California Healthline: Insurance and Uninsured

13.5M U.S. Residents Have High Deductibles, Health Savings Accounts

Thu, 31 May 2012 08:00:00 GMT

A report from America's Health Insurance Plans finds that about 13.5 million U.S. residents are enrolled in a high-deductible health plan paired with a health savings account. The number of enrollees in such plans has increased by 18.4% since 2011. Kaiser Health News/NPR et al.

CalPERS Must Offer Long-Term Care to Same-Sex Couples, Judge Rules

Tue, 29 May 2012 08:00:00 GMT

A federal judge has ruled that CalPERS must give state workers' same-sex spouses or domestic partners access to a long-term care insurance plan. Experts say that more than 2,900 state workers in same-sex relationships have sought such coverage. Sacramento Bee et al.

Legislation Seeks To Boost Health Care Cost Transparency

Fri, 25 May 2012 08:00:00 GMT

Reps. Michael Burgess and Gene Green have introduced legislation that would require states to establish laws mandating that hospitals publicly disclose the cost of inpatient and outpatient services. The measure also would require health insurers to provide enrollees with estimated out-of-pocket costs for health care services. Becker's Hospital Review, AHA News.

Reform Law Expected To Restrict Undocumented Residents' Care Access

Thu, 24 May 2012 08:00:00 GMT

The federal health reform law's planned expansion of health coverage is likely to strain the U.S. health care system and hinder access to care for undocumented residents. Some communities, like Los Angeles, are testing ways to extend care to undocumented residents. Politico.

Harold Miller of the Network for Regional Healthcare Improvement Discusses Innovation

Wed, 23 May 2012 08:00:00 GMT

Harold Miller, president and CEO of the Network for Regional Healthcare Improvement, spoke with California Healthline about the importance of pursuing innovative health care improvement strategies that are tailored to local needs.

Opinion: Rate Regulation Plan To Lead to ‘Political Clash’

Tue, 22 May 2012 08:00:00 GMT

In an Orange County Register opinion piece, columnist Dan Walters discusses a proposed November ballot measure that would give California officials greater regulatory authority over health insurance rates. He notes that the measure will trigger an "immense political clash" in which the "warring factions will be spending untold millions of dollars on the fall campaign over this complex and contentious issue." Orange County Register.

Insurance Rate Regulation Plan Moves Closer to Ballot

Mon, 21 May 2012 08:00:00 GMT

On Friday, California Insurance Commissioner Dave Jones and Consumer Watchdog officials submitted to state officials 800,000 voter signatures for a proposed ballot measure that would give the state greater regulatory authority over health insurance rates. At least 504,760 valid signatures are necessary to qualify the measure for the November ballot. A coalition of hospitals, physicians and other stakeholders oppose the measure. Sacramento Bee et al.

Study Finds Federal Poverty Level Undercounts in Calif.

Fri, 18 May 2012 08:00:00 GMT

Many California residents are ineligible for potential safety-net programs because the current federal poverty level, at $15,130 for a couple, is too low, according to a new study by the UCLA Center for Health Policy Research. The study's authors said the FPL should be nearly three times higher in some parts of the state, noting that 40% of adults older than age 65 and 25% of non-seniors are undercounted as being poor. Payers & Providers.

Study: Health Care Costs Rising for Families With Job-Based PPO Coverage

Wed, 16 May 2012 08:00:00 GMT

A Milliman study finds that the average annual health care costs for a family of four with an employer-sponsored preferred provider plan is $20,728, a 6.9% increase from 2011. The study found that workers on average pay about 41% of those costs. Los Angeles Times, CQ HealthBeat.

Bill Would Offer Benefits to Domestic Partners of Federal Employees

Tue, 15 May 2012 08:00:00 GMT

Tomorrow, a Senate panel is scheduled to mark up legislation that would extend certain health benefits to domestic partners of gay and lesbian federal employees. Meanwhile, more companies are offering health benefits to workers' domestic partners. Washington Times et al.

If Individual Mandate Is Overturned, States Still Have Lots of Options

Wed, 09 May 2012 08:00:00 GMT

As they await a ruling from the Supreme Court on the Affordable Care Act, state officials are weighing their options if the individual mandate is struck down. And there are a number of choices to consider.

Concerns Raised About Access to Primary Care in Sacramento County

Tue, 08 May 2012 08:00:00 GMT

Health care leaders in Sacramento County are concerned about the lack of primary care services available to low-income and uninsured residents. The county once operated six public clinics but now runs only one, while not-for-profit community clinics are scarce. Sacramento Bee.

GOP Report: Employers Would Save Money by Dropping Coverage

Wed, 02 May 2012 08:00:00 GMT

A report by House Republicans contends that the largest U.S. companies could save billions of dollars by dropping coverage and shifting workers into the federal health reform law's insurance exchanges. Democrats called the report's predictions "cynical." The Hill's "Healthwatch" et al.

GAO: Millions of U.S. Adults Have Pre-Existing Conditions

Mon, 30 Apr 2012 08:00:00 GMT

An estimated 36 million to 112 million U.S. adults have pre-existing conditions -- such as diabetes, hypertension and mental health disorders -- that could lead health insurers to deny coverage, according to a recent Government Accountability Office report. America's Health Insurance Plans downplayed the report, saying that the number of individuals with pre-existing conditions who are uninsured is low. The Hill's "Healthwatch," Modern Healthcare.

Employers Say Reform Law Will Increase Health Costs, GOP Report Finds

Fri, 27 Apr 2012 08:00:00 GMT

A report by Republicans on a House committee finds that certain companies on President Obama's jobs council expect the federal health reform law to increase their health care costs, which could lead them to drop health coverage for employees. Wall Street Journal et al.

WellPoint Reports Drop in Q1 Profit, Cites Rising Health Care Costs

Thu, 26 Apr 2012 08:00:00 GMT

WellPoint -- the second-largest insurer in the U.S. -- has reported an 8% drop in first-quarter profits. The company said lower enrollment and rising health care costs contributed to the loss, in addition to higher-than-expected claims from a Medicare plan. Los Angeles Times.

Patient Costs Increase Under Insurance Payment Method

Wed, 25 Apr 2012 08:00:00 GMT

A 2009 health insurance settlement required insurers to underwrite a new database that collects bills from insurers to calculate "usual and customary charges" for procedures in a given region. However, insurers were not required to use the database to calculate payments for out-of-network care and instead have used a calculation method based on Medicare rates that often results in lower provider reimbursements and higher patient costs. New York Times.

State Senate To Conduct Hearing on Bill Limiting Stop-Loss Insurance

Mon, 23 Apr 2012 08:00:00 GMT

The Senate this week will hold a hearing on a bill that would limit health plans known as stop-loss policies for small businesses. The bill would ban stop-loss coverage below $95,000 for each worker to equalize risk among small businesses that self-insure. Los Angeles Times.

California Lawmakers To Vote on Bill Addressing Patient 'Capturing'

Mon, 23 Apr 2012 08:00:00 GMT

State lawmakers will vote this week on a bill that would reduce insurer payments to hospitals that admit too many out-of-network, privately insured patients. The bill follows reports of aggressive billing practices by Prime Healthcare. California Watch.

Rate Reductions by Two Malpractice Insurers Will Save Nearly $4M

Thu, 19 Apr 2012 08:00:00 GMT

Planned rate reductions by two medical malpractice insurers will save policyholders nearly $4 million annually, according to the Department of Insurance. Insurance Commissioner Dave Jones called for reductions after reviewing the companies' rate filings. Healthcare Finance News.

Many U.S. Adults Faced Gaps in Coverage Last Year, Survey Finds

Thu, 19 Apr 2012 08:00:00 GMT

A Commonwealth Fund survey finds that more than 25% of U.S. residents ages 19 to 64 had gaps in insurance coverage at some point last year, and nearly 70% of those residents had been uninsured for one year or longer. Los Angeles Times et al.

Pre-Existing Condition Reform Passes Committee

Thu, 19 Apr 2012 08:00:00 GMT

The Senate Committee on Health yesterday passed SB 961 by Ed Hernandez (D-West Covina), which would change the individual health insurance market in California, in part by halting insurer denials based on pre-existing conditions. It is similar to a bill -- AB 1461 by Bill Monning (D-Carmel) -- approved by the Assembly health committee one day earlier.

Both measures are designed to conform to the federal Affordable Care Act, Hernandez said, in advance of many other states.

"While some of you may not support the Affordable Care Act, it is currently the law of the land," Hernandez said yesterday in introducing the measure. "And California continues to serve as a model for the rest of the nation."

UnitedHealthcare, DOI Reach Settlement on Autism Therapy

Wed, 18 Apr 2012 08:00:00 GMT

UnitedHealthcare has agreed to a settlement with the state Department of Insurance to provide immediate coverage of applied behavioral analysis for people with autism. Many insurers have argued that the treatment is not a medical service. Sacramento Business Journal.

CalPERS Cites Steps To Improve Services After Claims Processing Delays

Tue, 17 Apr 2012 08:00:00 GMT

CalPERS officials say the agency has improved services after months of delayed claims processing resulting from the launch of a new computer system. A new staff assessment shows that CalPERS has helped more employers use the new system correctly. Sacramento Bee.

Californians Struggle To Find Accurate Medical Pricing

Mon, 16 Apr 2012 08:00:00 GMT

It is difficult for California residents to determine the cost of common medical procedures. Although hospitals are required by law to publish average charges for certain procedures, the prices often are not what patients actually pay. Los Angeles Times.

Workers' Compensation Insurance Group Seeks 4.1% Premium Increase

Fri, 13 Apr 2012 08:00:00 GMT

The Workers Compensation Insurance Rating Bureau recently proposed a 4.1% increase in employer-paid premiums for workers' compensation insurance. Insurance Commissioner Dave Jones plans to hold hearings on the issue before making recommendations. Sacramento Bee's "Capitol Alert."

Health Committee Approves Additions to Medical Review Plan

Fri, 13 Apr 2012 08:00:00 GMT

The independent medical review process in California needs an update according to Senate member Ed Hernandez (D-West Covina) who introduced SB 1410 at Wednesday's Senate Committee on Health hearing.

"This bill deals with the Independent Medical Review program as an important safeguard for consumers of health care in California," Hernandez said. "Collectively these changes will improve the effectiveness and transparency of the IMR program."

Hernandez said the bill adds three improvements to the current IMR process in the state.

Opinion Piece Faults Health Reform Law for Cost Shifting

Mon, 09 Apr 2012 08:00:00 GMT

In a Los Angeles Times opinion piece, William Voegeli -- senior editor of the Claremont Review of Books, author and visiting scholar at Claremont McKenna College's Salvatori Center -- writes that "the rationale" for including the individual mandate in the federal health reform law "is to prevent 'cost shifting' -- from people who could purchase health insurance policies but don't to people who already have insurance." However, he writes, the law is "curtailed not to avert harm to others but to provide benefits for others." According to Voegeli, "Under the guise of preventing cost shifting, that is, Obamacare commits cost shifting." Los Angeles Times.

Consumers Union To Help Review Insurers' Rate Hikes

Fri, 06 Apr 2012 08:00:00 GMT

The California Department of Managed Health Care has awarded a $225,000 contract to Consumers Union to help DMHC evaluate health insurers' proposed premium rate increases. The contract is funded by the federal health reform law. Although DMHC is not authorized to reject proposed premium rate hikes, legislation that went into effect in 2011 gives the agency the power to review insurers' proposals and make recommendations. Payers & Providers.

Aetna Proceeds With Rate Hike Despite Pressure From State

Fri, 06 Apr 2012 08:00:00 GMT

Insurer Aetna plans to continue with a premium rate hike for small business workers, even though California's insurance commissioner has deemed the increase excessive. State officials are seeking the authority to reject certain rate hikes. Sacramento Bee et al.

State To Continue With Insurance Exchange Despite Court Case

Thu, 05 Apr 2012 08:00:00 GMT

California will work to launch a health benefit exchange regardless of the Supreme Court's decision on the federal health law, according to officials. The state already has received $40 million in federal funding for the exchange. San Francisco Chronicle.

Opinion Piece Stumps for Deregulated Insurance Market

Thu, 05 Apr 2012 08:00:00 GMT

In an Orange County Register opinion piece, John Cochrane -- a professor of finance at the University of Chicago Booth School of Business and an adjunct scholar at the Cato Institute -- argues, "If we had a deregulated, competitive" health care and health insurance market, "that market would be so much cheaper than what's offered today that we would likely not even need the [individual] mandate." Orange County Register.

Aetna Mistakenly Tells Members Their Doctors Are Out of Network

Thu, 05 Apr 2012 08:00:00 GMT

Aetna recently announced that it mistakenly sent letters to more than 8,000 policyholders in California saying that their physicians no longer are in the insurer's coverage network. The company has mailed retraction letters to affected policyholders and physicians. Sacramento Bee.

San Diego Seeks Ways To Manage Frequent Users of Emergency Services

Wed, 04 Apr 2012 08:00:00 GMT

San Diego officials are working to address the frequent use of emergency services by a largely homeless population. According to experts, frequent emergency service users need access to better coordinated health care and more permanent housing options. U-T San Diego.

Federal, State Officials Investigate SCAN Health Plan for Overbilling

Wed, 04 Apr 2012 08:00:00 GMT

SCAN Health Plan is being investigated by state and federal authorities for allegedly double-billing Medi-Cal and Medicare for treating the same pool of patients and intentionally hiding its actions. SCAN recently set aside $125 million for resolving the allegations. California Watch.

'We'll Deal With it Then': The State of Play if ACA is Struck Down

Wed, 04 Apr 2012 08:00:00 GMT

Most states -- even some that have sued the government over the Affordable Care Act -- are preparing contingency plans whether the law is upheld or struck down. But not all states are equally ready to respond.

Opinion: Free-Market Reforms Won't Fix Health Care System

Tue, 03 Apr 2012 08:00:00 GMT

In a Los Angeles Times opinion piece, Beverly Hills physician Daniel Stone questions Republican presidential candidate Mitt Romney's strategy to use free-market initiatives "to improve access to care." He writes, "Despite Romney's optimism, free markets will never solve the problems." Stone argues, "If universal coverage is the goal, there is no alternative to subsidies funded by employers and taxpayers." Los Angeles Times.

Medi-Cal Officials Assess Gold Coast Health Plan's Assignment Procedures

Tue, 03 Apr 2012 08:00:00 GMT

Ventura County Medi-Cal officials are examining procedures that assign beneficiaries covered by Gold Coast Health Plan to certain health care providers. According to an audit, the procedures appear to favor the Ventura County Health Care Agency's clinic system. Ventura County Star.

Sacramento Residents Line Up for No-Cost Health Clinic

Mon, 02 Apr 2012 08:00:00 GMT

Volunteer health care providers -- including physicians, dentists and optometrists -- are providing medical care to uninsured Sacramento residents during a four-day no-cost clinic at Cal Expo. The event was organized by the not-for-profit Remote Area Medical Foundation. Sacramento Bee et al.

Insurance Premiums in California Could Jump by 20%, Filings Show

Wed, 28 Mar 2012 08:00:00 GMT

California insurers have submitted rate filings that indicate premiums for policyholders could increase by as much as 20% in coming months. A spokesperson for Anthem Blue Cross says the hikes are necessary for the health plan to cover mandated benefits and medical claims costs. Orange County Register.

Does Obama Deserve Blame for Mandate's Troubles?

Wed, 28 Mar 2012 08:00:00 GMT

Candidate Obama opposed health reform's individual mandate; President Obama signed the mandate into law. Why did the president shift his thinking -- and will the decision haunt his signature legislation?

Changes Intended to Smooth MRMIP Operation

Wed, 28 Mar 2012 08:00:00 GMT

Assembly member Bill Monning (D-Carmel) is chair of the Assembly Committee on Health, but at yesterday's meeting he went to the other side of the dais to present a piece of new legislation.

Monning's AB 1526 would eliminate the annual and lifetime limits on coverage in the Major Risk Medical Insurance Program, popularly known as MRMIP.

"This bill is related to two goals I've had since I started in the Assembly. And number one is to make MRMIP more affordable for people who are in dire need of it," Monning said. "And the other goal was, to actually meet Mister Mip."

Medi-Cal Commission Discusses Concerns With Gold Coast Health Plan

Tue, 27 Mar 2012 08:00:00 GMT

The Ventura County Medi-Cal Managed Care Commission recently discussed complaints about Gold Coast Health Plan, which administers Medi-Cal for county residents. A health care provider at the meeting said the plan is months behind on payments. Ventura County Star.

Report Prompts Concern About Solvency of Gold Coast Health Plan

Mon, 26 Mar 2012 08:00:00 GMT

A preliminary report by the Berkeley Research Group finds that Gold Coast Health Plan's actual costs sometimes have been higher than its reported expenses. The findings have raised concern among state officials about the plan's solvency. Ventura County Star.

Calif. Officials Seek New Limits on Certain Small Business Health Plans

Fri, 23 Mar 2012 08:00:00 GMT

State officials are seeking ways to limit the sale of a certain type of self-insurance to small businesses. Critics say the plans do not require businesses to take on enough risk and that insurers are selling them mostly to companies with healthier workers. Los Angeles Times.

Anthem Blue Cross Will Reduce Planned Premium Rate Increases

Thu, 22 Mar 2012 08:00:00 GMT

Anthem Blue Cross has agreed to lower premium rate increases for about 600,000 policyholders from an average of 10.4% to 8.2%. State officials sought the lower rate hike after questioning Anthem's estimates for medical expenses. Los Angeles Times.

Clues to How the Supreme Court Might Rule on Health Reform

Wed, 21 Mar 2012 08:00:00 GMT

The fate of the Affordable Care Act rests in the hands of the Supreme Court justices, who next week will hear oral arguments over three days. How the court might rule is a hot topic -- and several historic court decisions provide some hints as to which way the case will go.

CalPERS Oversight Is Lacking, Recent Survey on Accountability Says

Tue, 20 Mar 2012 08:00:00 GMT

A survey by the Center for Public Integrity and Public Radio International finds that oversight of CalPERS is lacking. Critics want more independent guidance on the CalPERS board, noting that it is overrepresented by individuals who could benefit from its decisions. KPCC's "KPCC News."

Healthy San Francisco To See Changes in Wake of Health Reform Law

Fri, 16 Mar 2012 08:00:00 GMT

As the federal health reform law is implemented, Healthy San Francisco could see a significant reduction in funding and beneficiaries. As a result, experts say the universal health care program likely will need to revert back to its safety-net roots. San Francisco Public Press.

CBO Report Describes Worst, Best Outcomes of Health Reform Law

Fri, 16 Mar 2012 08:00:00 GMT

A Congressional Budget Office and Joint Committee on Taxation report predicts that the outcome of the health reform law could range from 20 million U.S. residents losing job-based coverage to three million residents gaining such coverage in 2019. The Hill's "Healthwatch" et al.

Bill Addresses Confusion Related to Benefit Exchange Website

Fri, 16 Mar 2012 08:00:00 GMT

A recently introduced Assembly bill seeks to end public confusion surrounding the California Health Benefit Exchange website. Meanwhile, the state exchange recently awarded three contracts totaling nearly $2 million. Sacramento Business Journal.

Kim Dempsey of NCB Capital Impact Discusses Ways To Boost Capacity of Community Clinics

Thu, 15 Mar 2012 08:00:00 GMT

Kim Dempsey, director of innovation and strategy at NCB Capital Impact, spoke with California Healthline about recommendations for improving the operations of community health centers.

Report: Health System Quality Varies Among Calif. Communities

Wed, 14 Mar 2012 08:00:00 GMT

A Commonwealth Fund report finds that communities vary in health system quality, with higher income areas mostly outperforming lower income areas. Santa Rosa and San Mateo ranked in the top 10 U.S. regions for health system performance. Los Angeles Times et al.

On the Health Reform Trail: The Good, the Bad and the Ugly

Wed, 14 Mar 2012 08:00:00 GMT

At the two year anniversary of the Affordable Care Act, California has made significant progress in establishing an insurance exchange and undertaking other provisions of the law. However, the road ahead is marked by uncertainty, and California must meet more challenges before the job is done.

Health Net Adds Financial Incentives to Low-Cost Plan

Wed, 14 Mar 2012 08:00:00 GMT

Insurer Health Net has added wellness incentives to its Bronze HMO plan. The low-cost health plan -- renamed SmartCare -- will provide members with financial rewards for completing a health risk questionnaire and visiting their primary care physician. The plan will be used in association with 40 medical groups in Los Angeles, San Bernardino and San Diego. Payers & Providers.

Health Insurers, Physician Group Oppose Ballot Initiative

Tue, 13 Mar 2012 08:00:00 GMT

It's not even a ballot measure yet, but it's certainly getting ballot-measure treatment.

Yesterday, a coalition of health insurance organizations, the California Medical Association, the California Hospital Association and other groups announced they were joining forces to fight a ballot measure designed to regulate health insurance rate increases.

"This initiative does nothing to address the cost drivers in the health care system," according to Paul Phinney, president-elect of the CMA. "I just think this initiative is the wrong idea."

Health Care Lobbying in California Tops List in Record Year

Mon, 12 Mar 2012 08:00:00 GMT

Health care issues generated $35.7 million in lobbying last year in California, leading the way to a record year. Lobbyists earned more money from more clients in California in 2011 than ever before, according to the secretary of state.

California Mandates 48 Specific Areas of Coverage

Fri, 09 Mar 2012 08:00:00 GMT

An analysis released yesterday by the California Health Benefits Review Program shows that a large cross-section of Californians -- about 32 million people -- will be covered by health care mandates passed by the Legislature. There are now 48 of those mandates that either require coverage or require an offer of coverage, and another five mandates that deal with more general terms and conditions of coverage.

That is not the final word on the number of mandates. CHBRP was asked to evaluate three more legislative bills recently that deal with mandated coverage of tobacco cessation, prescription drugs and children's immunizations. In addition, some of the 16 bills the agency analyzed last year are up for approval this year. They include mandates ranging from mental health coverage to oral chemotherapy treatment.

State-passed mandates could have a financial impact on the health plans that need to cover those conditions and also may affect the list of essential health benefits offered by the California health benefit exchange.

Study Links Health-e-App to Spike in Healthy Families Enrollment

Thu, 08 Mar 2012 08:00:00 GMT

A new study credits Health-e-App, an online application tool, with boosting enrollment in California's Healthy Families program. Use of the online tool was associated with a 14% increase in total Healthy Families applications from 2010 to 2011. Sacramento Business Journal.

CDC Survey: Many U.S. Families Struggling To Pay Their Medical Bills

Thu, 08 Mar 2012 08:00:00 GMT

A CDC survey finds that one in five U.S. residents are in families who struggled to pay medical bills during the first half of 2011. About 45.8% of survey respondents with incomes just above the poverty line had trouble paying medical bills. HealthDay/Philadelphia Inquirer et al.

LAO: Delay Action on Brown's Plan for Unemployment Fund

Wed, 07 Mar 2012 08:00:00 GMT

A new Legislative Analyst's Office report urges lawmakers to hold off on acting on Gov. Brown's proposal to change the state's Unemployment Insurance Fund until "a long-term solvency plan" is drafted. Brown's plan would continue borrowing money from the Disability Insurance Fund, raise payroll taxes on employers and tighten eligibility for unemployment benefits. Sacramento Bee's "Capitol Alert."

HHS: Health Reform Has Ended Lifetime Coverage Limits for 105M People

Tue, 06 Mar 2012 08:00:00 GMT

Yesterday, HHS released a report stating that the federal health reform law has eliminated lifetime coverage limits for more than 105 million U.S. residents. Meanwhile, Republican lawmakers are testing new methods to weaken the federal overhaul. The Hill's "Healthwatch" et al.

Health Reform in California Inevitable, Health Leaders Say

Mon, 05 Mar 2012 08:00:00 GMT

Health industry officials say that health care reform will happen in California regardless of whether the federal overhaul is upheld. They note that higher costs and lower reimbursements necessitate a statewide overhaul. Sacramento Business Journal.

Blue Shield Forms ACO With Newport Beach Health Groups

Mon, 05 Mar 2012 08:00:00 GMT

Last week, Blue Shield of California announced that it will partner with Newport Beach-area health groups Hoag Memorial Hospital Presbyterian and Greater Newport Physicians to establish an accountable care organization. Starting July 1, the new ACO will provide bundled payments to Hoag and Greater Newport in an effort to reduce the cost of health premiums for 11,000 Blue Shield enrollees. The ACO will operate for at least three years. Payers & Providers.

California Health Exchange Taps Ogilvy for PR Campaign

Fri, 02 Mar 2012 08:00:00 GMT

The California Health Benefit Exchange has selected Ogilvy Public Relations Worldwide to develop a statewide marketing, outreach and education campaign. The contract is tentative, pending a five-day protest period set to end March 7. The $900,000 contract is valid through October 2013 and could lead to an additional contract worth tens of millions of dollars to launch the exchange. Sacramento Bee's "Capitol Alert."

Insurance Agents Concerned by Industry Changes

Thu, 01 Mar 2012 08:00:00 GMT

A series of ongoing and anticipated changes to the health insurance industry at the state and federal levels are causing concern for California's health insurance agents. Those changes include new industry regulations under the federal health reform law and a proposed California ballot measure that would give state regulators the authority to approve health plan premium increases. Ventura County Star.

Budget Subcommittee Rejects Brown's Proposed Welfare Cuts

Thu, 01 Mar 2012 08:00:00 GMT

Democrats on an Assembly budget subcommittee voted to reject Gov. Brown's proposed cuts to the CalWORKs program. The vote marked the first significant legislative action against Brown's budget plan. Los Angeles Times' "PolitiCal" et al.

Costs Higher Than Expected for Calif. High-Risk Pool

Wed, 29 Feb 2012 08:00:00 GMT

Health care costs for California's temporary high-risk insurance program have reached more than $37,000 per patient annually, according to program administrators. The program -- established in 2010 under the federal health reform law -- was expected to cost roughly $12,000 per patient annually. The higher-than-expected prices could be driven by demand for coverage of various tests and treatments that patients have waited to obtain. KQED's "The California Report."

Cigna, HealthNet Agree To Cover Autism Therapies

Wed, 29 Feb 2012 08:00:00 GMT

On Monday, California Insurance Commissioner Dave Jones announced settlement agreements with Cigna and HealthNet to guarantee coverage and access to specialized therapy for people with autism. The settlements stem from a dispute over the insurers' compliance with the state's Mental Health Parity Law, which mandates coverage of medically necessary behavioral therapies. San Francisco Chronicle's "City Brights."

Blue Shield of California Seeks Damages From Monarch HealthCare

Wed, 29 Feb 2012 08:00:00 GMT

Blue Shield of California alleges that actions by physician group Monarch HealthCare after it entered into an acquisition agreement with UnitedHealth Group violate its contract with Blue Shield. Blue Shield has filed a demand for at least $10.5 million in damages. Wall Street Journal.

Kaiser Ordered To Cover Developmental Therapy for Certain Patients

Tue, 28 Feb 2012 08:00:00 GMT

California regulators have ordered Kaiser Permanente Foundation Health Plan to stop denying occupational, physical and speech therapy to patients who lack physical or mental disabilities. A Kaiser official said regulators have misunderstood the insurer's coverage policies. Contra Costa Times.

Blue Shield, Medical Groups Team Up for New Health Plan

Mon, 27 Feb 2012 08:00:00 GMT

Blue Shield of California, Hill Physicians Medical Group and AllCare IPA have collaborated to launch "Blue Groove," a new health insurance plan designed to reduce employer premium costs by 10% and help individuals adopt healthy lifestyles. The plan currently is available to residents of Sacramento and Modesto counties and likely will be expanded, according to Blue Shield officials. San Francisco Business Times.

Health Costs for PCIP Enrollees To Be Twice as High as Predicted

Fri, 24 Feb 2012 08:00:00 GMT

A report from the Obama administration estimates that health care costs for enrollees in the Pre-Existing Condition Insurance Plan will be about twice as high as predicted. About 50,000 U.S. residents currently are enrolled in PCIP. Washington Post, The Hill's "Healthwatch."

Republican Lawmakers Support Gov. Brown's Pension Reform Plan

Thu, 23 Feb 2012 08:00:00 GMT

State Republican lawmakers have introduced several bills based on Gov. Brown's pension reform plan and called on Democrats to support the proposals. Democrats said they are in the process of reviewing Brown's plan. Los Angeles Times, Los Angeles Times' "PolitiCal."

Major Calif. Health Plans Raise Premiums at Rates Outpacing Medical Costs

Thu, 23 Feb 2012 08:00:00 GMT

Major state health insurers are increasing premiums for individual plans at rates outpacing medical care costs. Insurers say they are raising rates based on claims experience with policyholders and because healthier individuals are leaving the market. Los Angeles Times.

More Uninsured Could Put Pressure on State

Fri, 17 Feb 2012 08:00:00 GMT

A UCLA Center for Health Policy Research report showed that 670,000 Californians lost employer-based health insurance in 2008 and 2009. That is a far cry from the earlier estimate of 2 million newly uninsured in the state. But what's interesting about the new number, according to the report's lead author Shana Lavarreda, is that it indicates that a new class of uninsured has been rising.

"The uninsured here is less and less an undocumented [worker] problem, and now it's more of a Main Street problem," Lavarreda said.

A majority -- if not all -- of those working-age Californians who lost coverage over that two-year period could have been considered residents of "Main Street."

Making a Place for Small Businesses in Exchanges

Wed, 15 Feb 2012 08:00:00 GMT

Health insurance exchanges for small businesses are set to go online in 2014, alongside state-based exchanges for the individual market. Recent research shows that the success of the so-called Small-Business Health Options Program will be based on whether it can offer more plan choices and contain costs.

Enrollment in Riverside Co.'s Health Plan for the Uninsured Nears 3,000

Tue, 14 Feb 2012 08:00:00 GMT

About 2,700 low-income Riverside County residents who do not qualify for Medi-Cal have been enrolled in a new countywide health plan that emphasizes timely primary and preventive care. The program directs residents seeking care to public health clinics. HealthyCal.

Editorial: Blue Shield Right To Seek Lower Costs From UCLA

Tue, 14 Feb 2012 08:00:00 GMT

A Los Angeles Times editorial supports Blue Shield of California's goal of cost containment that led the insurer to suspend its relationship with UCLA medical centers "in a dispute over the cost of treating patients there." According to the editorial, Blue Shield said the rates for services at certain UCLA hospitals are nearly twice as high as they were five years ago. The editorial notes, "Blue Shield is right about one thing: The health care industry is on an unsustainable path, and every segment must start focusing on cost control." Los Angeles Times.

Study: Women Retirees More at Risk for Economic Hardship

Mon, 13 Feb 2012 08:00:00 GMT

A study by the UC-Berkeley Center for Labor Research and Education suggests that women retirees in California are more at risk for economic hardships than men because they tend to live longer and earn less over their lifetime. HealthyCal.

Changes to Contraceptive Coverage Rules Draw Mixed Reaction

Mon, 13 Feb 2012 08:00:00 GMT

The U.S. Conference of Catholic Bishops argues that the White House's changes to contraceptive coverage rules do not go far enough, while women's groups said the plan accomodates religious groups but still ensures access to contraception. Washington Post et al.

State Considers Coverage Mandates

Mon, 13 Feb 2012 08:00:00 GMT

The deadline to pass legislation left over from last year has come and gone, with single payer, insurance rate regulation and the basic health plan all temporarily halted. The next big legislative push is coming up fast, as all new bills for 2012 have to be introduced by the end of next week, on Feb. 24.

A number of health-related laws recently were passed by the state Senate or Assembly. Many of them call for coverage mandates by health insurance providers.

Small Hospitals Boost Bottom Lines With Back Surgeries

Fri, 10 Feb 2012 08:00:00 GMT

An increasing number of small California hospitals are providing spinal fusions and other back surgeries for patients covered under workers' compensation insurance. In 2010, spinal fusion surgery made up 40% of inpatient hospital charges to California's workers' compensation system, a 10% increase from 2001. Wall Street Journal.

HHS Unveils Final Rules on Easy-to-Read Health Insurance Summaries

Fri, 10 Feb 2012 08:00:00 GMT

Yesterday, HHS released final rules requiring health insurers to provide consumers with a standardized form that includes an easy-to-read summary of what their plans cover and cost. The regulation was required under the federal reform law. AP/San Francisco Chronicle et al.

Calif. OKs Rule Making Insurers Spend More of Premiums on Care

Fri, 10 Feb 2012 08:00:00 GMT

The Office of Administrative Law has approved a regulation requiring insurers to put a larger share of premiums toward medical care. The rule aligns with a federal health reform law provision. Insurance Journal, CDI release.

Seniors Improperly Denied Home Care Payments, Lawsuit Says

Thu, 09 Feb 2012 08:00:00 GMT

A new lawsuit alleges that Senior Health Insurance Company of Pennsylvania avoided reimbursing California seniors for in-home care costs. SHIP has about 10,000 policyholders in California. AP/San Francisco Chronicle, KPCC's "KPCC News."

Study: Calif. Retirees Have Less Access to Employer Benefits

Wed, 08 Feb 2012 08:00:00 GMT

A study by UC-Berkeley finds that retired Californians have less access to employer-sponsored benefits compared to most U.S. residents. Researchers note that California retirees as a result rely more heavily on government programs. HealthyCal.

Most Calls to San Diego County HHS Do Not Get Through, Report Finds

Wed, 08 Feb 2012 08:00:00 GMT

A new InTelegy report finds that five out of six calls made to San Diego County seeking benefits like food stamps go unanswered. The report cites inadequacies in the Health and Human Services Agency 's staffing levels and phone system. AP/Sacramento Bee, U-T San Diego.

Democrats Question State-Based 'Essential Benefits' Plan

Wed, 08 Feb 2012 08:00:00 GMT

In a letter sent on Monday to HHS Secretary Kathleen Sebelius, House Democrats expressed concern that the agency's decision to grant states authority to determine "essential health benefits" in state-based insurance exchanges would give insurers more power. They noted that allowing states to choose their essential benefits would "undermine" the objectives of the federal health reform law by enabling insurers "to continue avoiding sicker individuals rather than competing on quality and efficiency." The Hill's "Healthwatch.

Pleasant Hill Mulls New Plan To Cut City Officials' Benefits

Tue, 07 Feb 2012 08:00:00 GMT

The Pleasant Hill City Council is considering a proposal that would eliminate no-cost dental and vision benefits for Pleasant Hill council members, as well as for the city clerk and treasurer. The plan -- which also includes cuts to the council's technology fund -- would save the city $25,195 annually, advocates say. If approved, the new policy would take effect in November. Contra Costa Times.

Sacramento Dentists Provide No-Cost Kids Dental Care

Tue, 07 Feb 2012 08:00:00 GMT

On Saturday, the Sacramento District Dental Society held its annual Smile for Kids event to provide no-cost dental care to uninsured children in five area counties. SDDS Executive Director Cathy Levering said the event is designed to help children whose parents are uninsured but who cannot qualify for public dental programs because of income requirements. Sacramento Bee.

Study: Uninsured Face Similar Debt as Medi-Cal Beneficiaries

Tue, 07 Feb 2012 08:00:00 GMT

More Californians are borrowing money to pay for health care services -- and two-thirds of them have medical insurance, according to a new study by the UCLA Center for Health Policy Research.

"When you think you're insured, you still end up paying a percentage and that adds up, into thousands of dollars," report author Shana Alex Lavarreda said. "So having insurance doesn't mean you will have things paid for."

Another surprising finding, Lavarreda said, is that uninsured Californians face a similar medical debt level to those who have insurance through Medi-Cal.

Low-Income Adults Less Likely To Have Coverage, Regular Source of Care

Tue, 07 Feb 2012 08:00:00 GMT

A Commonwealth Fund survey finds that low-income U.S. residents are less likely to have health coverage and access to a regular source of care than higher-income adults. Future surveys will aim to track coverage changes resulting from provisions in the federal health reform law. Modern Healthcare et al.

Task Force Considers Insurer Coverage of Autism Therapies

Fri, 03 Feb 2012 08:00:00 GMT

On Wednesday, California's new autism advisory task force launched a series of public meetings to develop recommendations on autism services that health insurers should cover. The panel -- chaired by Brent Barnhart of the Department of Managed Health Care -- will look at various treatments, including applied behavior analysis. The panel will deliver its recommendations to Gov. Brown by the end of the year. KQED's "The California Report."

Gov. Brown Releases Proposal To Overhaul Public Pensions System

Fri, 03 Feb 2012 08:00:00 GMT

Gov. Brown has sent a pension reform plan to the Legislature's Conference Committee on Public Employee Pensions. The proposal, which includes changes to retirees' health benefits, is being criticized by labor unions. Sacramento Bee's "The State Worker" et al.

Few People Aware of Medical Review Program

Fri, 03 Feb 2012 08:00:00 GMT

It has been 11 years since California launched its Independent Medical Review program, an appeals process that allows Californians to challenge denial or delay of coverage by private health care insurers.

In the Capitol Building in Sacramento yesterday, a policy briefing laid out the findings of a new report on IMR that includes praise for its effectiveness and some recommendations on how to make the program stronger.

The briefing was sponsored by the California HealthCare Foundation, which commissioned the report and publishes California Healthline.

State Officials Seek To Educate Residents With Long-Term Care Website

Wed, 01 Feb 2012 08:00:00 GMT

California officials are directing residents to a website that explains the benefits of long-term care plans and provides details on available policies. Many adults do not purchase long-term care insurance because of the cost or because they do not think they need it. HealthyCal.

UC-Davis Medical Students To Open Clinic in Yolo County

Fri, 27 Jan 2012 08:00:00 GMT

Beginning this Sunday and on the third Sunday of every month, students at UC Davis' School of Medicine will operate a new primary health care clinic in rural Yolo County's Knights Landing for low-income and uninsured residents. The clinic -- which will also be staffed by volunteer physicians, nurses and graduate students in public health -- is one of seven no-cost clinics operated by the medical school's students. Sacramento Business Journal.

Legislature Takes Action on Several Health-Related Bills

Fri, 27 Jan 2012 08:00:00 GMT

The Assembly has passed bills that would expand coverage of mental health care services and require insurers to cover oral chemotherapy treatments. Meanwhile, a bill to establish a universal health care system in California stalled in the Senate. Sacramento Bee et al.

Judge Likely To Strike Down Ban on Benefits for Same-Sex Partners

Fri, 27 Jan 2012 08:00:00 GMT

On Thursday, a federal judge indicated that she likely will strike down a federal law that prevents same-sex partners from receiving long-term health care benefits. The case stems from a lawsuit that UC-San Francisco employees filed against CalPERS. San Francisco Chronicle.