Roundup: Cuts in Calif. programs; Ga. seeks federal MLR waiver; N.J. lawmakers try to restore some health funding

Mar 18 2011

Los Angeles Times: Lawmakers OK Billions In Program Cuts In California Budget
State lawmakers Wednesday approved billions of dollars in cuts to welfare, medical programs for the poor and in-home care for the elderly and frail, among other services, moving forward key pieces of Gov. Jerry Brown's budget reduction package. They also voted to sharply reduce services for the developmentally disabled and shifted hundreds of millions of dollars away from mental health and early childhood programs to use instead to reduce the deficit (Goldmacher and McGreevy, 3/17).

The Philadelphia Inquirer: New Jersey Senate Panel Hears Pleas To Restore Funding Cuts
(Gov. Chris) Christie has said his budget continues a model of setting priorities and funding them at a level the state can afford. … But advocates questioned plans to institute $3 co-pays for adult medical day care, cut $3.7 million in funding for an AIDS drug-distribution program, and save $13 million by ending Medicaid coverage for Part D prescription drug co-pays and wraparound drugs for Medicare beneficiaries. Some also voiced opposition to a 10 percent proposed cut in reimbursement rates for federally qualified health centers (Rao, 3/16).

Modern Healthcare: Ariz. Governor Seeks $500 Million Medicaid Cut
Arizona hospitals say a new state Medicaid funding proposal will cost them $530.7 million. Gov. Jan Brewer late Tuesday announced a $500 million proposal to cut Medicaid. Instead of her original plan to drop 280,000 people from Medicaid, the new proposal would eliminate about 120,000 people, and reduce provider reimbursement by 5% starting Oct. 1. Medicaid recipients would see more co-payments for services and benefit limits. Hospitals say the 5% reimbursement cut, in conjunction with an already planned 5% rate cut going into effect in April, would result in nearly $1.3 billion in lost funding. That's including $700 million in Medicaid payment reductions hospital have seen since 2008 (Vesely, 3/16). 

Kansas Health Institute News: Trimming Medicaid Emergency Room Visits Would Create Small Savings
Eliminating unneeded emergency-room visits by Kansas Medicaid patients would produce only modest savings for the state treasury, auditors for the Kansas Legislature reported today. In 2008 and 2009, Kansas paid an average of $2.5 million a year for Medicaid emergency room claims, according to a report presented today to the Legislative Post Audit Committee. That was only a fraction of the $2.5 billion spent yearly in Kansas on Medicaid services. ... Lawhon told committee members that the state already has several measures in place to reduce unnecessary emergency room costs. For example, the state pays a reduced rate to hospitals and other providers for "non-urgent health conditions" (Shields, 3/16).

The Miami Herald / The Sun Sentinel: Two Sides Disagree If Medicaid 'Reform' Helps Or Hurts
Florida's five-year-old experiment of putting most Medicaid patients in five counties into managed care has sharply divided the state into camps: One sees disaster, the other sees a sound path for the future. … The fate of the Medicaid experiment rests with state legislators, starting Thursday when the House Health and Human Services Committee is expected to vote on Medicaid reform bills (Lamendola, 3/16). 

Politico Pro : HHS Sets High Bar For MLR Waivers
Kansas Insurance Commissioner Sandy Praeger wants to apply for a medical loss ratio waiver — but there's a good chance she won't. The devil, Praeger says, is in the data: She doesn't have enough information to support the type of application that HHS would approve. Not a single insurer has submitted data to her office suggesting the new medical spending requirements would drive them out of business (They have until March 21 to file). At a public hearing she hosted Monday, one company said they would likely exit the market but didn't provide any information to back up their claim (Kliff, 3/17). 

Georgia Health News: State Seeking Federal Waiver On Insurance Rules
State Insurance Commissioner Ralph Hudgens is requesting an exemption from a federal health reform requirement that insurers spend at least 80 percent of their premium dollars on medical care. The exemption sought would apply to health insurance policies for individuals. Without this waiver from federal rules, Hudgens said in a statement Tuesday, "Georgia's individual health market will become less competitive." ... The Affordable Care Act requires health plans sold in the large-group market to spend at least 85 percent of premiums on medical care. Those in the small-group and individual markets must spend at least 80 percent on health costs (Miller, 3/16). 

Modern Healthcare: Ga. Seeks Medical-Loss Ratio Waiver
Georgia has become the latest state to ask HHS for a waiver from the health reform law's requirement that at least 80% of policyholder insurance premium dollars be spent on direct medical costs. Georgia Insurance Commissioner Ralph Hudgens said he will request a waiver from the medical-loss ratio standard for 2011, 2012 and 2013 so no harm comes to Georgia residents with health issues who are currently insured in the individual market; so the phase-in period gives insurers time to adjust their business models to compete in the federal system, if it is found constitutional; and to help preserve consumer access to agents or brokers who facilitate the purchase of individual health policies (Zigmond, 3/16). 

The Atlanta Journal-Constitution: Governor Pulls Health Exchange Bill After Tea Party Objects
A last-minute tea party protest prompted Gov. Nathan Deal on Wednesday to shelve legislation that would have planned for a Georgia health insurance exchange. The new federal health care law gives every state the option of designing its own insurance marketplace, and the legislation would have created a commission to recommend an approach for Georgia. State leaders said it would have allowed them to plan for an exchange while also continuing to fight the federal law in court. The legislation enjoyed wide support until phone calls started rolling in this week from tea partyers. Deal said Wednesday that he would put the legislation on hold and instead create an advisory committee to study the state's options for an exchange (Teegardin and Hunt, 3/16). 

San Francisco Chronicle: Health Service Board Blamed For SF's Rising Costs
Eye-popping pension costs are the issue du jour at City Hall these days, but city officials say skyrocketing health care benefits are a far bigger concern -- and some of them blame a little known group of seven for exacerbating the problem. They're the members of the obscure Health Service Board, which meets monthly to select the medical and dental plans for employees and retirees, set the amount members pay for each plan, and set policy for the plans' administration. It sounds innocuous enough, but the City Charter requires that four of the seven be employees or retirees who are elected to their posts by the rest of the city's employees and retirees (Knight and Gordon, 3/16). 

McClatchy / The Sacramento Bee: CalPERS To Cut Ties With Medco Health Solutions
CalPERS today moved to cut ties with Medco Health Solutions Inc., the pharmaceutical-benefits company that has been swept up in the pension fund's bribery scandal. In a terse statement, CalPERS President Rob Feckner said CalPERS is halting negotiations with Medco on a new contract. Medco will continue to run the drug-benefit program for CalPERS through the end of the year (Kasler, 3/16).

Reuters: Surgery Referrals Don't Improve State's Outcomes
Initiatives aimed at getting more surgery patients sent to hospitals where they have the best chance of surviving may not be accomplishing their goals, at least in Washington State, according to a recent study. The authors say that the program, which is based on referring patients preferentially to hospitals that score high on measures related to patient safety, "has not had its intended impact" and needs further evaluation. Previous research has suggested that patients who need surgery have better outcomes if they get treated at a hospital that has a lot of experience performing their specific surgery (Pittman, 3/16). 

The Texas Tribune: Cecile Richards: The TT Interview
As the daughter of late Democratic Gov. Ann Richards, Cecile Richards always knew what adversity looked like. As the president of the Planned Parenthood Federation of America, she's in the thick of it now. ... She finds her New York-based organization effectively under siege, both in the U.S. Congress and the Texas Legislature. In an interview with The Texas Tribune, Richards discusses Republican lawmakers' efforts to defund Planned Parenthood, a Texas attorney general's opinion she says will keep low-income women from preventative care, and how her mother would've handled all of this (Ramshaw, 3/17).