A project of the Galen Institute

Issue: "States"

Narrow Networks Bill Passes Floor Vote

David Gorn, California Healthline
Fri, 2014-08-29
"The Assembly this week approved a bill to limit narrow networks in California's health plans. The legislation already passed a Senate vote and is expected to get concurrence today on the Senate floor and move to the governor's desk for final approval. SB 964 by Sen. Ed Hernandez (D-West Covina) directs the Department of Managed Health Care to develop standardized methodologies for health insurers to file required annual reports on timeliness compliance, and requires DMHC to review and post findings on those reports. It also eliminates an exemption on Medi-Cal managed care plan audits and requires DMHC to coordinate those plans' surveys, as well. "I introduced the bill in response to complaints we’ve heard about inadequate networks in the Medi-Cal program, as well as at Covered California," Hernandez said.

Cover Oregon turnaround consultant's bills grew to $600,000-plus as exchange obstacles multiplied

Nick Budnick,The Oregonian
Fri, 2014-08-29
"The price tag of the Cover Oregon health insurance exchange fiasco continues to grow. As Clyde Hamstreet, the corporate turnaround expert hired to lead Cover Oregon in April, wraps up his work he leaves behind a stabilized agency – and a hefty bill. Initially signed to a $100,000 contract, Hamstreet ended up staying longer than expected, with two associates joining him at Cover Oregon after Gov. John Kitzhaber essentially forced out three top officials there in a public display of house-cleaning. Through July, Hamstreet has billed $598,699 on an amended $750,00 contract. He hasn't submitted his August invoice. He says the price tag was driven by the exchange's increasing needs, as his firm stayed longer and did more than initially planned. "We didn't do this job to make a lot of money off the state," he said Thursday. "Our philosophy was to try and help get the boat righted and try to help clean things up and basically help the state. ...

As many as 1 in 5 exchange enrollees affected by technical problems, staff concedes

Carol Ostrom, Seattle Times
Fri, 2014-08-29
"A lack of transparency in describing and fixing technical problems became an issue in Thursday’s Washington Health Benefit Exchange Board meeting. Board member Bill Hinkle grew testy at what he said was mutual staff back-patting and excuses for the problems still plaguing thousands of accounts. “C’mon you guys, let’s quit blowing smoke here,” Hinkle said. “I’m tired of patting people on the back….We’re not doing great yet.” Board member Teresa Mosqueda pressed staff for numbers of enrollees affected by technical problems. “We really need to have the data in front of us to manage some of these issues,” she said.

U.S. officials reach deal with Pennsylvania on Medicaid

Hilary Russ and David Morgan, Reuters
Fri, 2014-08-29
"Federal officials have reached an agreement with Pennsylvania Gov. Tom Corbett over his plan to use federal funds to pay for private health insurance coverage for up to 600,000 residents, the governor said on Thursday. The deal highlights a growing number of Republican governors who are finding ways to accept money under President Barack Obama's Affordable Care Act, despite political opposition that has so far prevented nearly half of U.S. states from moving forward with the Medicaid expansion plan. Corbett sought a waiver in February to use those expansion funds to instead subsidize private health insurance for low-income residents."

Arizona Medicaid appeal to be heard by court

Mary Jo Pitzl, Arizona Republic
Thu, 2014-08-28
"PHOENIX — The Arizona Supreme Court has agreed to hear Gov. Jan Brewer's appeal of an appeals-court decision that could unravel the Medicaid expansion she fought for last year. The high court has not yet set a date, but indicated it will hear Brewer's argument that about three dozen Republican lawmakers don't have the legal standing to challenge the controversial vote. The court's decision, reached in a scheduling conference, comes on the heels of Tuesday's primary election in which every Republican lawmaker who voted to expand the state's Medicaid program won re-election. That means it would be highly unlikely the next Legislature would vote to reverse the 2013 decision, which was a consistent fault line in numerous GOP legislative primaries. The case revolves around whether the Legislature's 2013 vote to impose an assessment on hospitals to help cover the cost of expanding the Arizona Health Care Cost Containment program was a tax.

Talks on Pennsylvania Medicaid plan said to be nearing end

The Associated Press
Thu, 2014-08-28
"An announcement could be made soon on Pennsylvania Gov. Tom Corbett's plan to use billions of federal Medicaid expansion dollars under the 2010 healthcare law to subsidize private health insurance policies, a spokeswoman said Wednesday. Kait Gillis, a state Department of Public Welfare spokeswoman, said negotiations with the federal government are in the final stages, but details remain under wraps. HHS officials did not immediately respond to a request for comment Wednesday, and the federal agency consistently has declined to publicly discuss details of Corbett's plan. The 124-page plan was formally submitted in February, and closed-door negotiations began in April after a public comment period."

Why that one Democratic Obamacare ad didn’t signal a new trend

Matea Gold
The Washington Post
Thu, 2014-08-28
"When Sen. Mark Pryor of Arkansas went up with a television ad last week alluding to some benefits of Obamacare, partisans on both the left and the right saw the spot as a sign that vulnerable Democrats might finally be embracing the polarizing health-care overhaul in their campaigns. But in the days since, it's become clear: there's little evidence that the hotly debated law is on its way to becoming a central Democratic talking point heading into the fall campaign. "It’s basically the first pro-Obamacare ad we’ve seen by a vulnerable Democrat for months," said Elizabeth Wilner, senior vice president of Kantar Media Ad Intelligence, whose Campaign Media Analysis Group tracks political advertising. "It’s like seeing a unicorn – it just doesn’t happen very often.""

Cover Oregon: At least 2,000 Oregonians need to change coverage due to health exchange errors

Nick Budnick, The Oregonian
Wed, 2014-08-27
"Cover Oregon will hold a special open enrollment period for 1,400 Oregonians who were incorrectly enrolled into the low-income Oregon Health Plan by the state's troubled health insurance exchange. Starting Aug. 31, the people affected will have no coverage through the OHP, the state's version of Medicaid. However, they will have the option to sign up for coverage from private insurers and to qualify for tax credits through Cover Oregon to bring down premiums. Meanwhile, Cover Oregon is contacting at least 700 people who should have been enrolled in the Oregon Health Plan, but were incorrectly enrolled in a commercial health plan instead. If they were receiving tax credits for private plans, those will go away immediately, though they can keep their plan. Cover Oregon is currently negotiating with the federal government over whether those people will have to refund to the IRS all the tax credits they received incorrectly, said Amy Fauver, Cover Oregon communications director.

Federal auditors sought documents related to troubled Md. health exchange launch

Jenna Johnson and Mary Pat Flaherty, The Washington Post
Wed, 2014-08-27
"Noridian Healthcare Solutions, the company fired by Maryland officials after the disastrous launch of the state’s health insurance exchange, received a request from federal auditors last month to turn over documents related to the troubled project, chief executive Tom McGraw said Tuesday. McGraw said in a statement that Noridian was “cooperating fully” with the July 30 request by the inspector general’s office for the Department of Health and Human Services, which has been auditing the use of federal funds in creating the Maryland Health Benefit Exchange. McGraw’s statement came after Rep. Andy Harris (R-Md.), a fierce critic of the exchange and the federal health-care law that led to it, said that federal auditors had issued subpoenas as part of their review. “The Office of Inspector General has moved this from an audit into a full-blown investigation,” he said in a statement. “Now we know that fraud may have occurred.”"

Court filings show Oracle America stymied Oregon DOJ demand for documents

Tue, 2014-08-26
"The Oregon Department of Justice jousted for nearly two months with Oracle America over the state's demand for documents from the California software giant relating to the health exchange debacle. In fact, Oracle flouted state law and stymied the demand, according to DOJ. The state filed papers in federal court Friday that provide a glimpse into high-stakes jockeying that for months took place largely out of public view. DOJ filed its federal papers shortly after the state's lawyers sued Oracle in Marion County Circuit Court on Aug. 22. In its federal filing, DOJ accuses Oracle of "stalling" and attempting to manipulate the legal system by filing its own federal lawsuit against Oregon on Aug. 8."

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