South Carolina Rejects Federal Funds

S.C. Gov. Haley to reject federal health insurance exchange funds

By Gina Smith | The State (Columbia, S.C.)

Gov. Nikki Haley said she will let federal deadlines slip by and not accept millions in federal funds to help South Carolina set up its own health insurance exchange.

Health insurance exchanges, the centerpiece of federal health care reform, are online marketplaces, to be set up by each state, where the uninsured could compare insurance plans from private insurance companies and buy the one that best fits their needs. Uninsured people who meet certain federal poverty guidelines could buy coverage using federal tax credits.

The exchanges are scheduled to open in 2014 when the health care law goes into full effect. If a state has not made progress by Jan. 1, 2013, the federal government will step in.

But Haley and Tony Keck, whom Haley appointed to head the state’s Department of Health and Human Services, say the federal plan is not the right fit for South Carolina.

“The governor remains an equal opportunity opponent of ObamaCare, the spending disaster that South Carolina does not want and cannot afford,” said Rob Godfrey, Haley’s spokesman. “She and Tony Keck are focused on finding South Carolina solutions that provide our state with the most health at the least cost.”

Democrats say Haley is playing politics with an important issue that affects millions of South Carolinians. Other Republican governors, including Texas Gov. and GOP presidential candidate Rick Perry, also are saying they will not accept the money.

“If South Carolina would put half the effort into figuring out how to do this versus being opposed to it, we would be light years ahead in making sure people could get health care coverage they need,” said Rep. Gilda Cobb-Hunter, D-Orangeburg, who sponsored a bill this past session to set up a state health exchange.

“Governor Haley and all these people spouting the rhetoric have good health coverage,” Cobb-Hunter said. “The people who don’t have a place at the table, their voices are not being heard.”

Twenty-one percent of South Carolinians under age 65 are not insured, according to a 2004 survey by the state Department of Insurance, meaning they do not have private insurance or public insurance such as Medicaid or Medicare. An updated study is being conducted now for the department.

Keck said his opposition to applying for the money is that federal rules for the new exchanges are still not clear. And that’s making officials in many states hesitant to accept money and agree to yet-to-be-determined rules and regulations.

Read more: http://www.mcclatchydc.com/2011/09/01/122810/sc-gov-haley-to-reject-federal.html?utm_source=twitterfeed&utm_medium=twitter&utm_term=news#ixzz1Wp2QD9DC

No More Fine Print

New health insurance rules would let consumers compare plans in ‘plain English’

By N.C. Aizenman, Published: August 17
What would your health insurance cover if you got pregnant? How much could you expect to pay out of pocket if you needed treatment for diabetes? How do your plan’s benefits compare with another company’s?

Starting as soon as March, consumers could have a better handle on such questions, under new rules aimed at decoding the fine print of health insurance plans.

Regulations proposed by the Obama administration on Wednesday would require all private health insurance plans to provide current and prospective customers a brief, standardized summary of policy costs and benefits.

To make it easier for consumers to make apples-to-apples comparisons between plans, the summary will also include a breakdown estimating the expenses covered under three common scenarios: having a baby, treating breast cancer and managing diabetes.

Officials likened the new summary to the “Nutrition Facts” label required for packaged foods.

“If you’ve ever had trouble understanding your choices for health insurance coverage . . . this is for you,” Donald Berwick, a top official at the Department of Health and Human Services, said at a news conference announcing the proposal.

“Instead of trying to decipher dozens of pages of dense text to just guess how a plan will cover your care, now it will be clearly stated in plain English. . . . If an insurer’s plan offers subpar coverage in some area, they won’t be able to hide that in dozens of pages of text. They have to come right out and say it.”

Industry representatives said complying could prove onerous for insurers. “Since most large employers customize the benefit packages they provide to their employees, some health plans could be required to create tens of thousands of different versions of this new document — which would add administrative costs without meaningfully helping employees,” Robert Zirkelbach, press secretary for the industry group America’s Health Insurance Plans, said in a statement.

Insurance shoppers would also have to keep in mind that their actual premiums could change after they finalized their application, particularly in the case of plans for individuals, which can continue to adjust benefits based on detailed analysis of members’ health history over the next three years. (After 2014, the health-care law will essentially limit insurers to considering only three questions about applicants: how old they are, where they live and whether they smoke.)

The regulation, which is subject to a 60-day public-comment period, essentially fleshes out details of a mandate established by the the health-care law. But it also clarifies a question that the law left somewhat ambiguous: How soon into the application process can shoppers get the summary from insurers?

The regulations would require insurers to provide the summary on request, rather than waiting until someone applies for a policy or pays an application fee, a position that drew praise from consumer advocates.

“If consumers are really going to be able to compare their options, they should be able to easily get this form for any plan that they would like to consider,” said Lynn Quincy, senior health policy analyst for Consumers Union, the nonprofit publisher of Consumer Reports.

In addition to supplying the summary on demand, insurers would have to automatically provide it before a consumer’s enrollment, as well as 30 days before renewal of their health coverage. Plans must also notify members of any significant changes to their terms of coverage at least 60 days before the alterations take effect.

The summary form, which can be sent by e-mail, must be no longer than four double-sided pages printed in 12-point type. In addition to listing a plan’s overall premiums, co-pays and co-insurance amounts, it must include charts specifying the out-of-pocket costs for a range of specific services. A copy can be viewed at www.healthcare.gov/news/factsheets/labels08172011b.pdf.

Bill O’Reilly Joins the War on Women

O’Reilly Blames Women’s Health Care ‘Breast Feeding Stuff’ For High Unemployment

By Marie Diamond on Aug 3, 2011 at 2:10 pm, Think Progress

Fox host Bill O’Reilly has worked himself into a lather over the Obama administration’s recent decision to require new health insurance plans to cover birth control without co-pays. Last week he declared that women don’t deserve government subsidized birth control because they’re too “blasted out of their minds” during sex to use it. Yesterday during an interview with Rep. Dennis Kucinich (D-OH), O’Reilly went a step further in his tirade against women’s health care and said it was the reason businesses aren’t hiring:

O’REILLY: Now the federal government is ordering the health insurance companies to pay for all breast feeding stuff, all female birth control stuff, all preventative measures for doctors for ladies that go in. What do you think that’s gonna do? That’s going to inhibit hiring even more!

KUCINICH: Frankly, we ought to be very concerned about women’s health care.

O’REILLY: I am concerned, but they’re not going to expand and hire if they have to pay higher health care premiums for workers! Businesses aren’t going to do it…You can’t have both. You can’t have a welfare state and a robust capitalist system.

By “breast feeding stuff,” O’Reilly was railing about the fact that under the administration’s ruling, health insurers will be required to pay for a range of preventative care services, including HPV, DNA, and HIV screening, and the costs for renting breastfeeding equipment. Women’s premiums will actually pay for the services. But apparently conservatives like O’Reilly only support “family values” as long as the government never has to spend a dime to help poor women care for their children.

It’s also surprising that a professed fiscal conservative would be opposed to preventative health care for women, which not only improves the health of women and their families, but saves the government money when illness is caught and treated early on.

O’Reilly is wrong to suggest that women’s health care is the reason businesses aren’t hiring. Corporations are reaping enormous profits and sitting on a record pile of cash, but are still sending jobs overseas or hiring less than they were before the recession. Additionally, according to a recent Wall Street Journal survey, “the main reason U.S. companies are reluctant to step up hiring is scant demand, rather than uncertainty over government policies.”

Birth Control Will No Longer Require Copay

Obama Administration: Health Insurers Must Cover Birth Control With No Copays

Obama Birth Control Health Insurance
RICARDO ALONSO-ZALDIVAR   08/ 1/11 10:48 AM ET   AP

WASHINGTON — Health insurance plans must cover birth control as preventive care for women, with no copays, the Obama administration said Monday in a decision with far-reaching implications for health care as well as social mores.

The requirement is part of a broad expansion of coverage for women’s preventive care under President Barack Obama’s health care law. Also to be covered without copays are breast pumps for nursing mothers, an annual “well-woman” physical, screening for the virus that causes cervical cancer and for diabetes during pregnancy, counseling on domestic violence, and other services.

“These historic guidelines are based on science and existing (medical) literature and will help ensure women get the preventive health benefits they need,” said Health and Human Services Secretary Kathleen Sebelius.

The new requirements will take effect Jan. 1, 2013, in most cases. Over time, they are expected to apply to most employer-based insurance plans, as well as coverage purchased individually. Plans that are considered “grandfathered” under the law will not be affected, at least initially. Consumers should check with their health insurance plan administrator.

Sebelius acted after a near-unanimous recommendation last month from a panel of experts convened by the prestigious Institute of Medicine, which advises the government. Panel chairwoman Linda Rosenstock, dean of public health at the University of California, Los Angeles, said that prevention of unintended pregnancies is essential for the psychological, emotional and physical health of women.

Birth control use is virtually universal in the United States, according to a government study issued last summer. Generic versions of the pill are available for as little as $9 a month. Still, about half of all pregnancies are unplanned. Many are among women using some form of contraception, and forgetting to take the pill is a major reason.

Contraception is about more than simply preventing pregnancy – it can help make a woman’s next pregnancy healthier by spacing births far enough apart, generally 18 months to two years. Research links closely spaced births to a risk of such problems as prematurity, low birth weight, even autism. Research has shown that even modest copays for medical care can discourage use.

In a nod to social and religious conservatives, the rules issued Monday by Sebelius include a provision that would allow religious institutions to opt out of offering birth control coverage. However, many conservatives are supporting legislation by Rep. Jeff Fortenberry, R-Neb., that would codify a range of exceptions to the new health care law on religious and conscience grounds.

Although the new women’s preventive services will be free of any additional charge to patients, somebody will have to pay. The cost will be spread among other people with health insurance, resulting in slightly higher premiums. That may be offset to some degree with savings from diseases prevented, or pregnancies that are planned to minimize any potential ill effects to the mother and baby.

The administration did allow insurers some leeway in determining what they will cover. For example, health plans will be able to charge copays for branded drugs in cases where a generic version is just as effective and safe for the patient.

Finally, Some Good News For Women’s Reproductive Health!

Medical Panel Recommends No-Cost Birth Control

by JULIE ROVNER  05:45 pm July 19, 2011 NPR

Health insurance plans may soon have to offer prescription contraception at no upfront cost to women.

Will all health insurance plans soon have to offer all FDA-approved forms of prescription contraception at no upfront cost to women? They will if Health and Human Services Secretary Kathleen Sebelius accepts the recommendations released today from an expert panel of the Institute of Medicine.

The study — released a day early — actually calls for eight additional services for women to be added to the list of preventive care patients should be offered with no cost-sharing. The new services include annual “well-woman” visits; screening of pregnant women for gestational diabetes; screening for sexually transmitted diseases, including HIV; more support for breast-feeding mothers; and counseling and screening for possible domestic violence.

But it’s clearly the recommendation for free contraception that’s getting the headlines, as it probably should, since the Guttmacher Institute estimates that 98 percent of sexually active women will use contraception at some point during their reproductive years, and that cost concerns are frequently cited as a reason for inconsistent use or use of a less then optimal method.

In fact, Guttmacher said in testimony submitted to the IoM earlier this year, “Women citing cost concerns were twice as likely as other women to rely on condoms or less effective methods like withdrawal or periodic abstinence.”

The IoM panel was firm in rejecting claims by opponents, including the U.S. Conference of Catholic Bishops, that “to prevent pregnancy is not to prevent a disease.”

“Women with unintended pregnancies are more likely to receive delayed or no prenatal care and to smoke, consume alcohol, be depressed, and experience domestic violence during pregnancy, the panel wrote. “Unintended pregnancy also increases the risk of babies being born preterm or at a low birth weight, both of which raise their chances of health and developmental problems,” it noted.

Women’s groups were thrilled with the report. “Today’s news marks one of the biggest advances for women’s health in a generation,” said NARAL Pro-Choice America President Nancy Keenan. “We are confident that the Obama administration will adopt the IOM’s science-based recommendation and make affordable contraception a reality for all women.”

Members of Congress who had pushed for the inclusion of contraception as a preventive benefit added their praise.

“The IOM’s recommendation to include all FDA contraceptive methods as a critical preventative service—without cost sharing—and to cover the patient education and counseling necessary to ensure each woman can choose the method best for her, is a critical step in empowering all women to plan their pregnancies,” said Rep. Lois Capps, D-Calif.

But not everyone applauded the recommendations.

“Several drugs have been approved by the FDA to be legally categorized as ’emergency contraceptives,’ despite functioning in ways that can destroy a preborn baby before or after implanting in the mother’s womb,” said Jeanne Monahan of the conservative Family Research Council. “A federal mandate to all insurance plans to include drugs such as ella essentially would mandate coverage for abortion. Inclusion of contraceptives also undermines conscience protections that President Obama promised would be maintained.”