Managed Care - December 2008 - (Page 5)

LEGISLATION & REGULATION Massachusetts Model Seen As Health Care Reform Guide Insurance lobbying organizations push for guaranteed issue so long as mandatory coverage is part of the mix By John Carroll W hen Blue Shield of California’s Tom Epstein looks at the political players gathering now to take the lead on health care reform in the nation’s capital, he sees some familiar faces. One of them, incoming White House Chief of Staff Rahm Emanuel, was Epstein’s boss when he worked in the office of political affairs in the Clinton administration. Former Senate Majority Leader Tom Daschle is taking the helm at the Department of Health and Human Services while his old colleagues in Congress caucus on reform. And they are preparing big changes for the nation’s managed care companies. “It looks to me like all the major players are looking pretty seriously about this,” says Epstein, who is now the vice president for public affairs at the not-for-profit insurer. The “major players” include the two most influential lobbying groups for the managed care industry. Guaranteed issue Epstein is applauding a move by America’s Health Insurance Plans and the Blue Cross & Blue Shield Association to back a commitment pledging the guaranteed issue of insurance to all comers, regardless of health status, in exchange for a mandate requiring individuals to buy coverage for themselves and their families. “It’s a great step forward that both groups support mandatory universal coverage and for the first time endorsed guaranteed issue,” he says. Blue Shield of California proposed a shared-responsibility model back in 2002, with an individual mandate tied to public subsidies, says Epstein. The insurer is happy to see the leading industry groups follow suit. The next few months will determine whether Blue Shield of California and the rest of the managed care industry remain happy or hit the alarm button. The November election not only means a new president from a party with big majorities in the House and Senate; it also brings in a core group of top bureaucrats who will have a lot to say about how insurers make money and manage health insurance benefits. One sure sign that Obama isn’t going to put health care reform on the back burner: His decision to appoint Daschle to the helm of HHS. Daschle is widely seen as an influential Washington figure who will have the president’s ear. His work on reform up to now signals a leading role in the process. The appointment “telegraphs that Obama is not only serious about the health care challenge, but he intends to prioritize it,” says Karen Ignagni, CEO of AHIP. While Daschle is planning to take over the agency, top Senate leaders have been gathering to hammer out a consensus of their own over how reform needs to be handled in the upcoming legislative session. Senate Finance Committee Chairman Max Baucus has laid out an 89-page blueprint on health care reform, notes Epstein, while Sen. Ted Kennedy is signaling his intent to push new legislation. And Henry Waxman — a champion of reform — is taking the chairmanship of a committee that handles all health care legislation for the House. “The devil is in the details,” says Epstein. “Whether what they come up with will be something we will support or seek changes to, the core approach is one we favor.” That core approach looks a lot like the reform package rolled out in Massachusetts. The New England state is providing some important cues on how the entire industry would like to see insurance reform play out on nationally, and particularly on how mandates should be enforced. “We’ve done a lot of work on this,” says the DECEMBER 2008 / MANAGED CARE 5

Table of Contents Feed for the Digital Edition of Managed Care - December 2008

Managed Care - December 2008 Editor's Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor ICD-10 Offers Huge Opportunity, Challenge Part D at a Crossroads Plans Can Weather the Financial Crisis DM vs. Medical Home? Tackle Prediabetes Reasonable Approach to Morning Sickness Formulary Files Tomorrow's Medicine Outlook

Managed Care - December 2008

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