High risk pools, medical loss ratios and other health law implementation issues

News outlets report on state high risk pools and other implementation issues for the new health law.

"Eighteen states have said they will not administer a stopgap program to provide insurance coverage to people whose preexisting conditions have left them uninsured, forcing the federal government to do the work," The Washington Post reports. "The states' decisions increase the challenge the government faces as it sets out to translate the far-reaching health-care legislation into action, and they hint at the complexities to come. … As of Monday, 29 states plus the District of Columbia had said they would do so, and 18 said they would leave the job to HHS." Some governors who decided against administering the program "said they were unwilling to take on the task because it appears that Congress has allocated too little money. Meanwhile, it was unclear how soon coverage will be available." Funding is available as of July 1, "but the earliest enrollment dates will vary, depending on such factors as whether states must first adopt new laws or regulations, said Jay Angoff, director of the HHS Office of Consumer Information and Insurance Oversight" (Hilzenrath, 5/4).

Politico reports on early haggling over what counts as "a medical expense" for health insurers. "Under health care reform, insurers will be required to maintain certain 'medical loss ratios,' insurance-speak for the percentage of premiums they spend on medical expenses. Defining what a 'medical expense' is, it turns out, is crucial." For example, "Claims for visits to physicians clearly fit the bill; likewise for surgeries and hospital stays. But what about a 24-hour nursing hotline? Does a flier in the mail that encourages subscribers to reduce sodium intake count? Or a new computer system to better manage care for multiple chronic conditions?" (Kliff, 5/4).

NPR: "The new health law leaves it up to the states to control health insurance premiums," but "[s]ome states don't have their own experts to review rates. And they face enormous political pressure from insurers, which have lobbyists in every state." But Sen. Dianne Feinstein, D-Calif., "says there's a role for the federal government here. She wants the U.S. Secretary of Health and Human Services to be able to block increases that are more about profit than about health care" (Silberner, 5/4).

The New York Times reports "[t]he Community Living Assistance Services and Supports Act, or Class Act, the first national plan to help the great majority of Americans who have no insurance for long-term care, became law in March. Even though there was little fanfare — the measure was just one piece of the broader health care overhaul — the idea had been hugely important to Mr. Kennedy and his staff, who had been working on the current version of the plan since 2003." The Times spoke with several experts to parse out who is eligible for the program and how it will work (Span, 5/3).

Meanwhile, The Washington Post asked Gerard Anderson and Bradley Herring of the Johns Hopkins Bloomberg School of Public Health several questions about the health law, including which changes come into effect first (5/4).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.