IdahoReporter.com » insurance companies

Idaho insurance agents seeking change to health reform plan

Brad Iverson-Long — Fri, 18 Mar 2011 13:22:55 +0000

Idaho lawmakers are backing a plan from insurance agents to ask the federal government to strip part of the federal health care reform. Other states are asking for an exception to the federal requirement that health insurance companies spend a certain share of monthly premiums paid in by consumers on actual health costs. So far Idaho has yet to make that request.

Last year’s Patient Protection and Affordable Care Act (PPACA), which Idaho is currently suing in federal court to block, requires that insurance companies pay at least 80 cents out of every dollar they collect from premiums as actual medical costs or plan improvements. For large group insurance plans, that requirement bumps up to 85 percent. The requirement is known as a medical loss ratio (MLR).

Idaho insurance agents are asking state lawmakers to urge Congress and the Obama administration to not include their commissions in the non-medical part of MLR calculations. The Idaho House has already approved a memorial that would send letters to Washington, D.C., on behalf of agents, and the Senate Commerce and Human Resources Committee unanimously approved the plan Thursday.

“We hope that this memorial will send a loud message to Congress and (the Department of) Health and Human Services,” said Jim Genetti with the Idaho Association of Health Underwriters. “Consumers benefit greatly from the expertise of life insurance professionals.” Genetti told senators that the federal regulations mean insurance agents see a 50 percent drop in their commissions, and that the effect of those cuts could mean the elimination of 400 jobs for health insurance agents.

There are efforts in the U.S. House of Representatives to end the MLR requirement, though it’s not certain it would be approved by the Democratic-controlled Senate or White House.

The federal government is granting exceptions to the MLR rule. Earlier this month, Maine received a waiver for three years, since the state was able to prove that one of its three major insurance companies might need to pull out of the state if the requirement to pay out a certain amount in medical costs held. Four other states, including Nevada, are seeking similar waivers, according to the American Medical Association.

Idaho Department of Insurance officials say they haven’t asked for a request because the state’s major insurers, Blue Cross, Regence Blue Shield, and PacificSource, haven’t said the requirement would force them out of the state insurance market.

“None of them have requested a waiver,” said Department of Insurance Director Bill Deal. “We’re letting them dictate the need.”

Deputy director Shad Priest said the waiver would only be temporary, so action from Congress would be needed to permanently change the situation.

Senate approves insurance-funded vaccine pool

Brad Iverson-Long — Thu, 25 Feb 2010 19:00:02 +0000

The Idaho Senate unanimously approved legislation Thursday setting up a universal pool of vaccines for children that will be funded by insurance companies. The new pool comes after a decision last year to end state funding for vaccines that led to what Sen. Dean Cameron, R-Rupert, called unintended consequences. The move required doctors to have two separate stocks of immunizations, one for children with insurance and one for uninsured children.

“The result was not only devastating to physicians, but to insured parents,” Cameron said. The cost of vaccines increased for some, due to federal rules and some physicians having to buy their own vaccines. The new universal pool should result in lower vaccine prices.

Health insurance companies support the new assessments on them. A new panel, the Idaho Immunization Board, will oversee those assessments. Three of the nine members of the board will represent insurance carriers. “This was a hard fought-out compromise process,” Cameron said about the new assessment-funded pool. There is a three-year sunset on the new plan, which Cameron said will allow for a review of the system.

Read IdahoReporter.com‘s past coverage of the immunization pool here and coverage of immunization legislation this session here. The text of the approved legislation is available here.

Plan for universal childhood immunization pool headed for Senate vote

Brad Iverson-Long — Wed, 17 Feb 2010 02:38:08 +0000

The plan to reshape funding for Idaho’s childhood immunization program is headed for the state Senate after passing overwhelmingly in the House. Sen. Dean Cameron, R-Rupert, said the new program would rely on insurance companies to pool their money to buy a universal pool of vaccines for children in Idaho. “Essentially it’s a tax on themselves,” Cameron said about insurers. “The [legislation will] create a mechanism by which the insurance industry can assess themselves and help buy those vaccines at that lower, discounted rate.” Under the plan, no state tax dollars would pay for vaccines.
If the Senate passes the proposed legislation, the first assessment on insurance companies, based on the number of children eligible for vaccines they cover, would take place in April. A new nine-member immunization panel would oversee assessing and spending those fees. The Idaho Association of Health Plans, which represents health insurance companies, supports the plan to create a universal pool for immunizations because it will cost less to buy vaccines, thanks to bulk discounts and federal incentives. The assessments would also apply to third-party health insurers, which provide health care plans to some businesses. Some employer-run insurance plans are exempt from state health care regulations due to a federal law called Employee Retirement Income Security Act (ERISA). “The major business entities have agreed that, although they don’t like us going around ERISA, they have agreed that it is cost-beneficial to them and it is a beneficial item to the state that we can have children immunized at the same level whether they are insured or uninsured.”
Cameron and members of the medical field spoke in favor of the proposal to the Senate Health and Welfare Committee Tuesday. “Most doctors offices are really small businesses,” Dr. Patrice Burgess of Boise said. “Purchasing the vaccine without the discount is very expensive.” She said money spent on vaccines goes a long way. “A dollar spent now saves hundreds if not thousands later. Any infection you could prevent in children that could result in a hospital stay, possibly even an ICU stay, is avoidable for expense reasons but also quality of life reasons.”
Corey Surber, the advocacy and community health coordinator with St. Alphonsus Regional Medical Center in Boise, said the immunization assessments should help more children receive vaccines. “We already have pretty dismal immunization rates,” she said. “Just the purchase of the vaccine is really only the first step.” There is another proposal in the Senate Health and Welfare Committee to make the state’s Immunization Reminder Information System (IRIS) computer database an opt-out system for children instead of an opt-in. That change would likely lead to more children being part of the registry and could lead to higher immunization rates.

Lawmakers have immunization problem to solve

Brad Iverson-Long — Fri, 01 Jan 2010 20:43:08 +0000

One early hurdle for Idaho lawmakers in 2010 will be finding millions of dollars for the state’s childhood immunization program. Funding is set to run out at the end of January, though lawmakers working closely on the issue say temporary money should be found soon and a more permanent source—likely insurance companies—should be in place by July.
Idaho has some of the lowest immunization rates in the country, and the uncertainty over the vaccine funding is worrying some doctors.
“We’re working on it,” said Rep. Gary Collins, R-Nampa, one of the leaders of a task force of lawmakers trying to find funding for immunizations. Collins said he’s confident that lawmakers will find both short- and long-term money, but said there’s nothing concrete yet. The health care task force has held several meetings this year with doctors and representatives from insurance companies.
“We think we’re close to a compromise,” said Sen. Dean Cameron, R-Rupert, another task force leader. Cameron said the long-term source of money will likely be an assessment that insurance companies agree to pay for vaccines.
One doctor who gives vaccines to kids say physicians will need a plan from Idaho legislators by mid-January so they can make purchasing decisions on vaccines. Dr. Tom Patterson said further delays could lead to further drops in Idaho’s low childhood immunization rates. Patterson is a pediatrician in Nampa who leads the Idaho Immunization Coalition, a nascent advocacy group promoting immunization.
“When you’re last in the nation, the last thing you want to do is pull the purse strings,” Patterson said.
Two sources of money pay for vaccines in Idaho, which is run by the Department of Health and Welfare’s Idaho Immunization Program. The Vaccines for Children program uses federal dollars to pay for immunizations for children without insurance or on Medicaid, and kids who are Native American or have insurance that doesn’t cover vaccines. The state pays for vaccines for children not eligible for VFC immunizations.
That state funding is set to expire January 31st. The current search for more money for non-VFC vaccines replays a similar debate last spring when Gov. Butch Otter ordered zeroing out funding for the immunization program. The result was a one-month gap last July without state funding before Otter gave $2.1 million from a state rainy day fund to the immunization program.
Patterson said that gap in July without state money hurt his medical practice. Normally, the state reimburses doctors for vaccine purchases. The company Patterson works for, Salzer Medical Group, bought their own stock of vaccines July, but couldn’t use some of that supply when the state program came back in August.
“(Doctors) were left with vaccine sitting in a fridge,” Patterson said. “The burden fell to the provider to have a separate stock.” Doctors had to keep separate supplies of vaccines—one pool for children on VFC, and one for children with some kind of insurance.
“It turned out to be sort of a mess,” Cameron said about two-pool system. He said he got complaints from people in his district who had to pay more for vaccinations. “People were understandably upset.”
Patterson said repeating the gap in vaccine payments in February could be too much for some doctors. “I’m afraid that there will be providers that will just jump out of the immunization program altogether,” he said. If that happened, families in more remote areas of the state would have to travel farther to find providers still administering vaccines.
The likely source for permanent money for the vaccine program will be assessments paid by insurance companies that will go to a state pool of money for buying vaccines. Pooling that money would give the state a lower price for vaccines, thanks to a program run by the Center for Disease Control and Prevention. New Hampshire follows a similar fee-and-pooling system to buy immunizations.
“The insurance companies should be paying for these vaccines,” Cameron said. “An assessment is a much better deal for everybody.”
Cameron said that assessment will likely be between 25 and 50 cents per insured member per month or $3 to $6 a year. Idaho already runs an assessment on insurance companies for the High Risk Insurance Pool. Cameron said the high risk pool is a likely source for short-term funding for vaccines until a permanent immunization pool could start in July.
It’s difficult to predict if switching to an insurance-backed immunization program will lead to significant gains in Idaho’s immunization rate. The Gem State ranks at or near the bottom in the most recent federal survey of immunization rates for children under 3. All of Idaho’s neighboring states are also below the national average, though Oregon and Washington are close to it.
““When you’re last in the nation it’s really embarrassing,” Patterson said.
“It’s worse than a number of other third world countries,” Cameron said. “Obviously that’s something that’s very concerning.”
The health care task force will meet on January 13 to tackle the problem of funding the vaccination program.