles E. Schumer (D-NY) for filing an amendment to the Patient Protection and Affordable Care Act that would help protect the future use and value of FSAs. The amendment, filed yesterday afternoon, would adjust for inflation the currently pending $2,500 cap on FSAs, helping to ensure that participants will be able to meet their out-of-pocket health care needs over time.

"We are encouraged that Sen. Schumer filed an amendment to protect FSAs, a benefit relied upon by more than 35 million working American families to manage and hold down their health care costs," said Joe Jackson, chairman of Save Flexible Spending Plans and CEO of WageWorks Inc., a benefits company based in San Mateo, CA. "Without indexing the $2,500 contribution cap for inflation, millions of participants, including those battling chronic illnesses, will see the value of their FSAs quickly erode. The Schumer amendment would solve this problem, ensuring that access to FSAs stays in line with increasing costs. Filing of the amendment further acknowledges the importance and support in the Senate for preserving FSAs as a valuable cost-saving benefit."

Failing to adjust the contribution cap for inflation, as had been crafted in legislation passed by the House of Representatives, will cause the value of a $2,500 FSA to plummet to less than half its worth within a decade.

"Following the September introduction of Sen. Baucus' (D-MT) health care reform legislation, Senate Finance Committee members from both parties offered amendments to protect FSAs," added Jackson. "We are hopeful that once again, Senators from both sides of the aisle will sign on in support of the Schumer amendment and his solution that is critical to protecting FSAs."

Beyond the need to adjust the contribution cap for inflation, there are still concerns about the unreasonably low amount of the cap, which has been proposed. The restrictions will force approximately 7 million hard-working Americans who use their FSAs to pay for out-of-pocket health care expenses greater than $2,500 to pay higher taxes and health care costs. Federal employees who currently enjoy a $5,000 limit on FSA contributions will see their access to FSAs cut in half. Additionally, state employees in 46 states who currently have FSA contribution limits set at $3,000 or more will be negatively impacted. Sadly, those with the highest out-of-pocket health care costs - the sickest - will be hit the hardest by restrictions on FSA use.

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Insurance Industry Facing Uncertain Regulatory Environment, Competitive Shake-Up, Says PricewaterhouseCoopers Report

/PRNewswire/ -- The insurance industry may not see a return to relative stability and certainty for a few years as it reacts to the effects of regulatory reform, increased government intervention and potential tax law changes in the aftermath of the financial crisis, said PricewaterhouseCoopers LLP in a report released today. Within five years, the industry landscape could look markedly different, and Americans may find their insurance policies underwritten by a handful of large, well-capitalized firms that can demonstrate financial strength and economies of scale.

The PricewaterhouseCoopers report, entitled "Emerging from the Storm: The Day After Tomorrow for Insurance," outlines nine key developments that are expected to reshape the insurance industry and their strategic implications during the next five years. The most significant of these developments for U.S. insurers will likely be sweeping regulatory changes resulting from proposed legislation to reform health insurance and increase federal oversight of insurance and financial industries.

The majority of regulation of insurance firms in the U.S. occurs at the state level, but there is political pressure to expand federal oversight. Creation of a Federal Insurance Office could provide federal policymakers with the information and resources to better respond to crises, mitigate systemic risks and help ensure a well-functioning financial system, but it could also lead to dual regulation at both the state and federal levels.

"Insurers are in the business of managing risk and measuring probability. They don't like uncertainty, yet they are facing two massive reform initiatives, the outcomes of which are unknown but could alter their destiny," said Bill Chrnelich, partner, PricewaterhouseCoopers' insurance sector. "Some insurers are taking a cautious, wait and see approach, while others see this period as a once-in-a-generation opportunity to shape their future."

According to PricewaterhouseCoopers, the insurers most likely to succeed once regulatory changes are enacted are those that closely monitor developments and create business strategies that anticipate the most likely possibilities for reform. In addition, they will carefully factor the following considerations into their business decisions:

-- Insurance Industry consolidation: The U.S. insurance market remains
highly fragmented, and the strong underlying rationale for
consolidation and restructuring means that merger and acquisition
activity may be set to accelerate rapidly, particularly as larger,
better-capitalized firms consume smaller firms. Consolidation is
expected to help to deliver the capital stability and economies of
scale that will be important in attracting customers and demonstrating
financial strength not only to ratings agencies but also to
third-party distributors whose "ownership of the customer" makes them
a key determinant of an insurers' fate.

-- The end of innocence for retail investors: The faith of investors, who
had become accustomed to high yields but were unaware of the related
risks, appears to have given way to shock, disillusionment and
caution. The pursuit of innovation appears to have been displaced by
a focus on stability, risk management and demand for simpler, more
straightforward and transparent policies and investment products such
as index-linked investments. An example of this is the recent
resurgence in demand for whole life insurance. The apparent desire
for guarantees, however, could create dilemmas for insurance companies
that want to scale back such products as they seek to limit risk.
Potentially higher costs of risk and guarantees, along with what may
be higher commission payments to distributors, could change product
economics, and insurers will need to better understand component
costs, pricing and profit profiles.

-- Mounting uncertainty over tax: As debts and fiscal deficits mount,
governments are looking for ways to increase their tax revenues. They
will look closely at insurance companies, as the industry is a major
source of potential tax receipts and has moved significant business
capacity to other jurisdictions in recent years. Accordingly,
insurers can expect renewed scrutiny of their tax planning techniques,
as well as more stringent requirements for transparency and
information exchange relating to clients.

-- Organic restructuring: As a result of the financial crisis, many
insurers have been forced to raise prices, restrict the pursuit of new
business or withdraw from high risk and peripheral markets. As
insurers withdraw from some of their geographic markets and scale back
particular lines of business, the market shares and opportunities for
those that remain could sharply increase, leading to a significant
reconfiguration in the list of leading players. Companies with a
better understanding of their risks are likely to be in a stronger
position to capitalize on potential openings that less-informed and
less-assured competitors may miss.

-- Rethinking insurance financial reporting: Many insurance executives
justifiably complain that their share prices fail to reflect the true
level of value being created within their business. Without an
industry consensus on a genuinely relevant, intelligible, and
comparable basis of accounting and disclosure, insurers may find it
increasingly difficult to compete for capital. With funds
constrained, many portfolio investors could simply choose to put their
money elsewhere, leaving the insurance industry with major challenges.
According to PricewaterhouseCoopers, it seems imperative that the
industry come together to develop a basis of relevant disclosures that
reflect the nuances of their business and satisfy analyst and investor

-- Blurring the lines between the public and private sector: The
relationship between the public and private sectors could change as
the government exerts a stronger influence over the insurance market
as a result of bailouts, regulatory reform, and greater control over
pensions, healthcare, trade credit and mortgage support.

-- Greater scrutiny of executive compensation: Two concerns raised by the
financial crisis were the lack of understanding of risk at the board
of directors' level and compensation for senior executives. With
appointment of the Special Master for TARP Executive Compensation, in
the United States, insurers are likely to base much more of their
performance-related pay on risk-adjusted measures, aligned to their
business strategy. They also are expected to face tougher regulation
over how compensation is governed.

-- Challenging prospects for reinsurers: While demand for reinsurance is
likely to increase within emerging markets, this is unlikely to offset
the decline in reinsurance buying in developed markets and may force
many reinsurers to rethink how they sustain profitability and growth.
The trend toward higher retention of straightforward risks could
accelerate. As companies become more risk-aware through advances in
enterprise risk management, they will be better able to choose what
risks to retain and which to reinsure.

"There is only one certainty for the insurance industry: change is coming and, as a result, the competitive landscape will be very different in five years from what exists today," added Chrnelich. "This will jeopardize some insurers' business, but it should also enable those who are better prepared to excel in a new environment. Success will likely depend on close monitoring of developments and the ability to quickly capitalize on opportunities as reforms and changes within the industry become clearer."

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Friday, December 04, 2009

Medicare Open Enrollment Begins: Now Is The Time To Review Your Plan

(NAPSI)-You may know that new Medicare prescription drug and health plan choices are offered each year. Medicare's Open Enrollment Period runs through December 31.

Open Enrollment is your chance to review your current plan-including your Original Medicare coverage-compare it with your other options and make sure you're getting the best available coverage for your health care needs.

Your current health plan may have changed its cost or coverage for 2010, or maybe you'd like a plan with a lower deductible.

If you've had any changes in your health, it's particularly important for you to double-check your coverage during Open Enrollment so you can make sure that any new treatments or drugs are covered by your plan.

Since coverage varies by plan, know what's important for you. For example, make a list of the drugs you take so you can make sure they're covered by the plans you're considering.

If you are in Original Medicare and don't have prescription drug coverage, you can join a Medicare drug plan during Open Enrollment.

Medicare has several ways to get you the help you need to find a plan that works for you.

• Visit, where you can get a personalized comparison of the costs and coverage of the plans available in your area.

• Call 1-800-MEDICARE (1-800-633-4227) to find out more about your coverage options. TTY users should call 1-877-486-2048. Medicare customer service representatives are available 24 hours a day, seven days a week with multiple language options and resources for people with disabilities.

• Watch your mailbox for the 2010 "Medicare & You" handbook. The handbook is mailed to all Medicare households each fall and includes a listing of all plans in your area. This handbook is also conveniently available online at

• Meet one on one with a trained expert for personalized assistance. Call 1-800-MEDICARE or visit to find a Medicare specialist in your area. Select "Find Helpful Phone Numbers and Websites."

Important Medicare Enrollment Dates:

Dec. 31: Open Enrollment ends. Last day to join or change your Medicare drug plan.

Jan. 1: Your new plan coverage begins.

This message is brought to you by the U.S. Department of Health & Human Services.

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Thursday, December 03, 2009

Sebelius Statement on Benefits of Health Insurance Reform for Businesses

HHS Secretary Kathleen Sebelius today highlighted the benefits of health insurance reform for businesses and released a new fact sheet regarding a recent analysis from the Congressional Budget Office.

"Businesses across the country are struggling under the weight of high health care costs," Secretary Sebelius said. "Health insurance reform will help lift this burden, help businesses prosper, and ensure workers have the affordable, quality health care they need."

A fact sheet regarding the analysis is included below.

Fact Sheet: New CBO Analysis Confirms Benefits of Health Insurance Reform for Businesses

American businesses know the health care status quo is unacceptable. Since 2000, premiums have more than doubled, a rate three times faster than the growth in wages. Between 2000 and 2009, the percentage of firms offering coverage fell from 69 to 60, with much of that drop occurring in the past year alone. Small businesses in particular struggle under the current health care system. For firms employing less than 10 workers, the erosion in coverage is striking -- from 57 percent offering coverage in 2000 to 46 percent offering coverage in 2009. If we do nothing, over the next ten years, health care costs for large businesses are projected to reach $28,530 per employee, a 116 percent increase from 2009.

A new analysis by the Congressional Budget Office (CBO) affirms that businesses' health insurance costs will be lower under health insurance reform -- even though the analysis does not take into account the full range of policies that will benefit businesses.

Health Insurance Premiums for Businesses According to CBO. In a November 30 letter to Senator Evan Bayh, CBO assesses the impact of the Patient Protection and Affordability Act on premiums for the individual, small-group, and large group markets. In 2016, CBO estimates that 159 million or 83 percent of privately insured people will be insured through employers.

Premiums for small business will go down. Small businesses are likely to see premiums drop by 1 to 4 percent under the proposal due to lower prices. These lower prices come from:

-- Lower administrative overhead. Right now, each small business
has to consult with a broker or hire someone to collate plan
information, assist employees with decisions, and handle issues as they
arise. Under reform, in the exchange, there will be people whose job it
is to provide plan information and facilitate enrollment. The exchange
centralizes what is otherwise a process that is extremely duplicative,
streamlining administrative costs and lowering premiums.
-- Greater competition. CBO attributes savings to "providing a
centralized marketplace in which consumers could compare the premiums of
relatively standardized insurance products." This includes competitive
pressure from a public health insurance option.
-- Administrative simplification. Physicians spend on average about
140 hours and $68,000 a year just dealing with health insurance
bureaucracy. By simplifying and standardizing paperwork and
computerizing medical records, doctors will be able to focus on caring
for their patients instead of dealing with bureaucracy. CBO estimates
nearly $20 billion in Federal savings over 10 years, with additional
savings accruing to businesses and families.

Up to 3 percent premium savings as the risk pool for employer-based coverage improves. Today, businesses have seen their premiums skyrocket every year, with many facing double digit percentage increases in their premiums. Health insurance reform will stop this trend.

With nearly 30 million additional Americans gaining health insurance, the purchasing pool for businesses will expand and, largely, improve. Big businesses will save from 0 to 3 percent on premiums due to the changing risk pool while small businesses could save 1 percent on

Better options for small businesses. Small businesses would gain access to the health insurance exchanges and new benefit options and tax credits under reform.

-- 3.6 million small businesses could qualify for a tax credit to
help pay their premiums.[vii] An estimated 12 percent of people insured
through small businesses will qualify for tax credits that lower
premiums by 8 to 11 percent. This translates into $620 to $860 for
individuals and $1,540 to $2,120 for families assuming that the coverage
is comparable to what they get today.
-- Today, small businesses often have coverage that has high
deductibles and gap-ridden benefits. The legislation offers such
businesses better options that CBO assumes businesses will take. Such
better coverage has premiums that are 0 to 3 percent higher than the
average plans today, but will save money for employees by ensuring they
are not forced to pay high out-of-pocket costs for services not covered
by their current insurance.
-- In the current health insurance system, small businesses may see
premiums skyrocket if just one or two workers fall ill and accumulate
high medical costs. Health insurance reform will prevent insurance
discrimination based on health status, meaning that small businesses
will no longer be unfairly penalized if a worker falls ill.

9 to 12 percent premium savings for high-premium plans under current law. By assessing high-cost plans, the excise tax encourages businesses and individuals to streamline coverage, leading to lower premiums over time.

-- CBO estimates that the 19 percent of people in employer-coverage
in high-cost plans today will pay 9 to 12 percent less under reform.
This translates to premium savings of at least $835 for single and
$2,070 family policies.
-- This could yield increases in workers wages, by around $70
billion in 2019.

Nearly $10 billion in savings for small businesses.

-- Under current law, CBO estimates premiums to be $7,800 for
single policies and $19,300 for families in the small group market.
-- Small businesses that opt for comparable coverage under reform
could save up to $390 for single policies and $965 for family policies.
Assuming all 25 million people insured through small business save at
least $390 (more for families), this will yield nearly $10 billion in
savings in 2016 alone.
-- Additional savings will accrue to low-wage, small businesses
that newly offer coverage in the exchange. CBO estimates that roughly
12 percent of people in the small group market would get the credit
which would reduce premiums by about 10 percent in 2016. Multiplying
this by the population and average premiums in the report, this suggests
that about one and a half million people would save roughly $780 per
person on premiums in 2016.
-- Even those that CBO estimates will "buy-up" will save, paying
$100 less per family for coverage that is more protective.

At least $13.4 billion in savings for large businesses.

-- Under current law, CBO estimates premiums to be $7,400 for
single policies and $20,300 for families in the large group market.
-- CBO estimates that, under reform, large business premiums will
drop by $100 per single policy and $200 per family policy. With 134
million people enrolled in such coverage, this translates into at least
$13.4 billion in savings in 2016 alone.

Businesses can keep what they have.

-- CBO affirms that any proposed benefit mandates would not affect
the small or large group markets: "The requirement would have relatively
little effect on premiums in the small group market, however, because
most policies sold in that market already cover those services and would
continue to cover them under current law."
-- CBO also affirms the effectiveness of the grandfather policy:
"Further, small group policies that are maintained continuously would be
grandfathered under the proposal."
-- In the large group market, CBO affirms that "[Benefit]
requirements would have no significant effect on premiums in the large
group market."

No cost-shifting to the employer-based insurance market.

-- CBO states: "... CBO's assessment is that the legislation would
have minimal effects on private-sector premiums via cost shifting."

Additional Policies To Benefit Businesses. CBO does not include in its analysis several additional policies in the Patient Protection and Affordable Care Act that would benefit businesses.

Reinsurance for businesses that cover early retiree plans.

-- The proportion of employers that offer retiree coverage has been
declining precipitously over time, from 66 percent in 1988 to 29 percent
in 2009.
-- The proposal would provide a time-limited, Federal reinsurance
program to cover some of the cost of covering early retirees. This
translates to savings of up to $1,200 off the premium of every family
plan offered by that company.

Policies to slow health care cost growth.

-- Insurance oversight: In recent years, several states' insurance
commissioners have rejected unjustifiably high premium increases in the
small group and individual insurance markets. Health insurance reform
will allow insurance commissioners to continue to play this important
role and require transparency and oversight of premium increases.
-- Delivery system reform. Health insurance reform will invest in
care innovations such as accountable care organizations, make healthcare
providers more accountable and efficient through value-based purchasing,
and improve quality and patient safety, including reducing preventable
readmissions. A recent report by the Business Roundtable found that if
many of the delivery system reforms were adopted by the private sector,
large businesses could save $3,000 per employee by 2019.
-- Lowers expensive drug costs. Biologic drugs are some of the most
expensive drugs on the market, and yet there is no streamlined avenue to
get generics on the market to provide lower-cost alternatives. Reform
will create an expedited process to make generic biologic drugs
available, significantly lowering drug costs.

Immediate benefits. While the CBO report provides savings estimates for 2016, several of the policies discussed above would take effect immediately, including early retiree reinsurance, administrative simplification, small business tax credits, and increased oversight of the insurance industry.

Benefits to Businesses Beyond Lower Costs. CBO focused exclusively on health insurance premiums which are critical to businesses. There would be other benefits of health reform for businesses as well.

Improved workplace productivity.

-- The Institute of Medicine found that lost productivity due to
untreated illness among uninsured workers cost businesses between $75
billion and $150 billion per year. Expanding coverage to the uninsured
will create a more productive workforce.
-- Current job-lock (inability to leave current employment if it
will result in loss of health insurance) has been demonstrated to hurt
the economy through reduced productivity, and prevents an employee from
taking a job with potentially higher wages. By ending limitations on
coverage based on pre-existing conditions and expanding portable
coverage options through the health insurance exchange, reform will
increase the flexibility and productivity of the workforce.

New jobs.

-- Bringing down the cost of healthcare will enable investments in
business and job creation. The President's Council of Economic Advisers
(CEA) estimated that if the annual growth rate of health spending slows
by 1.5 percentage point, new jobs could rise by 500,000.
-- The health insurance exchange will expand options for coverage,
making small businesses a more attractive place for people to work, and
encouraging people to start up businesses of their own.
-- Health insurance reform could save 80,000 jobs in the small
business sector by 2019 and increase take-home pay by almost $30

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Friday, November 13, 2009

Rite Of Passage: The Plight Of Uninsured Young Adults

(NAPSI)-The health insurance coverage issue may uncover some surprises for certain Americans.

One segment of the population that's particularly affected by the uninsured problem is young adults between the ages of 19 and 29. They represent 31 percent of the nation's uninsured.

What a Difference a Year Makes

Young adults usually begin with health insurance coverage under their parents' plan or a public insurance program. But the 19th birthday is a crucial milestone for the health coverage of many young adults in the U.S.

Public programs such as Medicaid usually end eligibility at the 19th birthday. Employer-sponsored health insurance plans often won't cover young adults as dependents under their parents' policy after 19 years of age unless they are enrolled in college.

Young people, even working full-time, may not be offered or able to afford health insurance. Others believe in their own "invincibility" when it comes to future health concerns.

The Myth of the Not-So "Invincibles"

Actually, young adults are more susceptible to some illnesses than any other population. Over 40 percent of uninsured young adults have characterized their health as only fair or poor.

To address the problem, health care reform legislation includes a variety of provisions to help young Americans gain quality, affordable coverage, including proposals to allow young adults to remain on their parents' insurance through the age of 27. Young adults could also benefit from proposed sizable tax credits. According to a report by Jonathan Gruber of MIT, the tax credits could save young adults as much as $685 off their health insurance premiums.

It is time that all Americans, regardless of age, receive timely, affordable, quality health care. It is time for the enactment of systemwide health care reform that provides coverage to all citizens, slows down health care costs and improves the quality of medical care.

To learn more, go to or call (202) 638-7151.

By Ralph G Neas and Henry E Simmons, MD

• Mr. Neas is chief executive officer of the National Coalition on Health Care; Dr. Simmons is its president. The Coalition is the Nation's oldest and most diverse alliance working for the achievement of comprehensive health care reform.

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Thursday, November 12, 2009

National Survey Finds Many Consumers Missing Out on Insurance Discounts

Trusted Choice® recommends consumers maximize little-known discounts to ‘nickel and dime’ their way to big savings.

As millions of Americans look for ways to stretch their budgets to survive these tough economic times, too many are not utilizing all of the discounts that may be available to them in their homeowner and auto insurance, according to a new national survey conducted for Trusted Choice® and the Independent Insurance Agents & Brokers of America (the Big “I”).

The survey asked home and auto owners if they believed they are taking full advantage of all the discounts they qualified for on their homeowners and auto insurance policies. More than 34% of respondents, representing 53 million households, admitted they are probably not taking advantage of all homeowners insurance discounts or said that they simply didn’t know. Regarding auto coverage, more than 20% of car owners either didn’t know or said they were not maximizing all the car insurance discounts available to them.

“The latest survey shows what we suspected: many Americans could be foolishly throwing money away because they fail to ask about insurance discounts for which they may qualify,” says Madelyn Flannagan, Big “I” vice president of agent development, education and research. “Companies often offer some unique, regional, very specific and, at times, quirky discounts. In these economic times, every dollar counts—some consumers may be able to nickel and dime their way to big savings.”

And those who stand to benefit most from the discounts are often those who aren’t taking advantage of them: nearly 38% of respondents with a household income of less than $25,000 said they weren’t taking advantage of all possible homeowners discounts or said they didn’t know.

The survey also found that the largest percentage of respondents, about 26%, estimated they save 6-10% on their insurance premiums by using discounts. In reality, many consumers could be saving significantly more—as much as 30%.

“One of the biggest advantages to using an independent insurance agent is that they can explore the various companies and find the best possible coverage for each individual family or business,” says Robert A. Rusbuldt, Big “I” president & CEO. “Finding specific discounts can be time-consuming and confusing, so we advise consumers to consult with their Trusted Choice® independent insurance agent and ask questions.”

The Big “I” and Trusted Choice offer the following tips that may lead to substantial homeowners insurance savings.

· LIFE IN A GATED COMMUNITY? Some homeowners are entitled to gated community discounts.

· WHAT’S YOUR HOUSE WEARING? Some insurers give hail resistant roof discounts for Class 4 roofs and credits can be sizeable in some territories.

· “EVERYTHING OLD IS NEW AGAIN:” Some companies are coming out with new rating models that are oriented toward offering lower rates to new customers. Sometimes, a customer can even save money by applying for a new policy with the same company.

· ‘FOR BETTER OR FOR WORSE’ MAY ALSO APPLY TO YOUR CREDIT SCORE: For married couples, sometimes one person will have a better credit score than the other. Since some companies will use the score of the first person named on the application, putting the spouse with the best credit score on first can result in a lower rate.

· GOT NEW WIRES? Depending on the age of newer electrical wiring in your home, you may qualify for an age of wiring discount.

· HAS IT REALLY BEEN 10 YEARS? If you have not filed any home insurance claims in the last 10 years, ask about a discount. “Claims-free” homeowners can often save up to 20%.

The Big “I” and Trusted Choice provide the following tips and considerations that may lead to big auto insurance savings.

· IS YOUR TEEN A SCOUT? Some insurers give credits to young drivers who are involved in organizations such as Boy Scouts or Girl Scouts.

· WHAT’S YOUR ALMA MATER? At least one insurer gives a 5% credit if a driver is a graduate of a university on the company's approved list.

· DO YOU HAVE A COMPANY CAR? Many carriers will give a multi-car discount to consumers who have a company car even if they only own one personal vehicle.

· HAVE YOU BEEN WIDOWED? Some insurers give "married" discounts to widows and widowers.

· ARE YOU SHOPPING FOR NEW WHEELS? Before you buy a car, make a short list of the ones you're considering and ask your agent to estimate the difference in insurance premiums. The difference could save you thousands of dollars.

· ARE YOU A GREEN COMMUTER? Consider car pooling to reduce your commute frequency and ask your agent if that will impact your auto premium. In addition to reducing your carbon footprint, you may also be fattening your wallet.

· HOW YOUNG ARE YOU? In some states, if you're 55 or older, and you're the principal driver of your insured car, you could save on your premiums by taking an approved defensive driving class.

· GOT A TRACTOR? If you're a full-time farmer or rancher, and you're insuring a farm or ranch vehicle used exclusively for work on your property, a farm vehicle bonus could help keep your costs down.

While there are plenty of quirky discounts your independent agent can investigate, there are many ‘tried and true’ discounts that many, but not all, insurance consumers know.

· UNEMPLOYED? People who are out of work should qualify for a low-mileage discount or lower rating factor that can save 5-10% on their auto premium.

· MULTIPLE POLICIES? If you have property insurance with ONE company, you may qualify for a multiple policy discount to lower both your auto and your home insurance premiums by as much as 10-15%.

· SOUND THE ALARMS! Alarm credits are often available if your home is equipped with two or more of the following: fire alarms, smoke detectors, fire extinguishers, sprinklers, deadbolt locks and a burglar alarm. Savings can be up to 15%. (Criteria vary in some states. An agent can help determine what applies in your area.)

· ACCIDENT-FREE FOR THREE YEARS? If you've been safe on the road and accident-free for the past three years, and you haven’t received any moving violations, you might qualify for a good record discount. To be eligible, you and all additional drivers also need to have carried continuous, standard automobile liability insurance during those same three years. If you're a new driver and received your license within the past three years, you, too, could be eligible. Just make sure you meet the above qualifications from the date your license was issued.

· DOES YOUR CAR HAVE SAFETY FEATURES? Auto insurance discounts apply in many states, if your car comes equipped with approved anti-theft devices, anti-lock brakes, and/or passive restraint systems such as airbags.

The survey was conducted for Trusted Choice® via telephone by International Communications Research (ICR); an independent research company in Media, Pa. Interviews of a nationally representative sample of 1058 U.S. households were conducted in Oct. 28 – Nov. 1, 2009. More information about ICR can be obtained at
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Aetna and UnitedHealthcare Compete for College Student Market

/PRNewswire/ -- HealthLeaders-InterStudy, a leading provider of managed care market intelligence, reports that Aetna and UnitedHealthcare's StudentResources unit collectively enroll approximately 890,000 members in the university niche market, a growing segment as older and non-traditional students populate campuses. The recent Georgia, Alabama and Louisiana Health Plan Analysis finds that these plans typically include an annual limit on prescription drug coverage.

College health plans are considered to be part of the individual plan category, and across individual plans, insurers increasingly institute more stringent limits on pharmacy benefit options. However, within the college health plan segment, it's even more common to see an annual limit in place because prescription drug utilization among the younger student population will likely be less than the general population, and the limits provide a way to keep premiums low.

College health plans are tailored to dovetail with on-campus health services and often recognize the student health center as the primary provider.

"Most people assume that college students are insured under parent policies or by the university, but college plans are a growing market segment. The college plans offered by Aetna and UnitedHealthcare vary by institution, as each plan is designed to complement existing on-campus health and counseling programs," said Jan Shuxteau, analyst with HealthLeaders-InterStudy. "As college campuses become more diversified and attract more non-traditional students, the health needs have changed. Aetna's student health division, for instance, has reported a lot of use of its behavioral health services offered to students."

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New CVS/pharmacy Data Reveals Older Americans Could Save an Average of $612 Annually by Switching Medicare Part D Plans

/PRNewswire/ -- With the Annual Enrollment Period for Medicare Part D beginning on November 15, CVS/pharmacy and the National Council on Aging (NCOA) are urging older adults and their caregivers to review their Medicare Part D options in order to find the lowest cost plan that meets their needs.

Confusion around the number and variety of prescription drug plans often becomes a barrier to identifying and selecting the most cost effective plan. Free online tools like the CVS/pharmacy Medicare Part D Savings Calculator at simplifies the comparison process, helping seniors more readily identify the plan with the lowest overall costs.

"Plan review can seem cumbersome, but completing a plan comparison each year is an essential step toward saving," said Fernando Gonzalez, R.Ph at CVS/pharmacy. "Tools like the Medicare Part D Calculator are designed to simplify the process to help older adults and their caregivers select a plan that provides them with the greatest value and peace of mind."

A CVS/pharmacy analysis of more than 10,000 older Americans using the Medicare Part D Savings Calculator last year revealed plan participants could save an average of $612 in annual drug costs just by switching to their optimal Medicare Part D plan.(1)

"This data underscores the importance for older adults and their caregivers to review Medicare Part D plans each year," said Wendy Zenker, Vice President of the NCOA Benefits Access Group. "With the number of changes to Part D plans from year to year, Medicare beneficiaries can expect to see significant savings and receive better coverage, if they compare and shop around."

To that end, CVS/pharmacy today launches a campaign with the goal of helping millions of seniors and their caregivers realize savings on 2010 prescription costs through education and assistance in Medicare Part D plan comparison. Starting November 12, CVS/pharmacy and the NCOA are offering Medicare Part D educational events throughout Annual Enrollment period at senior centers across the country.

Consumers can also go online at to use the free Medicare Part D Savings Calculator. And, CVS pharmacists will be available throughout the enrollment period to provide plan comparisons in stores for those who would like assistance.(2)

Remembering the Three Cs: Cost, Coverage and Convenience

CVS/pharmacy and NCOA recommend considering three factors when evaluating plans:

-- Cost - What is the plan deductible, monthly premium and prescription
co-pay for the prescriptions you regularly take? Evaluate the total
cost and not just the co-pays. And, identify in advance if you fall
into the doughnut hole.
-- Coverage - Are the prescription medications you regularly take covered
in the plan? Are there restrictions such as prior authorization? Each
year insurance plans change, including premiums, co-pays, and the list
of covered drugs. Your own prescription needs change as well.
-- Convenience - Can you fill the prescription at the pharmacy of your

Before starting the plan selection process, older Americans should review their current medications with their pharmacist. Often, prescription costs can be lowered by switching to a generic alternative, consolidating pills or by switching to an over the counter alternative. Having these changes in place before selecting a plan can help in choosing the most affordable option and potentially avoiding the doughnut hole -- the gap in coverage if your prescription costs reach $2,830.

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Tuesday, November 10, 2009

When Making An Insurance Claim During Severe Weather Make Sure Your Insurer Knows How To Reach You

/PRNewswire/ -- The Georgia Insurance Information Service (GIIS) reminds all Georgians affected by the Tropical Storm Ida to inform your insurer as soon as possible if you have damage, and to make sure your insurer knows how to reach you if you cannot be reached at your home.

The GIIS Web Site at has the catastrophe hotline numbers for all member companies.

-- If your roof is damaged and water is entering your home, when it is
safe, put a tarp or similar covering over the damage to prevent
further destruction from occurring.
-- If you must leave your home, make sure your insurer knows where you
will be staying and how to reach you.
-- Be very careful around downed lines and don't assume you know the
difference between a power line, a cable line or a phone line.
-- Follow all law enforcement directives.
-- If you can safely take photographs of the damage do so to present to
your insurance adjuster.
-- It is most important to have a home inventory of your belongings room
by room for your adjuster. If you do not have one, free home
inventory software is available from the GIIS Home Page, Look for a blue and gray button on the upper
right of your screen.

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Care Improvement Plus Announces Major Expansion in Georgia, South Carolina for 2010

/PRNewswire/ -- Care Improvement Plus, a leader in improving the quality of care for seniors with chronic illness and operator of the largest special needs plan in Georgia and South Carolina, has released the details of its 2010 Medicare health plan benefits, including a new state-wide plan to be offered to beneficiaries across both states.

Care Improvement Plus' new plan, "Care Improvement Plus Medicare Advantage" will provide comprehensive medical, hospital and prescription drug coverage, and a variety of valuable extra benefits including dental and vision coverage. In addition, the company has strengthened benefits for its chronic condition Special Needs Plan for Medicare beneficiaries diagnosed with diabetes and/or heart failure, including lower premiums and generic drug copays across its Gold Rx plan options. The company currently has over 30,000 members in the region.

"Based on the success and quality achievements of our chronic condition plan, we felt there was opportunity for additional Medicare beneficiaries to benefit from our unique approach to managing care," said Frederick C. Dunlap, board chairman and chief executive officer of XLHealth, which owns and operates Care Improvement Plus. "We remain focused on delivering high-quality care and serving the underserved, with the added capability to offer enrollment to spouses and caregivers of our special needs plan members."

All Care Improvement Plus plans provide comprehensive Medicare coverage and a Part D prescription drug benefit, plus valuable benefits such as dental, vision, and transportation coverage, and care management support. In addition, all plans feature an open access provider network where members may go to any Medicare-approved provider that will accept payment from Care Improvement Plus.

"Our goal is to serve as a model for improving patient outcomes and reducing healthcare spending for Georgia and South Carolina's costliest Medicare beneficiaries," continues Dunlap.

Care Improvement Plus will open enrollment on November 15, 2009 for services effective January 1, 2010. Those interested in learning more about Care Improvement Plus may call 1-800-711-1656, or visit for more information.

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Thursday, November 05, 2009

AARP Endorses Affordable Health Care for America Act

/PRNewswire/ -- Today AARP announced its endorsement of the Affordable Health Care for America Act (H.R. 3962) and the accompanying Medicare Physician Payment Reform Act (H.R. 3961). The Association's support follows nearly two years of work with lawmakers on both sides of the aisle to craft a health care reform plan that meets the needs of AARP's nearly 40 million members and all older Americans. Among those needs are reforms that strictly curb insurance companies' discrimination against older Americans and Medicare improvements that strengthen benefits while protecting the program for future generations.

"We started this debate more than two years ago with the twin goals of making coverage affordable to our younger members and protecting Medicare for seniors," said Jim Wordelman, State Director for AARP in Idaho. "We've read the Affordable Health Care for America Act and we can say with confidence that it meets those goals with improved benefits for people in Medicare and needed health insurance market reforms to help ensure every American can purchase affordable health coverage."

Today's endorsement marks the first time in this legislative battle that AARP has put its full weight behind a comprehensive health care reform package. In the coming days, AARP will be educating its members about the health care reform package through its publications, paid advertising and more than five million calls and e-mails to its grassroots activists.

The Affordable Health Care for America Act and the Medicare Physician Payment Reform Act contain critical components AARP has been fighting for on behalf of its members and all older Americans to improve health care for them and their families. They include:

-- Protecting and strengthening Medicare for today's seniors and future
generations of retirees;
-- Ensuring seniors can see the doctor of their choice or find a doctor
if they need one by improving Medicare's payments to doctors;
-- Lowering drug costs for seniors by closing the Medicare Part D
"doughnut hole" and allowing Medicare to negotiate with drug makers
for lower drug prices;
-- Taking steps to reduce waste, fraud, abuse and inefficiency in the
Medicare program;
-- Requiring Medicare and insurance companies to provide for important
preventive services like screenings for diabetes, cancer and
osteoporosis free of charge;
-- Stopping insurance companies from denying you affordable coverage
because of your age;
-- Preventing insurance companies from denying you coverage if you have a
pre-existing condition or dropping your coverage if you get sick;
-- Limiting how much your insurance company can make you pay
-- Providing affordable health insurance options for those who don't have
insurance; and
-- Providing benefits to help seniors and people with disabilities live
in their own homes and communities by establishing the Community
Living Assistance Services and Supports (CLASS) program.

Wordelman added: "We cannot continue to let insurers price older Americans out of the market, just as we cannot stand idle while millions of seniors are forced to choose between their groceries and their prescriptions. AARP is proud to endorse the Affordable Health Care for America Act and the Medicare Physician Payment Reform Act, and we urge members of the House to pass this critical package in the coming days to help fix our broken health care system."

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Wednesday, November 04, 2009

HHS Secretary Calls on States and Communities to Get Health Coverage to Uninsured Children

HHS Secretary Kathleen Sebelius today called on states and communities to join with HHS to redouble efforts to find and enroll the 5 million children who are currently eligible for Medicaid or the Children's Health Insurance Program (CHIP), but are not yet covered. The Secretary
issued this call to action as she opened the National Children's Health Insurance Summit in Chicago, kicking off the nation's largest campaign to find and enroll uninsured children in over a decade.

Much progress has been made in recent years, but the enactment of the Children's Health Insurance Reauthorization Act (CHIPRA) creates new opportunities to move forward. At the same time, given the economic downturn, the need among families for affordable coverage for their children could not be greater. Not since the creation of CHIP in 1997 has the federal government, in conjunction with states, concentrated so many resources on the effort to find and enroll children who are needlessly going without health insurance coverage.

"As a society and as parents, we have no greater responsibility than to provide quality health care for our children," Secretary Sebelius said. "Our charge here today is to get all eligible children covered to ensure they are healthy throughout their childhood. A healthy child is the
block upon which all other successes are built, not just for the child, but for the nation they will lead in the future."

In February, President Obama signed CHIPRA into law. The legislation fully funds CHIP over the next four years and devotes an unprecedented amount of federal funding to support outreach and enrollment efforts for both CHIP and Medicaid. Currently, Medicaid serves more than 32 million low-income American children while CHIP has over 7 million beneficiaries.

Today's speech launched the three-day conference in Chicago sponsored by the Centers for Medicare & Medicaid Services (CMS) that has brought together state Medicaid and CHIP officials, local government, community-based organizations, safety net providers and others who are working to promote enrollment in children's health programs. These experts will exchange proven strategies for finding and enrolling children in health programs as well as removing program barriers that sometimes prevent children from staying in these programs despite
continued eligibility.

Participants in the conference will also hear from experts on a wide range of specialized topics, such as reaching diverse or isolated populations, the usefulness of online applications and how to best work with managed care plans and other health care providers.

Also attending today's conference are grantees from 69 organizations across the country that were awarded $40 million by HHS to fund outreach projects in their local communities. Over the next four years, HHS will award a total of $90 million in outreach grants.

"With the nation's unemployment rate at a staggering 9.8 percent and families losing their job-related health care, finding and enrolling eligible children could never be more important," said Cindy Mann, director of the Center for Medicaid and State Operations within CMS.
"Bringing together government officials, tribal leaders, community organizations and policy experts, we hope, will build on the successes achieved in recent years and lead to fresh, innovative and successful strategies to deliver quality health care to every eligible child in

For more information about free or low-cost children's health insurance, visit the newly updated and redesigned Web site or call toll-free 1-877-KIDS-NOW (1-877-543-7669). The site gives parents and caregivers information on connecting their children to health coverage through Medicaid or CHIP and also provides program
information and federal guidance for states and health policy professionals. It will be available in both English and Spanish. National Children's Health Insurance Summit presentations and other conference materials can be downloaded at

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Saturday, October 31, 2009

Aetna Signs Agreement with WellStar Health System

(BUSINESS WIRE)--Aetna (NYSE: ΑET) and WellStar Health System of Marietta, Ga. announced today that they have reached agreement on a three-year contract that provides access for Aetna’s Medicare Advantage members to the hospital’s facilities and physicians.

Under this new agreement, Aetna Medicare Advantage plan members will be able to receive covered services, at in-network rates, from WellStar facilities in the greater Atlanta area. Earlier this year, Aetna and WellStar reached agreement on a contract that applied to members of Aetna’s commercial plans. Aetna members also will be able to continue receiving covered services from WellStar physicians.

“Aetna is very pleased to expand its relationship with WellStar,” said Ramzy Elgomayel, Aetna’s vice president of network operations for Georgia. “WellStar has provided excellent care to our commercial-plan members for several years, and we’re delighted to be able offer in-network access to their facilities and providers for our Medicare Advantage plan members.”

“The expansion of the Aetna contract to cover the Medicare Advantage members further solidifies our relationship,” said Barbara Corey, senior vice president of managed care for WellStar. “We look forward to providing exceptional health care services to these members.”

Aetna provides health benefits to approximately 600,000 members in Georgia. Those members have access to a network that includes 80 contracted hospitals and more than 9,500 primary care physicians and specialists.

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Friday, October 30, 2009

Policymakers Have Many Options to Make Social Security Both Solvent and More Adequate

/PRNewswire/ -- Social Security, the foundation of economic security for millions of America's seniors and working families, can be made more adequate and solvent for the long term, according to a new report released today by the National Academy of Social Insurance (NASI).

The report, Fixing Social Security: Adequate Benefits, Adequate Financing, outlines approximately 30 options for putting the program's finances into 75-year balance and more than 10 ways to make Social Security more adequate for those who rely on it. All options have long-range cost estimates from Social Security actuaries.

"Fixing Social Security is a manageable job. While Social Security does not need more money now, policymakers could act now to make funds available in the future when the money will be needed," said Virginia Reno, co-author of the report and Vice President for Income Security at NASI.

"We also need to consider the adequacy of Social Security benefits," said Janice Gregory, president of NASI. "Long-term shifts in private retirement plans are placing more risks on individual workers. Recent losses in jobs, home equity, and individual savings are weakening all other sources of financial security in retirement. Only Social Security has held its value. Yet benefits remain modest for all, and inadequate for some especially vulnerable populations."

Benefit adequacy options in the report target such financially vulnerable groups as:

-- The oldest beneficiaries (over 85 years);
-- Widowed spouses of low-earning couples;
-- Low-paid workers generally;
-- Workers with gaps in paid work due to childcare; and
-- Students in college or vocational school who have lost parental
support due to death or disability.

Other adequacy options would increase benefits across the board for current and future beneficiaries.

Options to balance Social Security's future finances include:
-- Lifting the cap (now $106,800) on the earnings from which workers and
employers pay Social Security taxes;
-- Broadening the base for Social Security taxes;
-- Scheduling modest rate increases in the future when funds will be
-- Dedicating progressive taxes to pay part of Social Security's future
cost; and
-- Gradually lowering some future benefits.

A recent survey conducted by the Benenson Strategy Group (BSG) for NASI and the Rockefeller Foundation found that Americans want to preserve and improve Social Security, even if it means paying higher taxes to do so. "Even before the recession, fear of an insecure retirement was among Americans' top economic concerns," said Danny Franklin of BSG. "Those fears have only intensified in the past year. Americans today are willing -- even eager -- to invest in the peace of mind that Social Security provides."

The NASI project receives support from the Ford Foundation's initiative on Economic Fairness and Opportunity and the Rockefeller Foundation's Campaign for American Workers.

The National Academy of Social Insurance (NASI) is a non-profit, nonpartisan organization made up of the nation's leading experts on social insurance. Its mission is to promote understanding of how social insurance contributes to economic security and a vibrant economy.

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Thursday, October 29, 2009

New Report Highlights How Health Insurance Reform Will Reduce Costs for Small Businesses

HHS Secretary Kathleen Sebelius today released a new report, "Lower Premiums, Stronger Businesses: How Health Insurance Reform Will Bring Down Costs for Small Businesses." The report outlines the many ways health insurance reform will lower health care costs for small
businesses and is available now at

"Small businesses drive our economy and create jobs, but they are struggling as health care costs continue to rise," Secretary Sebelius said. "The high cost of care is making it difficult or impossible for these businesses to offer care or grow their business. Health insurance reform will bring costs down and give small businesses the relief they need."

The report notes:
* Small businesses, the backbone of job creation in our economy,
are disproportionately burdened by the financial strains caused by
rising health care costs. On average, small businesses pay up to 18
percent more than large firms for the same health insurance policy. This
difference is due in part to high broker fees (which can be up to 10
percent of premiums), and health plan administrative costs that are
three times those in the large group market.
* In a recent national survey, nearly three-quarters of small
businesses that did not offer benefits cited high premiums as the
* Nearly half of workers covered by a small business employer have
insurance that limits the total amount the plan will pay for medical
care and nearly one in ten small business workers have a health plan
that does not offer prescription drug coverage.
* Workers in small firms are more likely to shoulder burdensome
out-of-pocket health care costs. Thirty-six percent spent more than 10
percent of their household income on out-of-pocket medical expenses in
2007, compared with 27 percent of workers in larger firms.

Health insurance reform will bring down costs for small businesses by creating a health insurance exchange, providing a small business tax credit, ending the "hidden tax" on small businesses that provide health insurance and preventing arbitrary premium hikes. Reform will also ensure Americans have stable, secure insurance coverage, limit out-of-pocket spending and eliminate caps on benefits.

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Wednesday, October 28, 2009

Selecting Medicare Coverage: Four Considerations to Help Seniors Choose

/PRNewswire/ -- Open enrollment, the six-week period during which seniors can select healthcare coverage for 2010, begins Nov. 15. Health plans have begun sharing their costs and coverage, but making a choice can be a daunting task. Here are four considerations to help Medicare-eligible seniors select which Medicare coverage best meets their individual needs:

1. Understand the A, B, C and Ds of Medicare. There are four primary parts
to Medicare. Parts A and B cover hospital and medical expenses,
respectively. Parts C and D provide benefit and prescription drug
coverage through health insurance companies that are approved by
Medicare. Medicare Advantage plans include all of the coverage offered
by Parts A and B and can include prescription drug coverage under Part
2. Compare costs. Premiums can range for $0 to hundreds of dollars per
month, depending upon the type of organization (nonprofit or
for-profit) and the type of coverage. Total plan costs include
premiums, co-payments and deductibles for everything from preventive
care to hospitalization.
3. Compare benefits and doctors. Does the plan have a large network of
doctors and specialists for you to choose from? Is your doctor and
preferred hospital in that network? Does the plan cover your
prescription medications?
4. Compare quality. Call the customer service number for the plans you're
considering. Does a live person answer the phone? Are they friendly,
helpful and knowledgeable? Does the plan offer value-added programs
that help you maintain or improve your health and independence? Does
the plan offer services to help your loved ones take care of you if
needed? Will the plan coordinate your care between doctors and

Selecting Medicare coverage is an important decision, especially since Medicare rules indicate that members must maintain the coverage they've chosen for an entire year. Seniors currently enrolled in Medicare Advantage plans will soon receive letters from their health plans explaining any changes in coverage for 2010. "We recommend that people read this letter thoroughly to avoid any surprises in the coming year," said Tom Lescault, president of SCAN Health Plan Arizona. "Changes in government funding has forced many health plans to reduce benefits or increase costs. People need to make sure they are able to make informed decisions during open enrollment."

As part of an ongoing commitment to improving the lives of seniors, SCAN Health Plan Arizona is an exclusive sponsor of "Healthy Tips for Successful Aging" with ABC 15. Each week, the station airs 30-second health tips provided by SCAN. The health plan also is the exclusive studio sponsor for KOY radio and co-hosts "Senior Focus," a broadcast dedicated to senior-related issues.

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Tuesday, October 27, 2009

Overriding State Insurance Protections Should Not Be Part of Financial Re-Regulation Package, Writes Consumer Watchdog to Geithner, Frank

/PRNewswire/ -- Consumer Watchdog sent a letter to Treasury Secretary Geithner, House Financial Services Committee Chair Barney Frank, and Financial Services Subcommittee Chair Paul Kanjorski today, arguing that legislation intended to undermine state insurance protections (H.R. 2609) is inconsistent with the re-regulatory promise of the financial reform package. The bill will be marked up in the House Financial Services committee today.

"We are at a loss to understand why you have proposed a measure to deregulate the insurance industry by preempting state laws as part of the financial re-regulation package," wrote Consumer Watchdog. "Each version of the bill would restrict the ability of state lawmakers and regulators to protect insurance consumers by granting the Treasury Department and a new Federal Insurance Office the authority to preempt state laws and regulations on prudential matters on behalf of foreign insurance firms."

"This proposal is even more perplexing in light of the strong fight, on the part of both the administration and majority members of the Financial Services committee, to preserve states' ability to protect their citizens during the debate over the Consumer Financial Protection Agency," the letter continued.

As Assistant Treasury Secretary Michael Barr put it to the Washington Post last week:

"'Washington doesn't always know what's best'... He said the administration wanted to restore the right of states 'to protect their citizens with the rules that they think make sense.'"

"If Washington doesn't always know what's best for American consumers, why would you expect foreign diplomats and regulators to know what's best for American insurance policyholders?" asked Carmen Balber, Washington Director for Consumer Watchdog.

The letter concludes: "Wall Street firms are again riding high a year after the crash, but the rest of the country continues to suffer rising foreclosures, increased unemployment, and a dearth of credit. With American homes, jobs and businesses already on the line, now is hardly the time for Congress to place our insurance policies at risk as well."

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Friday, October 23, 2009

Sebelius Releases New Report on Benefits of Health Insurance Reform for Women with Breast Cancer

As Americans mark breast cancer awareness month, Secretary of Health and Human Services Kathleen Sebelius today released a new report, Health Insurance Reform and Breast Cancer: Making the Health Care System Work for Women. The report details how health insurance reform will help women diagnosed with breast cancer and is available now at

"Thousands of women and their families are impacted by breast cancer," Secretary Sebelius said. "We are fighting for health reform that will help improve treatment for women with breast cancer and doing all we can to encourage women to take the simple steps that can help prevent this disease."

The new report highlights the problems in the health care status quo that significantly impact women who are diagnosed with breast cancer or are breast cancer survivors. The report notes:

* Breast cancer is the second leading type of cancer among women.
The disease will affect one in eight American women during their
lifetime, with treatment costs totaling $7 Billion in 2007.

* Breast cancer patients with employer-based insurance had total
out-of-pocket costs averaging $6,250 in 2007, higher than out-of-pocket
spending for patients with asthma, diabetes, chronic obstructive
pulmonary disease (COPD), or high blood pressure.

* Breast cancer patients, even when in remission, are unlikely to
find meaningful insurance coverage in the individual insurance market. A
full 11 percent of individuals with any cancer said they could not
obtain health coverage in the individual insurance market.

"Today, breast cancer patients incur thousands of dollars in debt, and breast cancer survivors struggle to get the affordable care they need," Sebelius added. "Health insurance reform will bring costs down, make care more affordable and prevent insurance companies from discriminating against breast cancer survivors."

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Wednesday, October 21, 2009

Humana Will Cover H1N1 Vaccine for Members

(BUSINESS WIRE)--Humana Inc. (NYSE: HUM) today announced that the company will cover the administration cost of the H1N1 (swine flu) vaccine for all fully insured members including those members who have a benefit plan that excludes immunization coverage. All co-payment, coinsurance and deductibles will be waived for the administration of the H1N1 vaccination regardless of the preventative-services benefit currently provided in these members’ plans.

“The safety and well-being of our health plan members, country, communities and associates is of utmost concern to Humana,” said Lisa Weaver, M.D., Humana segment vice president, clinical strategies. “Our initial focus is to encourage the CDC-identified priority groups to get vaccinated.”

Humana is taking this step to support its members’ ability to get the vaccination. The company will continue to monitor and respond to guidance from the Centers for Disease Control and Prevention. For the most up-to-date H1N1 information, log on to their website: To reach the CDC by phone call 800-CDC-INFO (800-232-4636) or email:

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Tuesday, October 20, 2009

Sebelius, Mills Release New Report Insurance at Risk: Small Business Employees Risk Losing Coverage

Secretary of Health and Human Services Kathleen Sebelius and Small Business Administration Administrator Karen Mills today released a new report, Insurance at Risk: Small Business Employees Risk Losing Coverage. The report examines the health care status quo that has left
employees at risk of losing their insurance and underscores the financial difficulties small businesses face when providing health insurance to their employees. The complete report is available now at

"More Americans who work for a small business have lost their health insurance coverage, and those who still have coverage have seen their costs go up," said Secretary Sebelius. "Health insurance reform will drive costs down and make it easier for small business owners to give
their employees the quality coverage they need."

"The cost of health insurance is the number one concern of small business owners. On average, small businesses pay 18 percent more than big businesses for the same health insurance policy. This has left small business owners in an untenable situation, having to choose between their employees, who are often like family to them, and the bottom line," Administrator Mills said. "Health care reform will provide small business owners with greater access to the affordable, quality coverage they want and need for themselves and their employees."

The report notes:

* Employees of small businesses are 50 percent more likely to lose
coverage as workers at large businesses. Half of workers in small firms
that do not offer health benefits remain uninsured.
* Premiums for employer-based health insurance have more than
doubled since 2000, rising three times faster than wages. As a result,
fewer small businesses provide coverage for their employees. In 2000, 57
percent of firms employing less than 10 workers provided coverage. In
2009, only 46 percent of similar-sized firms provided coverage.
* In one national survey, nearly three-quarters of small
businesses that did not offer benefits cited high premiums as the
reason, and on average small businesses pay up to 18 percent more than
large firms for the same health insurance policy. This is due in part to
high broker fees (which can be up to 10 percent of premiums) and health
plan administrative costs that are three to four times those in the
large group market.

Health insurance reform will stabilize health insurance coverage for Americans who work for small businesses. Health insurance reform will provide small businesses with tax credits to help them provide health insurance for their employees. This will make health care more affordable for small businesses and their workers, solidifying and strengthening employer-based coverage for years to come.

Health insurance reform will also create a health insurance exchange so Americans without access to affordable insurance on the job can compare prices and health plans and decide which quality affordable option is right for them. The exchange will also significantly reduce
administrative costs for small businesses by enabling them to easily and simply compare the prices, benefits, and performance of health plans.

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Thursday, October 15, 2009

Blue Cross and Blue Shield of Georgia to Provide First Dollar Coverage of H1N1 Vaccine for All Members

/PRNewswire/ -- Each year, influenza causes illness, hospitalizations and deaths, and severely strains the health care delivery system. This year, seasonal flu is complicated by the emergence and rapid spread of the H1N1 virus. In an effort to ensure that individuals and their families can take the appropriate actions to help protect themselves against the H1N1 virus, Blue Cross and Blue Shield of Georgia (BCBSGA) will cover the administration of the H1N1 vaccine without co-pay or deductible for all of its members. BCBSGA is also are encouraging self-insured employers to cover the cost of the vaccination for their employees.

"At BCBSGA, our priority is to ensure that our actions and communications support public health," said Dr. Bob McCormack, BCBSGA medical director. "Our goal is to keep our members as healthy as possible. We are committed to working with the CDC and HHS on an information campaign to ensure that members and the public are vaccinated to prevent H1N1, and if they develop H1N1 flu, they are treated effectively and appropriately."

Since a significant proportion of the vaccine is likely to be administered through non-traditional providers such as pharmacies, retail clinics and public health clinics, BCBSGA is currently working to complete agreements with these providers to increase access to the H1N1 vaccine. In addition, the antiviral medications Tamiflu and Relenza will move to an economical tier in plan formularies.

The CDC has recommended that certain populations receive the 2009 H1N1 vaccine when it becomes available. Initial prioritization includes pregnant women, people who live with or care for children younger than six months of age, children and young adults from 6 months to 24 years old, and people from 25 through 64 years old if they have chronic medical conditions that increase their risk of complications from influenza infection.

The CDC also recommends people take common-sense steps like washing your hands frequently; covering your mouth with your arm when you cough and sneeze; and staying home when you are sick to help protect others from the flu.

"The U.S. health care system has a responsibility to achieve maximal vaccination and effective treatment of H1N1 flu and its emerging risks, and we are eager to do our part to be sure that populations at high risk are immunized against this virus," said Monye Connolly, president, BCBSGA.

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Tuesday, October 06, 2009

Insurance Deregulation Is Not Financial Reform, Says Consumer Watchdog

/PRNewswire/ -- Consumer Watchdog called on Congress to reject legislation allowing the Treasury Department to use international agreements to override state insurance laws, including those requiring insurers to hold enough money to pay all claims. The proposal is under consideration in the U.S. House Financial Services Committee today.

"State insurance regulators made sure that insurance companies had enough money in the bank to pay policyholder claims and weather the financial storm. Congress should not give a political appointee the power to take away that authority on behalf of foreign insurance companies," said Carmen Balber, Washington Director for Consumer Watchdog. "This bill promotes insurance deregulation as Congress should be strengthening financial service sector regulation."

Download Consumer Watchdog's letter with Public Citizen and US PIRG here:

The proposal, a discussion draft amending H.R. 2609 offered by Rep. Kanjorski, would give the Treasury Secretary unilateral new authority to negotiate international insurance agreements on prudential issues, determine if state insurance laws are "inconsistent" with such an agreement, and then preempt those state laws. Safeguards intended to exempt specific state insurance laws from preemption do not go far enough to protect important consumer protections, wrote the groups.

The letter reads: "Never before has the U.S. government allowed a federal agency to unilaterally interpret or enter into international agreements on subject matter under the authority of the legislative branch, and then preempt states through rule-making on the basis that state policies are in contradiction to those agreements."

Consumer Watchdog also objected to the lack of consumer representation on the Financial Services witness panel today.

Rep. Kanjorski offered similar legislation last year, which was pulled back in the wake of AIG's dramatic collapse.

Download Consumer Watchdog's letter opposing last year's legislation here:

Download last year's letter from Public Citizen and US PIRG:

The groups supported efforts to develop greater federal information and expertise in insurance but noted that the proposed legislation goes far beyond information gathering.

In California, where voters enacted the nation's toughest system of insurance regulation with Proposition 103, consumers are protected from unfair or excessive insurance rates, illegal surcharges and other abusive and discriminatory practices. Any move to federalize insurance regulation would jeopardize these consumer protections, said Consumer Watchdog.

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Thursday, September 24, 2009

Contact GEICO for storm claims at 1-800-841-3000 or

(BUSINESS WIRE)--GEICO urges policyholders whose vehicles have been damaged in the recent Atlanta area flooding to report their claims as early as possible. To reach GEICO’s claims team at anytime, 24 hours a day, call 1-800-841-3000 or report the claim on

“Our adjusters have been in Atlanta and the local areas all week assisting policyholders with damaged or flooded vehicles,” said Gary Musolf, head of GEICO claims in the region. “If you notice damage to your vehicle, contact GEICO right away so we can make arrangements to take care of your claim and get you back on the road.”

GEICO advises residents to heed all weather warnings and road closures. However, if driving is necessary, GEICO recommends these rain and flood driving tips to keep you safe:

* Heavy rain can make it difficult for other drivers to see you. Keep your headlights on and drive slowly, keeping your eyes out for on-coming traffic.
* If you see a large puddle or standing water, go around it or choose a different route. That puddle could be hiding a deep hole.
* Give yourself plenty of time to brake and do so gently in order to avoid hydroplaning.

“The safety of our policyholders and the quick and quality repair of their vehicles is our first priority during stressful times like these,” said Musolf.

GEICO (Government Employees Insurance Company) – as part of Berkshire Hathaway – is the third-largest private passenger auto insurer in the United States*. GEICO provides auto insurance coverage for 9 million policyholders and insures more than 16 million vehicles.

In addition to auto insurance, GEICO offers customers insurance products for their motorcycles, all-terrain vehicles (ATVs), boats, homes, apartments and mobile homes. Commercial auto insurance and personal umbrella protection and life insurance are also available.

As a member of the Berkshire Hathaway group of companies, GEICO is rated A++ for financial strength by A.M. Best Company and ranks at the top of several national customer satisfaction surveys. For more information, go to

*A.M. Best 2008 market share data

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Wednesday, September 23, 2009

Blue Cross and Blue Shield of Georgia Launches Zagat Health Survey Tool

/PRNewswire/ -- Blue Cross and Blue Shield of Georgia (BCBSGA) today announced the launch of the Zagat Health Survey tool, an online survey tool that will allow its members to share their physician experiences with other members throughout the state.

"Zagat is widely known and trusted for its ability to help people share and learn from other consumer experiences. By working with them we are able to create a trusted resource for our members that will actively engage them in sharing and using that information," said Monye Connolly, president of BCBSGA. "We are committed to providing our members with useful information to better help them navigate the health care system. Making information available, such as the patient experience information contained in the Zagat Health Survey, along with other quality and cost transparency information, is part of that commitment."

The Zagat Survey enables BCBSGA to address an unmet need for peer-to-peer interaction among health care consumers. The Zagat Health Survey tool provides a vehicle for members to review physicians based on a set of distinct criteria, creating a trusted resource to support informed member decision-making. The criteria are solely designed to reflect a consumer's experience with a physician and not to reflect the quality of care received. This tool not only helps members, but is also designed to assist doctors in understanding members' experiences.

The online survey tool allows consumers to review their doctor visits based on:

-- Trust - Confidence in the physician's approach
-- Communication - Physician's bedside manner, responsiveness and rapport
-- Availability - Convenience for making appointments and physician's
-- Environment - Condition of the office, staff helpfulness, atmosphere
and amenities

Members are also asked whether they would recommend their doctor to others. The survey also features a comments section, allowing members to explain their ratings.

The online entry will display physician contact information, ratings on a 30-point scale for each of the four categories, and the percentage of members who recommend that physician. The most recent comments will be displayed first, and members will have the option to rate the usefulness of comments and report suspicious comments. BCBSGA members can complete the Zagat Health Survey by logging on to the secure member portal on the BCBSGA Web site.

"For physicians the Zagat survey tool can provide valuable, objective feedback on how their patients feel about them and their practice, information that often remains unknown," said Dr. Robert McCormack, medical director for BCBSGA. "For consumers, the survey can provide information to help them select a physician who is most likely aligned with their personal style and who will meet their health care needs. All-in-all, it is a viable mechanism that could very well change the way health care is measured and delivered throughout Georgia."

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