Consumer groups still concerned as insurance rules are considered by HHS

Oct 28 2010

News outlets report on new rules and pending regulations for the implementation of the new health law.

The Wall Street Journal Health Blog: Consumer groups are already concerned that insurers might lobby HHS Secretary Kathleen Sebelius to weaken the medical-loss ratio rules suggested by the National Association of Insurance Commissioners last week. "Today, consumer representatives sent a letter to HHS Secretary Kathleen Sebelius to urge her not to tinker too much with what the NAIC came up with." The medical-loss ratio rules will determine "how much insurers pay out in health care compared with the total premiums they collect. The health law mandates insurers must pay out 80% of premiums on care for individuals and small businesses and 85% of premiums on care for large companies. That leaves less left over for broker commissions, programs insurers run such as fraud detection, and, of course, margin. … Other than one big concession to the industry — notably that insurers may deduct many taxes from premiums before calculating the ratio — Democrats were thrilled with the NAIC's final product," and it's "unlikely the secretary will come up with something that is more lenient on the industry" (Johnson, 10/26).

The Hill: "The Health and Human Services Department (HHS) is accepting applications for $335 million in grants to help community health centers serve low-income patients, the agency announced Tuesday. The grants — part of $11 billion in new funding for community health centers included in the health reform law — will be available to existing facilities able to demonstrate the money will expand capacity and care for the underserved (and underinsured) patients they tend to treat" (Lillis, 10/26).

The New York Times: "[N]ursing mothers will not be allowed to use their tax-sheltered health care accounts to pay for breast pumps and other supplies" under the new set of regulations for flexible spending accounts issued by the Internal Revenue Service. The IRS ruled that "breast-feeding does not have enough health benefits to quality as a form of medical care. With all the changes the health care overhaul will bring in the coming years, it nonetheless will leave those regulations intact when new rules for flexible spending accounts go into effect in January. Those allow millions of Americans to set aside part of their pretax earnings to pay for unreimbursed medical expenses. ..."

But "[t]he most far-reaching change involves over-the-counter medicines. Since 2003, most of them have been eligible expenses, making flexible spending accounts so popular that some plans issued debit cards that allowed users to make purchases without having to file for reimbursement later. As of Jan. 1, however, over-the-counter medications — including allergy remedies, cough suppressants or even pain relievers like aspirin or ibuprofen — will be eligible only if they are prescribed by a doctor" (Kocieniewski, 10/26).

Meanwhile, in an interview withCQ HealthBeat, Rep. Joe L. Barton, R-Texas, who "could be in line to regain his chairmanship of the Energy and Commerce Committee if the GOP is victorious on Election Day," offered "some insights Tuesday on his preferred approach to repealing the health care law. ... Barton described which parts of the law he would retain, said he wants to create a task force on Medicaid issues and explained how he would like the legislative process to unfold. … 'I'd recommend that we'd do a three-pronged approach,' he said. First, Barton would hold hearings and move a complete repeal 'of everything after the enacting clause' through his committee, ideally within the first 60 days. Then, he would push for replacement legislation that would retain some of the law" (Adams, 10/26).