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Legislative information
Health insurance is highly regulated at the federal and state levels.  Mandates were few years ago, but now all policies have many mandated coverage and provisions required by law.  The mandated coverage extends benefits for many conditions and treatments that were not historically considered to be medically necessary but are now required by law.  These mandated benefits are an increasingly larger part of premiums as the number of mandates continues to grow.

Federal Legislative Update June 14, 2013

HR 2328
On Wednesday, Representatives Mike Rogers (R-MI) and John Barrow (D-GA) introduced H.R. 2328, the Access to Professional Health Insurance Advisors Act of 2013

Oregon Legislative Update June 2, 2013

HB 2385 – DUII Insurance Non-Mandate
The Senate voted 20-9 to require insurers to pay for court-ordered DUII treatment.

SB 444 – Ban on Smoking in cars with Minors about to become law
The House approved 43-15 making smoking in cars with minors a secondary traffic offense. That means the officer must stop you for speeding or some other violation, but can then add a $250 fine for smoking if a child under age 18 is in the car.

SB 413B – Notices to Ratepayers regarding Rate Review; Rep. Mitch Greenlick doesn’t think the annual notice to health insurance policyholders about the Insurance Division’s rate review process (included in SB 413A) would really do anything. So, on a party-line vote, he added new annual notice requirements to SB 413 that require  Plus all enrollment and renewal notices must include information, prominently displayed, about the rate review process and how to receive notifications. Also, starting in 2015, insurers will have to incorporate cost containment strategies in their rate review processes. DCBS and the Oregon Health Authority are to jointly develop standards by which insurers will be judged. There were no hearings on this amendment in the process. Rep. Greenlick also added an amendment that would have the Insurance Division use a public process to determine the medical inflation rate that insurers would use when they file new rates. Rep. Greenlick said, “I call this the ‘Everyone is entitled to their own opinion but not their own facts’ amendment.”  The bill now goes to the floor for debate. Reportedly, Senate Health Committee chair, Sen. Laurie Monnes Anderson isn’t happy with the changes to this bill, so the Senate may not concur, assuming it passes the House, which means it would end up in a conference committee.

HB 2385 – Senate Committee passes DUII Mandate; On a straight party-line vote, the Senate Health Committee approved requiring health insurance companies to pay for court-ordered DUII treatment. The debate came down to whether this constitutes a new insurance mandate under the Affordable Care Act (ACA). If it is, the state has to pay for it.  In testimony to the committee, Rep. Phil Barnhart (D-Eugene) said, “It is quite clear that it is not a new mandate.” Barnhart cited information from the Center for Consumer Information and Oversight (CCIO) saying not paying for the treatment was discrimination. Sen. Jeff Kruse (R-Roseburg) disagrees saying, “Quite often the feds are wrong. I do think this is a new mandate. This is court ordered. That is a different critter.”  Committee chair Sen. Laurie Monnes Anderson (D-Gresham) pushed the bill through saying, “I feel strongly if you have insurance, and have not been dropped by insurance, that treatment should be covered by your insurance.”  The bill now goes to the Senate floor for debate.  But that may not be the end for this issue. There is at least the possibility of a federal lawsuit to determine whether these new insurance requirements qualify as mandates under the ACA.

HB 2128 – OEBB & the Exchange; A bill passed in 2012 allows school districts to opt out of OEBB if they purchase health insurance through the Insurance Exchange starting in October 2015.  OEA is using HB 2128 to weaken that option. It started out as a bill that would require OEBB and the Exchange Board to agree on what plans would be offered to schools on the Exchange.  On the last day of committees, OEA added a previously unseen amendment that says every plan offered by the Exchange has to have coverage comparable to plans offered by OEBB. They also have to be underwritten using one risk pool.  There was no discussion in the Senate Health Committee. The bill was approved and sent to the floor for debate.

HB 3458 – Reinsurance bill passes House; Starting in 2014, health insurance plans in the individual market will be guaranteed issue, meaning people can no longer be rejected because they are a poor health risk. So there is no longer any need for Oregon’s high-risk pool (known as OMIP). The high-risk pool will simply become part of the individual pool. But because of their poor health and expensive claims, they will be expensive to insure and cause rates to go up.  So Oregon decided to create a new reinsurance program, in HB 3458, using the assessment authority that previously funded OMIP. This reinsurance will wrap-around the federal reinsurance program so that combined they will pay 90% of claims between $30,000 and $300,000. In carrying the bill on the House floor, Rep. Joe Gallegos (D-Hillsboro) said, “This will mitigate the rate increase from adding these high-risk rate payers to the pool.”  The bill passed the House 59-0. It now goes to the Senate for a vote.

HB 2240 – Aligns Insurance code with ACA; HB 2240 makes a number of technical changes to bring Oregon law into compliance with the Affordable Care Act (ACA). Among other provisions, HB 2240 would:

  • Define pre-existing conditions that cannot be excluded or used to deny coverage.
  • Change small groups from 2-50 to 1-50 in 2013 and then to 1-100 in 2016.
  • Allow DCBS to regulate multistate plans.
  • Change the definition of bona fide association plans to conform with federal law.
  • Outline requirements for student health benefit plans.
  • Abolish the Office of Private Health Partnerships and the Family Health Insurance Assistance Program.
  • Repeal portability requirements in light of the ACAs guaranteed issue provisions.

No one spoke against the bill on the House floor but 22 Republicans voted against it, which makes you think the vote is primarily a symbolic protest against federal reforms. The bill now goes to the Senate for a vote.

HB 2859 – Ends OHP Standard; The key to this bill is that it changes the Oregon Health Plan to one benefit package – OHP Plus. It eliminates OHP Standard benefits for the “expansion population” which allows Oregon to expand Medicaid eligibility for single adults up to 138% FPL. Because of that change, starting in January 2014, the federal government will pay 100% of the cost for that group and they will all receive the OHP Plus benefits.  But on the floor of the House it was simply described as “aligning OHP with new Medicaid standards.” Rep. Tim Freeman (R-Roseburg) objected saying, “This is a huge policy shift, asking Cover Oregon to determine eligibility for the Oregon Health Plan.” Rep. Mitch Greenlick (D-Portland) responded, “Eligibility still remains with OHA. The application goes through Cover Oregon but OHA makes the determination.”  The House voted 38-21 to approve the plan. It now goes to the Senate for a vote.

SB 683 – Patient Referrals; As health care systems grow and integrate, Sen. Chip Shields told the House Consumer Protection Committee he worries about what that means for patient referrals. “How does that work for the little guy? The independent physical therapist who might provide better service at a lower price.”  So Shields has pushed through SB 683, what he describes as “A shot across the bow to discourage anti-competitive behavior,” that carries with it a $1000 potential penalty per investigation.  Patty O’Sullivan from the hospital association says providers “Must notify patients orally and in writing if you have a financial interest in the facility to which you are referring them and must let them know they may choose a different facility.”  This bill was pushed in large part by a group of independent physical therapists whose lobbyists said, “Patients are going to be educated about their choices.”  The bill now goes to the House floor for debate. 

SB 539 – Wellness program demonstration program; 
The federal Affordable Care Act prohibits the use of wellness incentives in the individual insurance market except through a 10-state wellness program demonstration project. SB 539 instructs DCBS to apply for participation in that demonstration project.  The House Health Committee approved the bill and sent it to the floor for debate.  The Oregon State Legislature convened on February 4, 2013 and is schedule to adjourn at the end of June. 

More Oregon Legislative information here

Washington State Legislative Update June 1, 2013

  • The Washington State Legislature adjourned on April 28th. 
  • Washington is having some budget challenges 
  • A special session started on May 13.
  • Some health care related bills have been passed
  • Health insurance exchange financing activity
  • Small Health Options Program (SHOP) Exchange for small employers - Kaiser only
  • The Washington Health Benefit Exchange Board will certify Qualified Health Plans (QHPs) for Exchange
  • More Washington Legislative information here