Monday, February 22, 2010, 12:08 AM - Political developmentsCould it be that Anthem Blue Cross has given the gift that keeps on giving?
Anthem Blue Cross recently announced rate hikes of as much as 39% for many of its 700,000 California customers. The company claims that troubled economy has caused many to drop coverage, leaving it with a sicker, more expensive population.
Critics claim that in 2009 the 5 largest private insurers reaped over $12 billion in profits.
California is one of 25 states that don't regulate health insurance rates
(just as it doesn't actually regulate workers' comp rates either).
Outrage over Anthem Blue Cross's action has given the Obama Administration a hook to revive the moribund healthcare reform process. To those who say the healthcare system is doing just fine, the White House can cite the 39% rate hikes.
And Obama will be doing just that. He'll be proposing federalizing a rate review process by creating a Health Insurance Rate Authority, composed of 7 members (to include consumer advocates, an industry representative, a physician, etc).
The authority would issue an annual report setting the parameters for reasonable rate increases based on consumers in the market.
It reminds one of the function of the WCIRB in California's workers' comp market, though the WCIRB governing board is largely from the insurance industry.
Details are sketchy, but the proposal would apparently give some power to the Secretary of Health and Human Services to block insurance rate hikes or order rebates to customers.
Politically this is probably a winner.
But eventually all aspects of the healthcare delivery system need to be retooled. If expanding coverage and controlling costs were easy, a reform plan would have sailed through already. But without a public option or single payer system, expanding coverage through mandating that individuals buy coverage is tricky and controversial.
Getting rid of pre-existing coverage exclusions remains popular. As I've been noting for a long time, this is critical for so many of California's injured workers, many of whom lose their group insurance coverage.
But the experience in New York is a cautionary tale. In New York, a "guaranteed issue" law and "community rating" mandate have combined to make insurance costs high. Allowing people to purchase insurance on the way to the hospital tends to undermine a stable system of healthcare financing. Here's an excellent piece from Los Angeles Times writer Noam M. Levey, "A Cautionary Tale in Healthcare Reform":
http://www.latimes.com/news/nation-and- ... full.story
Saturday, February 20, 2010, 08:55 AM - Political developmentsCalifornia is sure to have an interesting political season.
It's a novel campaign strategy: hold your fire to the end of the campaign, then let em' have it....
But that appears to be the Steve Poizner strategy against Meg Whitman:
http://www.contracostatimes.com/politic ... ck_check=1
It's a rope-a-dope strategy. Somebody needs to tell the Commish that's not the way to build enthusiasm in a political campaign.
But then again, Whitman has been ducking a 1 on 1 with Poizner. Finally, yesterday she agreed to a May 2 debate.
Whitman has been so averse to answering substantive questions that planes are now circling some of her events, trailing banners asking questions about her plans for the state.
If Whitman doesn't talk to the press soon, perhaps they'll have to hire skywriter planes (skywriter trivia for you: remind any of you readers out there of Roberto Bolano's "Distant Star"?:
http://www.amazon.com/Distant-Star-Robe ... 0811215865
Meanwhile, over in the Democratic camp there was some grumbling about the Brown campaign and Brown's rambling speech at a Sierra Club event:
http://www.sfbg.com/politics/2010/02/18 ... among-dems
I suspect it was just Jerry being the philosophical Jerry, part Jesuit and part Zen master. Brown is brilliant. With him the voters will not get rope-a-dope.
DiFi has apparently removed any doubt that she plans to remain in the senate rather than enter the gubernatorial race. Today Feinstein is focusing on legislation to allow federal regulation of health insurance rates in the wake of 39% rate hikes by Anthem Blue Cross:
http://www.sfgate.com/cgi-bin/article.c ... ss.bayarea
What's the Whitman plan to control those health insurance costs?
Anybody have a skywriter plane?
Thursday, February 18, 2010, 07:26 AM - Political developmentsIdeas that seem good don't always work out well in practice.
Today we see that the program to use Federal stimulus money to create jobs and save energy by weatherizing homes (at a $5 billion price tag) has bogged down. Instead of the projected 595,000 homes, less than 25,000 were weatherized in 2009:
http://abcnews.go.com/WN/Politics/stimu ... id=9780935
Here in our little California workers' comp world, furloughs have been applied with an axe rather than a scalpel. In a user funded department, workers and employers have seen service they paid for reduced.
But now State Senate Pro Tem Darrell Steinberg proposes to prohibit this by statute. Steinberg has introduced SB 29. The bill would exempt employees funded at least 95% by sources other than the General Fund.
Here's the bill text:
http://www.leginfo.ca.gov/pub/09-10/bil ... duced.html
This year the Governor proposes pay cuts, of course. Applying those to agencies funded by non-taxpayer revenue streams has been criticised by the Legislative Analyst. Here's my post on that issue:
http://www.workerscompzone.com/index.ph ... 131-114926
Tuesday, February 16, 2010, 09:15 AM - Political developmentsIt's always interesting to see what's going on in workers' comp in other states. I often follow comp developments in other states through e-mails from the Workers' Comp Executive and through news bits on Workcompcentral.com
In Colorado there's a move to limit video surveillance of injured workers. Last week Colorado lawmakers approved (on a 6-5 House of Representatives committee vote) a bill to make it more difficult for insurers to do surveillance.
The bill would allow insurers to start surveillance at any time, but the worker would have the right to ask for a hearing on why they were being watched. An insurer who could not justify a basis for the surveillance could be fined $1,000 a day. Further, the judge could bar use of the videos in any trial or settlement negotiations.
The Colorado legislature heard testimony from many workers about abuses of surveillance films.
The bill is opposed by Colorado's attorney general's office, which sees video surveillance as an important fraud fighting tool.
Here's a link to a Denver website with more information about the issue:
http://www.9news.com/news/local/article ... ;catid=346
I have no reliable line on Colorado politics, but I suspect the bill will not pass the full Colorado legislature. Apparently several legislators voted in favor simply to move the matter forward.
What does intrigue is the concept of putting some judicial limits on surveillance activity. The bill does not require pre-authorization of surveillance, so it's not like insurers need to get a "warrant".
The Colorado bill (the exact language of which I haven't seen) appears to be aimed at surveillance "fishing expeditions".
It would seem that it's not rocket science to create a mechanism to give a workers' compensation judge some authority to strike a balance between harrassing surveillance and surveillance based on legitimate tips or concerns raised by doctors, for example.
Here's a link to a blog post I did several years ago, "Hold that Camera":
http://www.workerscompzone.com/index.ph ... 125-202439
Sunday, February 14, 2010, 02:25 PM - Medical treatment under WCFriday 4:30.
It could have been any Friday. On this occasion it was an irate spouse on the voicemail. Something has to be done.
The spouse noted that pain meds prescribed for the worker were being denied at the pharmacy. The worker has been on a long list of medications for years after multiple surgeries failed to provide pain relief or improve functionality.
Those meds included opioid drugs which could have severe withdrawal effects. Those effects can include extreme anxiety, diarrhea, fever, nausea, tremors and sweating. The workers' meds also included anti-depressants which are not to be abruptly ceased.
Whether the worker should or could be detoxed from some of the multiple meds was a moot point on a late Friday afternoon.
The caller didn't reference it, but the over the counter cost to fill those multiple meds was probably over $1,000. That's money that family did not have.
The worker's anxious voice could be heard in the background as the spouse demanded immediate action.
It was too late for the worker to reach the doctor's office.
The caller left no details as to why the meds were being denied.
There may have been some dosage adjustments, but there was little change in what had been prescribed for some time. The treating pain management specialist (on the carrier's MPN list) had always compliant in filing reports that documented quite explicitly the symptoms and the various medications prescribed. The case had been settled some years ago, and future medical was not in dispute.
Did the carrier have a pharmacy administrator as an intermediary between the adjuster and the pharmacy? Perhaps the intermediary could not reach the adjuster?
Perhaps the adjuster was not paying the pharmacy bill, so the pharmacy
(at a major supermarket chain) was not willing to refill the meds until the bill was cleared? The supermarket pharmacy was unlikely to fill these on a lien.
As the attorney listened to the 4:30 voicemail, he recalled that when he'd last seen this file several months ago it was apparent that the carrier was not sending copies of all treatment progress reports. The attorney recalled no recent UR delay or UR denial notices. Perhaps the adjuster had sent the medication request out to UR but not sent out UR notices?
Or as the spouse claimed in the voicemail, did the adjuster "deny" the medications without any UR basis?
The attorney's staff tried to reach the adjuster by phone and fax. No response. At the end of the day it wasn't clear whether the worker would wind up in the emergency room, whether the worker would use
his Medicare card (through Social Security Disability) to pay for the medications (shifting liability onto Medicare), or whether the worker would undergo a hellish weekend.
What was apparent was that on a Friday afternoon, before a long holiday weekend, one worker's family was in crisis.
It was a puzzle. A very unpleasant puzzle.
It's a puzzle many of us often see. Even if it's not a Friday afternoon it can be a very unpleasant puzzle.