On Thursday, ITUP staff joined representatives from the U.S. Department of Health and Human Services for the first of their weekly conference calls with states on implementation of the health reform. Speakers included: Governors’ staffs, state Insurance Commissioners, state contacts on high risk pools, state Medicaid Directors, and intergovernmental organization partners.

Here are some of the major take-aways and pertinent Q-and-A:

Health Insurance Web Portal
• HHS: After just under three months, the federal health reform website is now LIVE. The goal of the site is to empower consumers, providing them with information to get better coverage options. By answering a few simple questions, individuals can receive a list of state-specific private and public health insurance options available to them and their family.
• If there are issues with the website or information you’d like to see that isn't yet there, you can email questions or comments to lisa.wilson @ hhs.gov.

Exodus of Individual Insurers
Bill from Illinois: We face the potential under health reform of insurers deciding to exit the marketplace rather than meeting the requirements to participate. There may be individuals who were currently insured, but will lose their coverage due to insurer withdrawal, thus being put back into the marketplace to buy insurance. Is there any way for those individuals to access the high risk pool before the 6-month stipulation?
• HHS: Under the reform statute, if the insurance company can demonstrate that the market will be destabilized, then the Secretary can reduce the 80% medical loss ratio threshold. We encourage companies to submit data that would show such destabilization would occur. There are a few things on which the Secretary doesn’t have discretion; one of these is the 6-month qualification period. As you know, there are existing high risk pools for which that restriction may not apply, but for the federally authorized ones, it is clear that individuals must be uninsured for at least 6 months.

State High Risk Pools
Anne from California: Can states make their own lists of potentially eligible beneficiaries? Can they alter those lists?
• HHS: We have received proposals from states that have their own lists and those that do not. We do not believe that there is anything in the federal law preventing states from administering their own lists. So states can do so, as long as they get it federally approved.

Allison from Nevada: If a person currently has insurance, but the insurance doesn’t cover their condition (i.e. limited or bare-bones coverage), can they be eligible for the pool?
• HHS: No. They have to be completely uninsured for 6 months. Even if they have a plan that doesn’t cover their needs, any coverage prevents them from being eligible for the new pools.

Yvette from California: Is there a cap on the insurance through the pool?
• HHS: That varies by state. In the 21 states where the government is administering the high risk pool, there will be no annual or lifetime limits. It is however a mixed bag among the states. You can email at highriskpools @ gms.hhs.gov for more info.

Mary from Arizona: Is the credible coverage from the new laws and not from HIPAA?
• HHS: There is a gray area between acceptable benefits and credible coverage. It depends on the state. If there are acceptable benefits, then it is okay. If you have specific questions, please just email highriskpools @ gms.hhs.gov to submit a question.

Joel from California: What about individuals in states not participating in the program?
• HHS: Regardless of any state you live in, you will have access to the risk pool plans. If your state chooses not to run its own pool, you will have access to the federal pool/plan.

Mary from Nevada: In Nevada, premium rates won't be available until July 15. Can you tell us now what the copay will be so people can plan for that event?
• HHS: The premium is a range of premiums for someone in his/her 50s. It isn’t precise, but we want to give a range of what the cost for the plan would be. The premiums allow one to have initial deductible of $2500, not subject to preventive services. It also includes generic prescriptions copays of $4 and $30 for brand names. Details will be on the website soon.

Lenny from Mississippi: Will premiums be subsidized by income?
• HHS: No, we do not have the authority to subsidize by income, only by age. There will be one standard deductible and one standard premiums package. They are both being developed to reflect standard risk rates as closely as possible.

Mary Beth from Florida: Will there be enough money to pay for coverage in the pools? How can states stretch the limited federal dollars until full implementation of reform in 2014?
• HHS: We have received projections from states. The challenge is that this is a new product, with exception of Maryland, there is no other state that has done this. We have projected loss, but we don’t have actuarial data yet. Based on experiences that we have had, we believe that we can at least double the amount of people who have high-risk coverage. Probably around 200,000 total people at one time will be covered. In terms of the concern about funding made available from Congress, we have a number of steps we can take: modify benefits package, co-pays, premiums, initial deductibles. If some states have lackluster growth, we could redistribute some of the funds to other states, we do have that authority. Also, the Secretary does have authority to place limitation restrictions to stay within the funding allowed.

Data Submission
Nicole from CA: Regarding early retiree programs, when will HHS provide more info about the data submission program?
• HHS: We just started receiving applications on this. We will start to release more Q&A’s imminently. We are aware of your question and will answer it shortly.

The official health reform web portal is officially up and running! Check it out.

As many of you know, our beloved Adam Dougherty had his final day at ITUP last Friday and is now enjoying a few weeks of much deserved R&R before commencing medical school. We wish Adam all the best on this new adventure. You are already missed, Adam!

For those I don't yet know, my name is Cliff Sarkin, and I am ITUP's new Policy Director. Based in Sacramento, I will be collaborating closely with an array of stakeholders, elected officials, policy makers, and administrators to ensure the most effective implementation of health policy here in California. I will also take a lead role in ITUP's policy development, research, and writing.

In addition, I will serve ITUP's blog master. Please bear with me as I attempt to fill Adam's large shoes.

I'm am thrilled to join ITUP at such an exciting time in for health policy in California. Let's get to work!

Hello and welcome to the ITUP Spotlight on Health Reform blog! For the readers that I haven't met personally, my name is Adam Dougherty and I have been with ITUP for the past year as the Senior Research Analyst, while also recently finishing my MPH at USC. We at ITUP have been very busy as of late with all the activity surrounding federal reform. ITUP hopes to continue to be a resource and after arriving in Washington, DC last week, I look forward to acting as a correspondent for all our constituents in California and beyond.

Be you an experienced policy wonk, health professional, county employee, educator, or student, I hope to provide you with up-to-date information as well as a glimpse into the hardfought efforts being undertaken here in DC for comprehensive health reform. Throughout the summer I will use this blog to address various perspectives on hot topic issues, and I urge readers to express their own comments/questions/concerns as well. For more in-depth analyses, refer to the e-newsletter I will be providing as well as the library of valuable resources at: www.itup.org.