HCPro Health Plan Insider - September 9, 2009 | Indiana Program Shows Health Reform Without Individual Mandate is Costly View as a Webpage | Subscribe for Free
Indiana Program Shows Health Reform Without Individual Mandate is Costly
Les Masterson, Senior Editor-Managed Care

Everyone knows about the highs (more insured) and lows (higher costs) in the Massachusetts reform program, but there are other states that have their own reform plans, albeit much smaller. To create a health reform plan that will insure more Americans, improve quality, and lower health costs, Congress and policymakers must learn from successes and failures in state health reform programs. One program they can learn from is the Healthy Indiana Plan, which is a Medicaid expansion program. [Read More]
  September 9, 2009

Editor's Picks
Obama speech aims to reenergize healthcare effort
In the most anticipated healthcare reform event of the year, President Barack Obama will push for his health reform plan before Congress tonight. Critics have questioned Obama's hands-off approach in crafting a health reform plan and pundits are saying this is a make or break time for the Obama administration. Buzz words to watch for include how often Obama mentions "public option," "insurance exchanges," and "health insurance reform." [Read More]
Obama Backs Public Option, Exchanges, Cap on Out-of-pocket Costs
As President Barack Obama prepares for his critical health reform address to Congress tonight, he has been dropping hints as to what to expect. At a Labor Day picnic in Cincinnati on Monday, Obama spoke about his support for a public insurance option, an insurance exchange, and caps on out-of-pocket expenses. The past month, while Congress has been on its August recess, the health reform debate has taken on a much more partisan and heated tone. Here's hoping with Obama's speech and the Senate Finance Committee's plan that is expected this week that the health reform debate can return to the high ground. [Read More]
HMO claims-rejection rates trigger California investigation
In a move that could affect the health reform discussion, California Atty. Gen. Jerry Brown and state regulators are scrutinizing how HMOs review and pay insurance claims submitted by doctors, hospitals, and other medical providers. The increased attention comes after a report said California health insurers reject 1 in 5 medical claims. In fact, six of the state's largest insurers rejected 45.7 million claims for medical care, or 22% of all claims, from 2002 to June 30, 2009, according to the California Nurses Association's analysis of data submitted to regulators by the companies. Health plans say claims often are denied because: they are duplicates, patients are no longer members, and a particular treatment is not a covered benefit. Depending on the result and timing of this investigation, it could help federal lawmakers who support reform push their ideas. [Read More]
Insurance firms defend rescissions as fraud control
Industry foes often point to health insurers' rescission policies as a reason for more regulations, but health insurance companies say rescissions are a way to prevent fraud. Insurers say they need to cancel policies of members who are not truthful on their documents, such as not listing preexisting conditions, are committing fraud, but critics and lawmakers use these cancellations as a way to criticize health insurers. In California, for instance, health insurers have paid almost $19 million in fines over the past 18 months, which related to the companies' rescissions. [Read More]
Managed Care Headlines
Older Women Have More Difficulty Obtaining Health Insurance
Janice Simmons, for HealthLeaders Media, September 4, 2009
Snowe's Trigger Plan to Boost Insurance Competition
Janice Simmons, for HealthLeaders Media, September 4, 2009
Health Plan Premiums Vary Widely by State
Cheryl Clark, for HealthLeaders Media, September 3, 2009
Group Charges Health Insurers Are Violating State Labor Code
Les Masterson, for HealthLeaders Media, September 3, 2009
Underinsured find health bills piling up
Miami Herald, September 3, 2009
Kaiser study finds shortcomings in Massachusetts insurance programs
New York Times, September 3, 2009
Baucus Healthcare Reform Framework Drops Public Policy Option
Janice Simmons, for HealthLeaders Media, September 9, 2009

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From HealthLeaders Magazine
Hang On

Get ready for the failure of the HIT stimulus dream, episode of care contracting, the end of easy credit, and a public plan. [Read More]
From HealthLeaders Media
Challenges to Marketing New Patient-Centered Technologies Ahead

Kaiser Permanente's latest "Thrive" campaign ads are just as visually stunning as the others in the series. One of the two new ads focuses on technology and innovation in general, and electronic health records in particular. [Read More]
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