MHA Comparison of Michigan Legislative Health Insurance Reform Proposals

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Alison Lloyd
8 years ago
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1 Overall approach to expanding health care coverage Amends the Insurance Code to create Health Care Affordability Fund within Treasury. These funds are used to: expand MIChild to 300% of poverty level Subsidize purchase of insurance for households at or below 300% of poverty level extend subsidy for Medicare Supplemental policies to households at or below 300% of poverty level Funds are raised through assessment of nonprofit carriers. The assessment is a payment in lieu of taxes equivalent to projected local tax and Michigan business tax liability. Creates a new public act titled MI-HEALTH. MI-HEALTH is an insurance exchange responsible for facilitating the purchase of health insurance by those defined as eligible under the new act. MI-HEALTH is governed by the Cover Michigan Board, a public board of 13 members appointed by the Governor and the legislature. MI-HEALTH will offer a variety of health coverage plans, each subject to qualification and approval by MI-HEALTH. Mandated benefits currently required under chapters the Insurance Code and PA 350 may not be required to be included an eligible health coverage plan. MI-HEALTH will provide premium subsidies on a sliding scale. Enrollees with income of 200% of the poverty level or less receive the greatest subsidy. An individual is not eligible if household income exceeds 300% of the poverty level. The subsidies are funded through a health access surcharge. The surcharge is applied to all paid claims beginning July 1, MI- HEALTH is also funded through a payment in lieu of taxes from Blue Cross Blue Shield of Michigan. 5/28/2009 Prepared by Michigan Health & Hospital Association Page 1 of 5

households at or below 300% of poverty level Funds are raised through assessment of nonprofit carriers.

2 Preexisting Condition rules Basic Benefit Design Individual and small group coverage plans sold by any carrier would be allowed to look back at a personal health record for up to six months and limit coverage for six months from date policy is issued. By administrative rule, the OFIR Commissioner must establish a basic health benefit plan and a basic enhanced benefit plan each designed to: minimize non-emergent use of Emergency Departments. encourage health and wellness. cover medically necessary inpatient and outpatient services, medical and surgical services and diagnostic services. Eligible health plans within MI-HEALTH would be required to include wellness services, inpatient and outpatient services, preventive care, and a value-based pharmaceutical benefit. Portability requirement under the Health Insurance Portability and Accessibility Act (HIPAA) Health Maintenance Organization (HMO) health benefits Requires all carriers to take HIPAA-eligible enrollees without preexisting condition exclusions. Currently BCBSM is the only carrier who must enroll these individuals pursuant to HIPAA requirements Allows HMOs to offer contracts with level of coverage other than the basic health services currently defined in the Insurance Code. HMOs would be required to offer at least one contract that covers basic health services. HMOs are also subject to new health plan requirements established in legislation. Except for HMO contracts that are eligible health coverage plans under MI-HEALTH, HMOs are required to offer basic health services. 5/28/2009 Prepared by Michigan Health & Hospital Association Page 2 of 5

By administrative rule, the OFIR Commissioner must establish a basic health benefit plan and a basic enhanced benefit plan each designed to: minimize non-emergent use of Emergency Departments.

3 Consumer Protection All carriers required to issue health plans to all applicants (also known as guarantee issue). Guaranteed renewal and no new underwriting allowed related to age or change in health status for both individual and small group health plans. Carriers may not pay different compensation rates related to health status of an agent s book of business. Health coverage offered under the MI- HEALTH program cannot exclude an individual for any reason, including health status and age. No guaranteed issue requirement for plans marketed outside of the MI-HEALTH program. Rating for health conditions allowed only at the time a policy is initially issued. Coverage is guaranteed to be renewable. Loss Ratios Rescission of policies Limits premium differential related to age to 65%. Premium increases based on age cannot exceed 10%. Requires minimum loss ratios for all carriers: 70% for commercial insurers 80% for HMOs and BCBSM 90% for Medicare Supplemental policies No carrier may rescind a policy for an individual or small group if the carrier fails to resolve questions of eligibility or health prior to issuing a policy. Coverage may be rescinded for intentional misrepresentation. Carriers may not pay different agent compensation related to health status of agent s book of business. Rate differentials may be based only on age, tobacco use, body mass, index and other healthy behaviors. No minimum loss ratios. 5/28/2009 Prepared by Michigan Health & Hospital Association Page 3 of 5

Carriers may not pay different compensation rates related to health status of an agent s book of business.

4 Healthy behaviors incentives All carriers would be allowed to offer premium discounts for health lifestyle, not to exceed 50% of premium. Each carrier must offer a health benefit plan incorporating value-based insurance design, improvements in health outcomes and health care cost containment. BCBSM would be allowed to charge rate differentials based on body mass index, tobacco use and subscriber participation in covered health screenings and covered wellness programs Reinsurance mechanism for catastrophic claims Changes to PA 350 Creates MI-CAPP (Michigan Catastrophic Accessibility Protection Plan) Funds held by Treasury; administered by OFIR Commissioner. Covers all individual health claims over $25,000 annually in aggregate. Paid for by assessment of all carriers doing business in Michigan. Assessment based on market share. If funds are not adequate to pay all excess claims, available funds are distributed on a pro rata basis. Rate filing time frames are shortened. Rates considered approved and effective remain in effect during the pendency of a hearing process to challenge the rate filing. Creates the Michigan Claims Fund and the Michigan Claims Board. The Board is chaired by the OFIR Commissioner and made up of appointees of the Commissioner. The fund for the Michigan Claims Board is created in Treasury. Funds are used to pay 90% of the claims paid between $25,000 and $250,000 on behalf of a covered enrollee. Paid for by assessment of all carriers doing business in Michigan. Assessment based on market share. If funds are not adequate to pay all excess claims, available funds are distributed on a pro rata basis. Rate filing time frames are shortened, but new rates are not allowed to remain in effect during challenges to rate filings. 5/28/2009 Prepared by Michigan Health & Hospital Association Page 4 of 5

BCBSM would be allowed to charge rate differentials based on body mass index, tobacco use and subscriber participation in covered health screenings and covered wellness programs Reinsurance mechanism

5 E-prescribing Bulk purchase of pharmaceuticals Health assessment website Reuse of single use devices Advance directives for health care Requires all individuals licensed to write prescriptions to electronically transmit every prescription for a prescription drug. Creates the Michigan Prescription Cooperative and Gold Benefit Plan, a bulk prescription drug purchasing cooperative for the uninsured and underinsured. Requires the Department of Community Health to create a health assessment website to promote healthy behaviors. Prohibits the reuse of a single use product and creates a felony for doing so. Requires the Secretary of State to create a statewide advance health care directive registry and require information regarding advance health care directives be given to an adult when enrolling in Medicaid. 5/28/2009 Prepared by Michigan Health & Hospital Association Page 5 of 5

Creates the Michigan Prescription Cooperative and Gold Benefit Plan, a bulk prescription drug purchasing cooperative for the uninsured and underinsured.

What is a state health insurance exchange (i.e. "American Health Benefit Exchange")?

What is a state health insurance exchange (i.e. American Health Benefit Exchange)? MEMORANDUM DATE: 11/07/2011 TO: Members of the House Appropriation Subcommittee for LARA FROM: Paul Holland, Fiscal Analyst RE: State Health Insurance Exchanges In response to the requirements pertaining