Each month, this page features selected short items about state health-care policy digested from newspapers around the country.
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Oregon voters to decide whether insurers must cover services by alternative providers
SALEM, OR—Oregonians will vote on a ballot initiative Nov. 5 that would force insurers to cover services by alternative providers such as chiropractors, naturopaths and acupuncturists.
Backers of Measure 39 say the provision would not only increase choice in health care but also would lower the cost of insurance, noting that providers such as chiropractors and naturopaths charge far less than conventional doctors.
Opponents cite a report by the actuarial firm of Coopers & Lybrand, which estimates that adding chiropractic coverage alone to the Oregon Health Plan would increase costs by 2.5%. The report predicts an increase of more than 15% for the full range of alternative-care providers
Ken Rutledge, president of the Oregon Association of Hospitals and Health Systems, says the measure is worded so vaguely that it seems to require 25 categories of health care providers to be covered, including podiatrists, dieticians and massage therapists.
The Oregon Legislature has rebuffed previous efforts to expand coverage by alternative providers, but Measure 39 supporters have been boosted by a $750,000 contribution from the tobacco
industry. An article in the New England Journal of Medicine reported in 1993 that a third of people surveyed had used unconventional therapies in the previous year.
Oregonian, Portland, Ore., Sept. 26, 1996
New magazine report evaluating 10 Colorado health plans draws mixed reviews
DENVER, CO—A health-care report card grading 10 Colorado health plans was published in Health Pages in late September and widely distributed among area employees, but the usefulness of the report is being questioned by some. The 64-page magazine went on sale on newsstands and was distributed by large employers such as Lockheed Martin, U.S. West and Coors.
One criticism was the similarity of results among health plans. "This stuff is everywhere and everybody gets an A- or B+," David Shanks, chief executive of Boulder-based Consumer Health, told Rocky Mountain News. "These surveys have either not discovered the differences between the health plans or they are unwilling to talk about them."
In answer to the question, "Do you receive care you and your doctor believe is necessary?" Kaiser Permanente scored the highest with 88% answering "no problem." United HealthCare HMO scored the lowest at 73%. The report grades the plans based on consumer satisfaction and standard health measures such as the number of women given mammograms and the number of low birth-weight babies, as well as more specific measures such as diabetic retinal screening. Some health plan executives, for their part, question how much employers actually use the information, even though they lean hard on plans to furnish them with the data. One executive said some employers are still contracting on price over quality considerations.
Rocky Mountain News, Sept. 26, 1996
Empire Blue Cross seeks to convert to for-profit
ALBANY, NYEmpire Blue Cross and Blue Shield, one of the country’s biggest non-profit health care companies, is seeking approval to become a for-profit insurance company. One implication of the change is that Empire would no longer be directly responsible as insurer of last resort in the state.
Plans call for Empire to establish a charitable foundation to provide money for the more than 2.5 million New Yorkers who are uninsured.
The state’s recent move to deregulate hospital rates helped precipitate the conversion. The company said it planned to hold public hearings on the conversion before seeking approval from the state Insurance Department.
In a separate development, which is likely to provide more competition for Empire, Anthem Inc. a large insurance company based in Indianapolis, said it is planning to merge with Connecticut Blue Cross.The Anthem East division, based in Newark, N.J. would also include Blue Cross and Blue Shield plans in New Jersey and Delaware and would have at least 3 million enrollees, including 1.2 million in lucrative managed care networks.
Health-care analysts predicted that Anthem would eventually compete head-on with Empire in New York, New Jersey and Connecticut .
Times Union, Albany, NY, Sept. 26, 1996 and New York Times, Oct. 2, 1996.
Maryland plans to move 220,000 Medicaid
beneficiaries into managed care by June
BALTIMORE—The state of Maryland has begun enrolling Medicaid recipients into managed care plans in anticipation of the January start-up of its Medicaid managed care program. State enrollment counselors will present recipients with a chart comparing benefits offered by the different plans and with a brochure from each plan.
One key issue is whether the state-run enrollment process, by saving HMOs marketing dollars, justifies a reduction in the reimbursement rate. One HMO official disagrees with this logic, noting that the plans will have to spend more on advertising to reach prospects. HMOs are waiting for the state to spell out in more detail how it will determine the reimbursements and exactly what the benefit plan is before making a decision to participate.
The state’s plans call for 220,000 low-income Medicaid recipients to be moved into plans between January and June. Another 110,000 Medicaid recipients are already in HMOs, but also will be part of the new enrollment process.
Baltimore Sun, Sept. 23, 1996
Detroit partnership wins $7.3 million federal grant to improve worst-in-nation immunization rate.
DETROIT—A $7.3 million, five-year grant from the federal Centers for Disease Control and Prevention will help Detroit raise its bottom-ranked immunization rate.
The grant to Child Health Network—a partnership of the Henry Ford Health System and the Detroit Medical Center Children’s Hospital of Michigan—will be used to
develop a computerized registry that will track children from birth to age 3. At first, the program will include only children born in Henry Ford, Detroit Medical Center and Mercy Hospital and Family Centers, which account for about half the infants born in the city each year. But, by the end of the five-year grant, the registry will cover the entire city.
Each child’s name as well as his or her doctor will be entered into the registry before the infant leaves the hospital.
Among 28 urban areas, Detroit ranked last in immunization of children aged 19 to 35 months old, with a rate of only 51%, according to a recent CDC study.
Detroit Free Press, September 28, 1996
Blue Cross Blue Shield of Mass. seeks 30% increase for supplemental Medicare insurance
BOSTON—Calling it an "unsustainable product," Blue Cross and Blue Shield of Massachusetts wants a 30% increase for supplemental Medex, which provides drug benefits and other health care coverage to the elderly. More than 300,000 Massachusetts seniors have Medex insurance for supplemental Medicare coverage.
About 200,000 of those seniors have Medex Gold, which offers unlimited drug benefits and is expected to rack up a $40 million loss this year. Blues executives say the product has lost $200 million over the last 10 years and is attracting sicker and older seniors as the premiums have gone up.The average age of Medex subscribers has climbed from 76 years to 78 years since 1991.
As a long-term solution to this problem, Blue Cross proposes to stop enrolling new Medex Gold members and to offer an alternative product that caps the drug benefit at $3,000 a year and has a 50% copayment.
Under Medex Gold, seniors pay nothing for generic drugs and a 20% copayment for brand name drugs. Only 2% of seniors incur drug expenses surpassing $3,000.
The attorney general’s office has promised to fight the rate increase and challenges the insurer’s claims that they can’t be sustained, pointing to the experience of other insurers in the state which offer similar products at lower premiums.
Boston Globe, Sept. 25, 1996.
Each month, this page features selected short items about state health-care policy digested from newspapers around the country.
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