State Legislatures Pursue Insurance Mandates, Transparency


WASHINGTON — State legislation mandating health insurance will continue, with “at least 12 more states going to debate bills to expand employer participation coverage” in 2007, according to Susan Laudicina, director of state services research for the Blue Cross and Blue Shield Association.

The health care transparency debate also is heating up with a few states, such as Colorado and Ohio, passing laws requiring provider-specific data on quality and requiring that costs be made available publicly. At least 10 or more states will debate similar bills to promote transparency in 2007, she said.

Ms. Laudicina made her predictions when the Blue Cross and Blue Shield Association's annual “State Legislative Health Care and Insurance Issues” report was unveiled at a briefing sponsored by the association.

The report updates the top health care and insurance issues from state legislatures around the country and the overview given by Ms. Laudicina detailed how, despite healthy revenue growth in 2006, state governments are grappling to stem rising health care expenses. “Health care expenditures now account for about one-third of all state budgets, and states are in desperate need of solutions.”

The report found that in 2006 states began implementing a range of initiatives including employer and individual mandates to cover the uninsured, public-private insurance partnerships to promote coverage and contain costs, and initiatives to improve quality care.

The Blue Cross and Blue Shield Association (BCBSA) reported that there was a flurry of new laws introduced around the country last year and the beginning of 2007—all aimed at providing affordable, quality coverage.

“I read about 200 new legislations per week,” said Ms. Laudicina. “That's how fast new legislation is coming in.”

According to the report, employer and individual mandate legislations were pursued by three states in 2006: Massachusetts, Vermont, and Maryland. Twenty-five other states followed with introductions of similar bills last year, but none of those were enacted.

During 2006, 11 states—including Kentucky, Utah, Oklahoma, and Washington—also worked to create or expand programs to make private insurance coverage affordable for low-income workers. Seven of these states decided to use public funds to build subsidies to offset the premium costs of private employer-sponsored health plans for those eligible for Medicaid as well as for other low-income residents.

The BCBSA “State Legislative Health Care and Insurance Issues” report is compiled from a survey of each of the 39 independent Blue Cross and Blue Shield companies across the country that together provide health coverage for almost 98 million Americans. BCBSA officials were also on hand to provide an overview of the association's top health care issues facing the 110th Congress.

“We have three priorities and the top of the list is addressing the uninsured,” said Alissa Fox, the BCBSA's vice president of legislative and regulatory policy.

Ms. Fox reported that the association is urging Congress to fully support the State Children's Health Insurance Program (SCHIP) to lower the number of uninsured children, adding that Congress' “priority has to be to enroll these children.”

According to the BCBSA, a surprising 74% of children without health coverage are eligible under public programs, but are not presently enrolled. Adequate funding is necessary to streamline enrollment procedures and ensure that these children get health care. In his budget submitted to Congress on Feb. 5, President Bush called for an increase in SCHIP funding of $5 billion over the next 5 years—short of the $12 billion experts say is needed to fund the program.

Another priority for the BCBSA is maintaining funding for the Medicare Advantage (MA) program that provides coverage to more than 8.3 million people. Ms. Fox explained how further budget cuts will disproportionately hurt low-income and minority Americans who rely on the program for health care.

“There's some talk in Congress about eliminating MA, and we are very concerned,” Ms. Fox said. “The MA program has suffered from $13 billion in funding cuts in the past 2 years, and further cuts would put access to affordable, comprehensive coverage in jeopardy.”

The BCBSA's third priority is the vision of the Bush Administration and Congress to create a nationwide health information network that will allow for the use of electronic health records in every hospital and doctor's office. Ms. Fox said the association is “very supportive of the bipartisan mission.”

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