On Wednesday, March 5, the House of Representatives voted to pass H.R. 1424 by a margin of 268-148. This mental health parity bill is opposed by NAHU and our broad coalition of insurance, business and mental health groups, as it includes too broad coverage of a mandate by requiring that all employers that provide mental benefits cover all diagnoses contained in a privately developed diagnostic manual (DSM-IV) at the same level as other covered medical conditions. The bill also limits medical management of benefits, would allow for an inconsistent pattern of stricter state mental health parity laws and mandates mental health out-of-network coverage if other medical benefits include an out-of-network option.

Instead, NAHU supports a much more reasonable and bipartisan bill, S. 558, which was crafted with coalition input. S. 558 passed the Senate unanimously last fall, and an effort to pass it in the House Wednesday night failed by a vote of 196-221.

While the passage of H.R. 1424 is disappointing, it was not unexpected. NAHU is pleased the impact our legislative efforts (particularly the more than 3,000 Operation Shout! messages our members sent to members of Congress on the issue last week) had on mitigating the damage. We achieved our goal of preventing passage by a veto-proof majority and were successful in getting 15 Democrats to join with Republicans in supporting the attempt to pass S. 558 in the House. Also, President Bush issued a statement following the vote that echoed many of our concerns and expressed support for S. 558. All of these small victories will be helpful during the conference committee negotiating process.  

The next step will be the formation of a conference committee to resolve the differences between S. 558 and H.R. 1424.  NAHU expects there will be active staff-level preconference discussions, and we intend to work with staff in both the House and Senate to advance the provisions contained in S. 558.

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Action by the House Rules Committee on H.R. 1424 required that the provisions of H.R. 493, the Genetic Information Nondiscrimination Act (GINA), as passed by the House originally in April 2007, be added to the text of H.R. 1424. The original GINA legislation is currently pending in the Senate Finance Committee, where it has received no action. Including its provisions in H.R. 1424 is a controversial attempt by House leadership to move the bill forward. 

NAHU has serious concerns about some of the GINA provisions that would prevent group health plans from adjusting premiums on the basis of genetic information, would not allow insurers to require genetic testing, and would not allow the collection of genetic information for purposes of underwriting. The legislation also addresses genetic discrimination by employers, and the lack of a clear firewall between the two titles of the bill is very problematic.

NAHU will work with coalition partners to eliminate the GINA provisions from the mental health parity conference discussions so that the legislation can receive fair consideration by the whole Senate. In addition, we will continue our work with Senate Finance Committee members to ensure that any genetic discrimination legislation passed does not have a negative impact on a health plan’s ability to medically underwrite health insurance coverage. 

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There continues to be a great deal of discussion in Washington health policy circles about conduct of health insurance agents and brokers regarding private Medicare product sales. The Senate Finance Committee held hearings on this subject in February, and Finance Committee Chairman Baucus has indicated his desire to include restrictions of private Medicare plan marketing efforts in Medicare legislation expected to be considered by the full Senate this June.

In addition, the Centers for Medicare and Medicaid Services (CMS) is in the process of developing regulations on this topic, and the National Association of Insurance Commissioners is in the process of crafting a white paper on the topic. Just this past week America’s Health Insurance Plans (AHIP) released a detailed proposal it feels will help stop marketing abuses in the private Medicare market.

NAHU has developed its own series of recommendations based on our past congressional testimony on this subject, as well as our work with the NAIC and CMS, and the many private briefings we have given Senate Finance and Select Aging Committee staff members on this topic. NAHU also submitted comments this week to the NAIC's Senior Issues Task Force's Private Medicare Plan Subgroup regarding its evolving white paper on the regulations of private Medicare plans and producers.

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A related issue for NAHU is potential cuts in Medicare Advantage payments, which are on the table to pay for a potential Medicare physician reimbursement fix. The House budget plan introduced on March 4 instructs Ways and Means to produce a reconciliation bill that reduces the deficit by $750 million over five years. The panel is likely to use reconciliation to stave off a scheduled 10% cut in Medicare physician payments scheduled to go into effect July 1, perhaps by trimming subsidies to private insurers under the Medicare Advantage program.

NAHU strongly supports the Medicare Advantage program because, while it is certainly not the right choice for every senior, its existence provides an affordable private-market alternative for the millions of seniors happily insured under these plans. Medicare Advantage products are a particularly attractive option to seniors in rural areas and also disabled Medicare beneficiaries, who may not have any other alternatives for private coverage. NAHU feels that a wide range of benefit options is essential for all Americans, including Medicare beneficiaries.

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The NAIC recently completed a state-by-state, on-site producer licensing assessment. The purpose of the project was to review and verify states that have been certified as compliant with licensing reciprocity standards.

The findings were that most states are compliant with the majority of standards. However, there are six categories where there was low compliance among the states: 1) Major Lines of Authority, 2) Limited Lines of Authority, 3) Fingerprint Requirements, 4) Use of NAIC Uniform Application, 5) Pre-licensing and CE Requirements, and 6) Secretary of State Registration Requirements. Legislation may be introduced in some states in order to rectify some of these inconsistencies in reciprocity standards.

The NAIC has made producer licensing one of its top priorities for the coming years and will continue to commit to simplifying and standardizing the process. Next steps include simplifying the business entity licensing process, rejuvenating the discussion of a nationwide resident fingerprint initiative, and establishing a new Working Group to address reciprocity issues. Click here to read the full report.

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The National Conference of Insurance Legislators held its Spring Meeting in Washington, DC, February 27 to March 2. Action items included reiterating NCOIL’s opposition for the creation of an optional federal charter by adopting a resolution for states to use. NCOIL also unanimously passed a resolution encouraging states to implement the National Insurance Producers’ Registry in hopes of streamlining the licensing process and promoting reciprocity among states.

The Health, Long-Term Care and Health Retirement Committee continued discussions on resolutions raising the dependent age to age 25, regardless of student states, prescription drug transparency and model legislation on physician reimbursements relative to provider networks. No action was taken on any of these items.

A special meeting was held on the progress of implementation of state long-term care partnership programs. Presenters included Hunter McKay, HHS, Bonnie Burns, California Health Advocates, Rod Perkins, Genworth, who is the chair of the ACLI/AHIP LTC working group, and Sandy Praeger, Kansas insurance commissioner and NAIC president. McKay reported that 12 states currently have LTCP policies for sale, 10 states have had their state plan amendments approved, and another five states have plan amendments pending. HHS has 90 days to approve an SPA after it has been submitted. The panel of speakers also discussed pending issues that continue to be ironed out, including inflation protection on the LTCP policies, reciprocity and uniform reporting requirements. HHS has put draft recommendations out to the industry to seek input on reciprocity and uniform reporting. 

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On December 26, 2007, President Bush signed H.R. 2764, the Consolidated Appropriations Act. Fifty million dollars was appropriated for FY 2008 to support high-risk insurance pools.

A solicitation will soon be issued inviting proposals from qualified state high-risk pools for two grant types: 1) to offset operational losses incurred in 2007 and 2) bonus grants to provide supplemental consumer benefits to current or potential enrollees. The grant opportunity requirements and instructions will be announced soon on www.grants.gov.

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