State Attorney General Sues Blue Cross, Regulator over Rates

Detroit Free Press

The Michigan attorney general’s office has sued Blue Cross Blue Shield of Michigan and a state regulator over rate changes for some customers who buy insurance coverage to supplement Medicare.

The lawsuit filed today in Ingham County Circuit Court says the Office of Financial and Insurance Regulation should have held a public hearing. Attorney General Mike Cox calls the changes “illegally raising rates.”

Blue Cross and the regulator say the rate changes stem from elimination of a discount on so-called Medigap policies for people who don’t live in Michigan or do get help from employers in buying coverage.

The commissioner of the regulating office in June ordered an end to the discounts. Blue Cross says it’s complying with the order.

BCBS Hikes Rates in State

Health CMI

 

Blue Cross Blue Shield of Michigan (BCBSM) has asked permission for a rate hike of up to 15% for nearly 200,000 individual subscribers. Hikes for group subscribers will range from 8-12%. The premium increase must be approved by the Michigan Office of Financial and Insurance Regulation for it to take effect. BCBSM claims that they will lose over $50 million dollars without the hike.

This may come as a surprise to many policy holders since Michigan’s insurance commissioner approved a 22% increase last year for both individual and group policy holders. Despite the increase, BCBSM claims to have lost nearly $100 million last year. Michigan Attorney General Mike Cox has questioned the loss claims since BCBSM increased its surplus by $528 million in 2009. That is profit on top of the already $2 billion surplus that the company holds. Cox has also questioned the purported losses because the State of Michigan gives the company $100 million in tax breaks every year to help control costs and prevent losses.

Last year, Attorney General Cox asked Blue Cross Blue Shield of Michigan pointed questions about their finances. In a letter to BCBSM, Cox asked about bonuses and  salaries to board members, perks such as entertainment expenses, and the total value of the BCBSM art collection. Cox also asked for BCBSM to state the amount of funds transferred to affiliated companies. The Attorney General estimated the transfer of funds out of BCBSM to be over $450 million since 2005. Such a transfer would then show up as a loss for the company even though the funds are received by affiliates. This line of inquiry shows that the Michigan Attorney General suspects clever accounting techniques and financial manipulation to help show a loss for BCBSM.

At the same time, Michigan Congressmen John D. Dingell and Sander Levin questioned Blue Cross Blue Shield of Michigan President and CEO Daniel J. Loepp about proposed rate hikes. The Congressmen asked questions concerning how much of the rate hikes will go towards paying benefits to subscribers, why the BCBSM massive surplus is not used to offset any losses, and what types of bonuses did employees making more than $500,000 per year receive. This line of inquiring was partially triggered by BCBSM paying enormous bonuses to executives  prior to announcing a reduction of its workforce, salary freezes, and rate hikes. Blue Cross Blue Shield of Michigan CEO Leopp had a 23% increase in salary in 2009 to $1.12 million. However, his bonus pay has now dropped to approximately $650,000 down from last year’s $888,269.

As Patients Flock to Medicaid, Doctors Drop Them

NY Times

With Medicaid Cuts, Doctors and Patients Drop Out

 Rebecca and Jeoffrey Curtis searched for care for their son. In the process, they felt like “second-class citizens,” Ms. Curtis said.

FLINT, Mich. — Carol Y. Vliet’s cancer returned with a fury last summer, the tumors metastasizing to her brain, liver, kidneys and throat.

As she began a punishing regimen of chemotherapy and radiation, Mrs. Vliet found a measure of comfort in her monthly appointments with her primary care physician, Dr. Saed J. Sahouri, who had been monitoring her health for nearly two years.

She was devastated, therefore, when Dr. Sahouri informed her a few months later that he could no longer see her because, like a growing number of doctors, he had stopped taking patients with Medicaid.

Dr. Sahouri said that his reimbursements from Medicaid were so low — often no more than $25 per office visit — that he was losing money every time a patient walked in his exam room.

The final insult, he said, came when Michigan cut those payments by 8 percent last year to help close a gaping budget shortfall.

New doctors, with their mountains of medical school debt, are fleeing Michigan because of payment cuts and proposed taxes. Dr. Kiet A. Doan, a surgeon in Flint, said that of 72 residents he had trained at local hospitals only two had stayed in the area, and both are natives.

“My office manager was telling me to do this for a long time, and I resisted,” Dr. Sahouri said. “But after a while you realize that we’re really losing money on seeing those patients, not even breaking even. We were starting to lose more and more money, month after month.”

It has not taken long for communities like Flint to feel the downstream effects of a nationwide torrent of state cuts to Medicaid, the government insurance program for the poor and disabled. With states squeezing payments to providers even as the economy fuels explosive growth in enrollment, patients are finding it increasingly difficult to locate doctors and dentists who will accept their coverage. Inevitably, many defer care or wind up in hospital emergency rooms, which are required to take anyone in an urgent condition.

Mrs. Vliet, 53, who lives just outside Flint, has yet to find a replacement for Dr. Sahouri. “When you build a relationship, you want to stay with that doctor,” she said recently, her face gaunt from disease, and her head wrapped in a floral bandanna. “You don’t want to go from doctor to doctor to doctor and have strangers looking at you that don’t have a clue who you are.”

The inadequacy of Medicaid payments is severe enough that it has become a rare point of agreement in the health care debate between President Obama and Congressional Republicans. In a letter to Congress after their February health care meeting, Mr. Obama wrote that rates might need to rise if Democrats achieved their goal of extending Medicaid eligibility to 15 million uninsured Americans.

In 2008, Medicaid reimbursements averaged only 72 percent of the rates paid by Medicare, which are themselves typically well below those of commercial insurers, according to the Urban Institute, a research group. At 63 percent, Michigan had the sixth-lowest rate in the country, even before the recent cuts.



In Flint, Dr. Nita M. Kulkarni, an obstetrician, receives $29.42 from Medicaid for a visit that would bill $69.63 from Blue Cross Blue Shield of Michigan. She receives $842.16 from Medicaid for a Caesarean delivery, compared with $1,393.31 from Blue Cross.

If she takes too many Medicaid patients, she said, she cannot afford overhead expenses like staff salaries, the office mortgage and malpractice insurance that will run $42,800 this year. She also said she feared being sued by Medicaid patients because they might be at higher risk for problem pregnancies, because of underlying health problems.

As a result, she takes new Medicaid patients only if they are relatives or friends of existing patients. But her guilt is assuaged somewhat, she said, because her husband, who is also her office mate, Dr. Bobby B. Mukkamala, an ear, nose and throat specialist, is able to take Medicaid. She said he is able to do so because only a modest share of his patients have it.

The states and the federal government share the cost of Medicaid, which saw a record enrollment increase of 3.3 million people last year. The program now benefits 47 million people, primarily children, pregnant women, disabled adults and nursing home residents. It falls to the states to control spending by setting limits on eligibility, benefits and provider payments within broad federal guidelines.

Michigan, like many other states, did just that last year, packaging the 8 percent reimbursement cut with the elimination of dental, vision, podiatry, hearing and chiropractic services for adults.

When Randy C. Smith showed up recently at a Hamilton Community Health Network clinic near Flint, complaining of a throbbing molar, Dr. Miriam L. Parker had to inform him that Medicaid no longer covered the root canal and crown he needed.

A landscaper who has been without work and without a Michigan health insurance company for 15 months, Mr. Smith, 46, said he could not afford the $2,000 cost. “I guess I’ll just take Tylenol or Motrin,” he said before leaving.

This year, Gov. Jennifer M. Granholm, a Democrat, has revived a proposal to impose a 3 percent tax on physician revenues. Without the tax, she has warned, the state may have to reduce payments to health care providers by 11 percent.

In Flint, the birthplace of General Motors, the collapse of automobile manufacturing has melded with the recession to drive unemployment to a staggering 27 percent. About one in four non-elderly residents of Genesee County are uninsured, and one in five depends on Medicaid. The county’s Medicaid rolls have grown by 37 percent since 2001, and the program now pays for half of all childbirths.

But surveys show the share of doctors accepting new Medicaid patients is declining. Waits for an appointment at the city’s federally subsidized health clinic, where most patients have Medicaid, have lengthened to four months from six weeks in 2008. Parents like Rebecca and Jeoffrey Curtis, who had brought their 2-year-old son, Brian, to the clinic, say they have struggled to find a pediatrician.

“I called four or five doctors and asked if they accepted our Medicaid plan,” said Ms. Curtis, a 21-year-old waitress. “It would always be, ‘No, I’m sorry.’ It kind of makes us feel like second-class citizens.”

As physicians limit their Medicaid practices, emergency rooms are seeing more patients who do not need acute care.

At Genesys Regional Medical Center, one of three area hospitals, Medicaid volume is up 14 percent over last year. At Hurley Medical Center, the city’s safety net hospital, Dr. Michael Jaggi detects the difference when advising emergency room patients to seek follow-up treatment.

“We get met with the blank stare of ‘Where do I go from here?’ ” said Dr. Jaggi, the chief of emergency medicine.

New doctors, with their mountains of medical school debt, are fleeing the state because of payment cuts and proposed taxes. Dr. Kiet A. Doan, a surgeon in Flint, said that of 72 residents he had trained at local hospitals only two had stayed in the area, and both are natives.

Access to care can be even more challenging in remote parts of the state. The MidMichigan Medical Center in Clare, about 90 miles northwest of Flint, closed its obstetrics unit last year because Medicaid reimbursements covered only 65 percent of actual costs. Two other hospitals in the region might follow suit, potentially leaving 16 contiguous counties without obstetrics.

Michigan Medicare and Medicaid enrollees in the state's midsection have grown accustomed to long journeys for care. This month, Shannon M. Brown of Winn skipped work to drive her 8-year-old son more than two hours for a five-minute consultation with Dr. Mukkamala. Her pediatrician could not find a specialist any closer who would take Medicaid, she said.

Later this month, she will take the predawn drive again so Dr. Mukkamala can remove her son’s tonsils and adenoids. “He’s going to have to sit in the car for three hours after his surgery,” Mrs. Brown said. “I’m not looking forward to that one.”

Study: 750,000 In State May Get Health Insurance

Detroit Free Press

As the Senate debates landmark health insurance reforms, an advocacy organization released a report Wednesday saying 776,000 Michigan residents will gain coverage by 2019 if Congress approves the changes.

If the legislation does not pass, at least 200,000 more Michigan residents will lose health insurance by 2019, according to FamiliesUSA, a Washington health research organization that supports federal reforms. Now, about 1.3 million people in the state are without health insurance or Michigan Medicare, according to the Michigan Department of Community Health. The numbers grow monthly as more people lose jobs and workplace health benefits.

"The consequences of inaction are very severe for people across the country," said Ron Pollack, executive director of the organization, in a news media briefing Wednesday.

Pollack said pending Senate legislation would require insurers to take people with pre-existing conditions; expand eligibility for Medicaid, and give tax credits, a type of subsidy, for others slightly above federal poverty guidelines, so they can buy Michigan health insurance. He expects monthly premiums paid by those who now are insured may drop because reforms would end cost-shifting to care for the uninsured by charging insured patients more.

Senate Passes Bill To Benefit Michigan Companies, Jobless

Detroit News

Washington -- The Senate passed the $636 billion Department of Defense appropriations bill this morning that includes millions of dollars for military-related projects by Michigan companies, plus an extension of unemployment benefits and COBRA health insurance subsidies for laid-off workers.

The Senate passed the bill, passed 88-10, with Sens. Carl Levin, D-Detroit, and Debbie Stabenow, D-Lansing, voting for it. The bill goes to President Barack Obama, who is expected to sign it.

"It was a little bit of struggle to get here, but we got here," said Sen. Majority Leader Harry Reid, referring to the massive snowfall that began Friday night and is blanketing Washington.

The Senate squeezed in the vote to fund the Fiscal Year 2010 military in its ongoing debate on overhauling the nation's health care system. Senate Democrats hope to get to a final vote before the Christmas holiday next Friday.

The DoD bill also includes $128 billion to fund the wars in Iraq and Afghanistan.

The precise dollar amount that Michigan companies will receive in the Defense bill isn't known because companies must compete for the contracts. The amount will easily top $100 million, however, because much of the funding goes to projects already under way in Michigan.

The bill also sets aside $320 million for the Warren-based Army Tank Automotive Research, Development and Engineering Center and its National Automotive Center.

That money will support such research into protecting Army vehicles against rocket propelled grenades and other explosives, strengthening combat and tactical vehicle armor, and developing fuel cell and hybrid electric vehicles.

The legislation also funds programs of the Army's TACOM Life Cycle Management Command in Warren, including the Abrams main battle tank, the Bradley Fighting Vehicle and the Stryker Armored Vehicle.

Michigan lawmakers requested funds for projects in which Michigan companies will be leading contenders for the contracts, including:

• $1.2 million to develop rooftop photovoltaic systems for military housing by United Solar Ovonic in Auburn Hills.

• $219 million to continue work on the lightweight 155mm howitzer, which Howmet Castings of Whitehall has worked on.

• $6.4 million for a program that Peckham Industries of Lansing has been part of to create multi-climate clothing for soldiers.

• $2 million for laser scanning technology that NVision of Wixom is developing.

• $1.2 million to continue work by Cybernet Systems Corp. of Ann Arbor on a shipboard wireless device for Navy ships.

• $1.6 million to continue development by Dexter Research Center in Dexter on a security sensor to protect military intallations from chemical and biological attacks.

"This bill ensures that Michigan's factories and research centers will continue their cutting-edge work that has helped make our military the strongest the world has ever seen," said Levin, the chairman of the Senate Armed Services Committee.

Stabenow said the funds will help create jobs in the state.

"I am very pleased that this legislation not only provides critical funding to support our troops, including a 3.4 percent increase in military pay, but also invests in my priorities for alternative energy research and more energy-efficient combat vehicle technology," Stabenow said.

The bill also extends a federal subsidy that helps laid-off workers pay for health care from nine months to 15 months.

Under the program, the federal government picks up 65 percent of the cost of an individual's health insurance with their former employer.

The subsidy, initially offered for nine months, began in March, meaning some laid-off workers got kicked out of the program Dec. 1. They'll be allowed to continue for six months, and be reimbursed for the subsidy they didn't receive for December, once the bill becomes law.

Eligibility to tap into the COBRA program for Michigan health insurance was set to expire Dec. 31, but the DoD bill extends it through Feb. 28. The bill also extended the expiration date of expanded unemployment benefits from Dec. 31 to Feb. 28.

Without the extension of the jobless benefits program, 70,000 Michiganians will cash their last unemployment checks by mid-February.

Last month, Congress passed an extra six weeks of unemployment benefits for hard-hit states such as Michigan. But because there were too few weeks left on the calendar before the cut-off date of Dec. 31, virtually no one in Michigan would have qualified for the six extra weeks.

Michigan provides a maximum of $362 per week in unemployment benefits to previously full-time workers, plus an additional $25 per week provided by the Recovery and Reinvestment Act, for a total of $387 per week. The weekly $25 bonus was also in the DoD bill.

Levin said the steps will "soften the blow of unemployment."

About 470,000 Michiganians are receiving unemployment benefits.

Priority Medicare Earns 5-Star Rating For Second Straight Year

Reuters

 

GRAND RAPIDS, Mich.-- Priority Health`s Medicare plan was recognized with a 5-star rating by the Centers of Medicare and Medicaid Services (CMS). It is the only plan in Michigan to earn the top rating two years in a row. The rating was published in the CMS annual Medicare & You handbook mailed to all Medicare beneficiaries prior to the Nov. 15 - Dec. 31 annual enrollment period. Medicare beneficiaries through a Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey determine the rating.

"This rating is a testament to our ability to provide Michigan with access to excellent and affordable health care," said Kimberly K. Horn, president and chief executive officer for Priority Health. "Medicare beneficiaries can be confident when they select a Priority Health plan, that they are getting the best value available."

Priority Health`s Michigan Medicare Advantage insurance plans vary in price based on where individuals live and what benefits they need. Those individuals eligible for Medicare may choose from four Medicare Advantage plans or a prescription-drug plan Priority Health offers, including:

* PriorityMedicare ValueSM - offers the lowest monthly premiums, making it ideal for those individuals who   don`t use their medical benefits very often.
* PriorityMedicareSM - offers a slightly higher premium than PriorityMedicare Value with lower copays and out-of-pocket costs.
* PriorityMedicare PlusSM - offers medical coverage that`s similar to PriorityMedicare with enhanced prescription-drug coverage in the Medicare Part D coverage gap, called the "donut hole."
* PriorityMedicare ChoiceSM is the newest and most comprehensive Medicare Advantage plan offered by Priority Health.

In addition to Priority Health`s Medicare Advantage plans, it also provides several Michigan Medigap insurance options and a prescription drug plan.

Priority Health's Medicare Advantage plans are available in 31 counties including Allegan, Antrim, Barry, Benzie, Cass, Crawford, Emmet, Grand Traverse, Hillsdale, Ionia, Jackson, Kalamazoo, Kalkaska, Kent, Leelanau, Livingston, Manistee, Mecosta, Missaukee, Monroe, Montcalm, Muskegon, Newaygo, Oakland, Oceana, Osceola, Ottawa, Roscommon, St. Clair, Washtenaw and Wexford counties.

All Priority Health Medicare Advantage plans offer:

• Medicare Part D prescription drug coverage with no deductible
• Low out-of-pocket costs
• Preventive care
• Worldwide emergency and urgent care coverage Local in-Michigan customer service

For more information, visit prioritymedicare.com.

About Priority Health

Priority Health is a nationally recognized health benefits company based in Michigan. It serves more than half a million people with a broad portfolio of products including commercial and government health plans. As a nonprofit, Priority Health has been dedicated to providing all people access to affordable health care for more than 20 years. It continues to be recognized as one of America`s Best Health Plans by U.S. News & World Report and NCQA.

Attorney General Protests Blue Cross Rate Hikes, Offers Own Plan

Story from the Detroit Free Press

Michigan Attorney General Mike Cox filed a petition Thursday to stop proposed individual rate hikes for more than 400,000 individual Blue Cross Blue Shield of Michigan customers.
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"Blue Cross should stop putting profits over people and focus on its mission as the insurer of last resort," Cox said in a statement announcing the challenge.

Overall, average increases sought would be 56% for non-elderly people buying their own insurance; 42% for group conversion policyholders who purchase coverage they once had at work, and 31% for seniors with supplemental Medicare, also known as Medigap policies.

Michigan's Office of Financial and Insurance Regulation was to have ruled on the rate hikes by June 2. Now the office has 30 days from Thursday to hold the hearing.

Blue Cross has said it needs the rate hikes to offset mounting losses for its individual policies, to exceed $1 billion through 2011, according to Blue Cross estimates. It also is laying off or not filling 1,000 jobs, has frozen executive and board salaries and cut spending on advertising, lobbying and other expenses, the Detroit-based company has said.

In a statement, Blue Cross said that it would prefer not to raise rates but "unfortunately our broken regulatory system puts us in this uncomfortable position."

Cox has had mixed results with rate challenges.

He and Ann Arbor attorney Joe Aoun lost a challenge earlier this month of 2007 Blue Cross rate hikes for non-elderly people who buy their own Michigan health insurance. But Cox won a separate challenge in 2007 to raising Medigap rates.

Cox has issued his own 10-point plan to reform Michigan's health insurance industry. He said challenges like the one he filed Thursday will be reduced by proposals pending in the House.

Rep. Marc Corriveau, D-Northville, said he has tried unsuccessfully to work with Cox to frame the bills to retain his oversight. His proposals would allow the Attorney General to file a challenge to a rate hike, but would shorten the time he could do it.

State Proposals To Cover Half Of Uninsured

Story from Toledo Blade

LANSING, Mich. — Roughly half of Michigan's 1.2 million uninsured residents could wind up with subsidized, relatively low-cost health coverage under a proposal rolled out Thursday by some key Senate Republicans.

The proposal will add to the long-simmering debate regarding what to do about rising health care costs and the growing number of uninsured in Michigan. Democrats in the state House have introduced a competing plan, and while there appears to be some common ground between the two approaches, major differences must be resolved before any new laws could be passed to guide the Michigan health insurance market.

The Senate proposal calls for an assessment on all claims paid by health insurance companies in the state to help subsidize the cost of basic coverage plans for relatively low-income residents who don't buy coverage because they can't afford it. The bill as introduced would allow an assessment of up to 1.8 percent, although it's possible a much lower rate could provide enough money to fund the program. A board established by the legislation would help determine the assessment rate.

"We're asking everyone to chip in," said Sen. Tom George, a Republican from Kalamazoo County's Texas Township and the chief architect of the Senate proposal. "We're stepping on everyone's toes a little bit in order to expand access to health care."

That's better than the current system, bill supporters say. People with insurance coverage pay significantly higher costs because they are helping offset the estimated $2 billion in annual uncompensated health care provided to the uninsured in Michigan. Supporters of the George plan say broadening insurance coverage could help lower costs overall.

House Democrats who sponsor a competing plan are wary of a broad assessment on health insurance claims, saying it could raise costs for automakers and businesses that can least afford it. But some provisions of the Senate and House plans appear to overlap and could lead to a compromise.

"We're both headed in the right direction, which is encouraging," said Rep. Marc Corriveau, a Democrat from Northville and a key sponsor of the House plan.

Both plans feature somewhat similar provisions to help cover people who have claims of $25,000 or more in a given year through assessments on companies competing in Michigan's individual health insurance market. Both would require more payments from nonprofit Blue Cross Blue Shield of Michigan in lieu of taxes. In exchange, Blue Cross could get some relief from some of the costs associated with its role as the Michigan health insurance company of last resort.

Both plans would increase consumer protections, including provisions aimed at preventing insurers from dropping people when they become sick.

Another piece of the Senate plan is aimed at getting more federal money tied to Medicaid to help expand coverage. It would include incentives for healthy behavior.

BCBS of Michigan Raises The Price For Individual Health Coverage

Story from the Detroit News

As more Michigan residents flock to Blue Cross Blue Shield of Michigan to buy their own Michigan health insurance, the state's largest insurer is replacing several types of individual policies with plans that will cost up to $600 a year more -- and come with higher co-payments and other out-of-pocket costs.

The new insurance plans -- with monthly premiums ranging from $51 to $292 per a person -- are on sale now and take effect Wednesday.

On March 27, Blue Cross stopped enrolling new consumers in several older plans, including Value Blue, a catastrophic coverage policy, and its no-deductible Individual Care Blue. The changes don't affect Blue Cross members enrolled in those plans. Instead, the new rates will apply to newly unemployed residents seeking to replace workplace coverage by buying their own insurance from Blue Cross. The new plans also differ from those for which Blue Cross is seeking state permission to raise rates and would not be affected if that request is approved.

With the rollout of these new plans, Blue Cross has introduced a lengthy application that includes optional health questions and ties insurance agents' commissions to the medical condition of new enrollees.

The changes are so drastic that some insurance agents say Blue Cross is deliberately making its money-losing individual policies less attractive to slow sales. Blue Cross contends that it's simply keeping up with market trends, as well as the rates and plan offerings of its private-sector competitors.

As the state's insurer of last resort -- a responsibility tied to its tax-exempt status -- Blue Cross must cover all Michigan residents, regardless of their medical history. But that arrangement, Blue Cross officials say, leaves them with the state's sickest and costliest members. Last year, Blue Cross lost $133.2 million on individual insurance policies, dragging its bottom line to a $144.9 million loss for 2008.

Insurance agents say the new rates will make it harder to sell the plans. New members aren't going to want to pay more in premiums for higher out-of-pocket costs, especially if there are better deals offered by other insurers.

"It's not good for the consumer," said Patrick Pennefather, president of the Michigan Association of Health Underwriters, which represents Michigan health insurance company agents and buyers for employer groups. The new plans, he added, are going to slow down sales for Blue Cross, a move that could help stem the rising tide of losses on individual policies.

Some agents are likely to stop selling Blue Cross' individual policies altogether because the commission structure lowers incentives for enrolling sickly customers into its individual plans, Pennefather added.

Blue Cross's new incentive structure offers a 15 percent commission to agents who sign up healthy members and only 2 percent for signing new enrollees with severe medical problems. A 2 percent commission could translate into only a couple of dollars a month on some policies, say insurance agents, and is much lower than the 8 percent commissions previously offered by Blue Cross on all policies, regardless of the applicant's health status.

Blue Cross said the tiered commissions better match incentives offered by their rivals in the individual insurance market.

"It may drive a lot of agents out of the individual insurance business. In fact, many have said they plan to get out of it," Pennefather said, noting that agents can make 20 percent with other private insurers.

Some Blue Cross critics, including Michigan Attorney General Mike Cox, have questioned why Blue Cross is collecting health information, since that is at odds with the company's mission as the state's insurer of last resort. Cox's office has said it's investigating whether the changes are lawful.

Answering the questions about health status, however, is voluntary and won't affect consumer eligibility or rates, but will help applicants qualify for lower co-payments, Blue Cross officials said.

Blue Cross also points out that it still pays at least some portion of the commission to agents for all applicants. Most other insurers pay no commission if they end up rejecting the applicant, said Helen Stojic, a Blue Cross spokeswoman.

As for the new plan prices and coverage, Stojic said Blue Cross hopes to better reflect the marketplace, where deductibles and higher out-of-pocket maximums are common.

The insurer also contends its rates are still better than most plans for people with serious medical conditions.

"Our plans are aligned more closely with those in the market, with one important difference: We still don't medically underwrite and we are still the insurer of last resort," Stojic said.

Unlike rate hikes for existing customers, state regulators don't require Blue Cross to seek public input before introducing new plans or closing new enrollment in existing policies.

Blue Cross is seeking rate hikes on its existing individual policies that cover about 400,000 members. It's asking for an average rate hike on three types of policies: a 56 percent increase on individual plans, 42 percent on group conversion coverage (which extends benefits from a former employer) and 31 percent for Medigap plans.

Family Fights Insurance Industry Autism Policies

Story from HometownLife.com

Val McFarland isn't getting help from the insurance companies in paying for treatments for her 5-year-old son with autism.

It costs about $100,000 annually, which includes physical, occupational and speech therapy seven days a week, at home and at William Beaumont Hospital's Center for Human Development in Berkley.

“Either families are going further and further in debt or children are not receiving care,” said McFarland, of Commerce Township.

Two local lawmakers are trying to help families like the McFarlands. State Reps. Lisa Brown (D-West Bloomfield) and Vicki Barnett (D-Farmington Hills) launched a campaign Wednesday to support the growing number of families struggling with the costs of autism care by requiring health insurance companies to provide coverage for the treatment of the disorder. Autism is a complex brain disorder that inhibits a person's ability to communicate and develop social relationships.

Many Michigan health insurance companies cite unproven treatment methods when denying coverage for therapy. In support of National Autism Awareness Month, Brown and Barnett also launched an online petition for residents who would like to show their support for the plan and raise autism awareness.

“It is simply unacceptable for a Michigan health insurance company to refuse coverage and let the quality of life of these children be an afterthought,” Brown said. “While health care companies cover prevalent diseases like cancer and diabetes, they continue to discriminate against autism. We can't stand on the sideline as these companies turn their backs on autistic children who may never reach their full potential without treatment.”

The Centers for Disease Control and Prevention have called autism a national public health crisis whose cause and cure remain unknown. But research shows that early, intensive intervention can help.

The disorder effects 1 in 150 children, and boys are four times more likely than girls to be diagnosed. According to the Autism Society of America, Michigan has the highest rate of diagnosed autism cases in the U.S., with 12,166 children between the ages 3 and 21 effected.

Currently, 10 states mandate insurance coverage for autism. In Michigan, most health insurance companies cover only screening for the disorder, leaving families with autistic children to bear the high costs of treatment on their own.

“Insurance companies basically discriminate against autism treatments,” Brown said. “Insurance companies cover the diagnosis of autism but they don't cover the treatment.”

Last week, the House passed legislation to encourage greater research into the causes and treatments of the disorder. The plan would create the Autism Research Fund to research its causes and treatments, as well as establish a new income tax checkoff box to allow Michigan residents to voluntarily designate a portion of their tax return to the fund.

“I would hope it has bipartisan support,” Barnett said. “We're talking about covering children with a specific diagnosis.”

Val McFarland and her husband, Kevin, started the Celebrities Against Autism organization to raise awareness of the disorder and help offset the cost of therapy for them and other families.

Long term, the organization hopes to open a therapeutic center, which would include horseback riding, service dogs, an indoor pool and camps for autistic individuals.

“We started this for Callahan but it has grown much larger than just our son,” Val said. “As I began networking with other families impacted by autism, I learned how difficult it is for so many to both locate and afford quality treatment and how isolated they can feel.”

Residents can sign the petition at www.housedems.com/petitions. While on the site, residents can also share personal stories about how autism has affected them and their families.

Some Hard Data On Michigan's Uninsured

Originally Posted at ABC12 News

The number of people without Michigan health insurance coverage is expected to grow exponentially in the future.

As we wind down Cover the Uninsured Week on ABC12, HealthFirst reporter Leslie Toldo has some of the hard facts about the state of health care in Michigan.

There are many people who qualify for free or low-cost insurance coverage, but don't know that it's available.

Fortunately, one Fenton woman found that out, quite literally, before it was too late.

The number of people without insurance in our state is high and the number of people who are actually on some type of public assistance is even higher.

Today we go back to a town hall meeting held in Flint on Thursday to get some insight from the state's top experts.

Right now, one-in-six Michiganders and one-in-three children are on Michigan Medicaid insurance. One-in-four people in the state is covered by some type of public assistance.

According to the director of Michigan's Department of Community Health, one quarter of the state's general fund goes to Medicaid coverage.

Janet Olszenwski is the director of the state Department of Health. "That's a tremendous amount of investment. That's money that can't be used for education, that can't be used for other needs the citizens have. But it's money that goes to protecting children, the elderly, the disabled and Michigan womens' health."

The resulting good news, according to our panelists, is Michigan has the ninth-lowest number of children who do not have health coverage.

Sadly, according to the Marianne Udow-Phillips, the director of the Center for Healthcare Research and Transformation in Ann Arbor, there are still 150,000 kids who are not covered and the number is going up. "In one year we saw a very large increase in the percentage of our children who are uninsured. We went from having 4.7 percent of our children who are uninsured to 6.2 percent who are uninsured."

Finally, our panelists pointed out that those on public assistance and those without a Michigan health insurance company are not the only ones feeling the pinch.

"Increasingly, those who have private coverage are having great difficulty in affording that coverage and affording care because all of us have seen increases in our co-pays and our deductibles. And you see that in our data a 25 percent increase in a relatively short period of time," Udow noted.

Uncompensated care equates to costs hospitals have to eat because unpaid or underpaid bills increased by 68 percent last year.

We have a link to more of Michigan's specific stats at abc12. com, as well as more information about how to get help finding coverage.

Michigan Clinics Receive Stimulus Money For Uninsured

Originally Posted at WZZM13

At least 2 health centers in West Michigan will get a portion of new stimulus money coming to the state.

More than $8 million dollars will be divided between 29 federally qualified community health centers. The Cherry Street Health Services and Saint Mary's Heartside Clinic are two of them.

"The amount of money that we are getting right at this time is $604,000 and with that we will be able to add 13 new staff members. Those include two dentists, a hygienist a physician and medical assistants, dental assistants and others," said Chris Shea, the executive director of Cherry Street Health Services.

The agency operates 13 clinics in Kent County where low income residents can get help with health, dental and counseling services. Shea said last year the clinics served 45,000 people but says there were many more they could not help.

"We estimate there are as many as 4 times that number of people who have limited access to health care primarily due to income. It is right on time. It is coming to us quickly it certainly is not in the amounts that are needed to serve everyone, but it is at least a good boost to get us moving in the right direction," he said.

Shea said the money will allow the clinics to provide care for more people who have lost their jobs or Michigan health insurance.

Nationally clinics will use the funds over the next two years to create or keep about 150 jobs and provide care for nearly 54 thousand new patients.

St. Mary's Health Care is receiving stimulus money to the tune of $194,000. A spokesperson for the center says it will use it's money to extend hours and services offered at it's Heartside Clinic.

Each year about 8,000 homeless people visit the clinic. These are generally people without a Michigan health insurance company. The grant money will allow the clinic to provide 2,500 more visits to the homeless or destitute.

Two Michigan Health Systems See Gains And Losses

Originally Posted To The Detroit News

Two major Detroit hospital systems -- the Detroit Medical Center and Henry Ford Health System -- made money on operations in 2008, despite huge losses incurred from unpaid medical bills and a deepening recession that's causing more people to lose their jobs and Michigan health insurance.

The DMC reported making $39 million on operations in 2008, an increase from the prior year and the largest one-year gain on operations since 1997, said CEO Mike Duggan.

Across town, Henry Ford also made money on operations in 2008, netting about $53.5 million, according to its unaudited financial results. That profit, however, was a drop from 2007 when Henry Ford made about $100.2 million from operating activities.

Operating income is an industry yardstick for measuring hospital performance absent investment income and other non-operating items.

Warren-based St. John Health, which has its flagship hospital in east Detroit, doesn't release its year-end financials until after June 30, when its fiscal year ends.

Despite the gains, Henry Ford and the DMC lost hundreds of millions of dollars last year on uncompensated care -- unpaid medical bills they don't expect to collect payment on -- and in the investment market, which plummeted last fall, putting millions of dollars in unrealized losses on their books. Many of the losses are due to newly unemployed workers who are no longer insured by a Michigan health insurance company.

Henry Ford, which has its headquarters on West Grand Boulevard in Detroit, saw its uncompensated care costs rise from $132 million in 2007 to $161 million last year. The seven-hospital health system also lost about $45 million on investments, dragging down its net profit to $8.5 million by the year's end.

Similarly, the DMC, which has its main hospital campus in Detroit's midtown, booked $47 million in unrealized investment losses in 2008, causing the organization to post a net loss of $6.5 million in 2008 -- the first red ink the hospital has seen since it began making money again in 2004 after nearly a decade of losses.

Duggan said the medical center doesn't usually focus on unrealized investment gains or losses, because the stock market is constantly in flux and those figures aren't directly related to operating performance.On uncompensated care, the DMC did better, reducing its losses from $266 million in 2007 to $255 million last year. The reduction came largely because the medical center made a better effort at enrolling its Medicaid-eligible patients in the Michigan Medicaid insurance program, Duggan said.

"We consider it to have been an excellent year," Duggan said, adding the city's long-term economic problems have forced the DMC to make cuts ahead of some industry rivals. "What other people are going through right now, the DMC went through in 2003 and 2005," Duggan said.

Duggan added the DMC hopes to begin construction on a $30 million outpatient center for its Children's Hospital of Michigan this year, but is waiting for the bond market to improve.

Other Metro Detroit hospitals have faced a challenging year.

In Oakland County, Beaumont Hospitals -- a historically strong financial performer in the region -- lost $29 million on operations in 2008 and has had to lay off staff.

And a report by the Michigan Health and Hospital Association released earlier this year found that 60 percent of Michigan hospitals reported a negative operating margin in the third quarter of 2008, following huge investment losses and last fall's Wall Street meltdown.

In that same quarter, the average margin had fallen to minus 2.9 percent, from plus 2 percent in 2007, the report found.

UAW Members Await GM Health Deal After Ford Contract Ratified

As Originally Posted at Bloomberg

United Auto Workers members at General Motors Corp. will have to wait for an agreement on a union retiree health-care fund before voting on labor concessions GM needs to keep U.S. aid.

A UAW-GM agreement approved Feb. 17 by negotiators is similar to the economic matters ratified by UAW members at Ford Motor Co., UAW Vice President Cal Rapson wrote in a letter yesterday to local presidents and chairmen. GM and the UAW are still negotiating changes to the so-called Voluntary Employee Beneficiary Association, the letter said.

GM must persuade the UAW to swap $20.4 billion in future obligations to the VEBA for half that in cash and the rest in equity as part of U.S. Treasury requirements to keep $13.4 billion in loans and win approval for as much as $16.6 billion more. GM has said it needs at least $2 billion in fresh aid by the end of this month or it will be bankrupt.

Changes to the GM contract “in the area of economics, pattern the UAW Ford agreement,” Rapson said in the letter. Other parts, he said, are “drastically different.”

For example, there are no mandatory physical examinations and “other parts of the agreement are different to better fit GM culture.”

The UAW walked out on GM talks on Feb. 13 in a dispute over the VEBA demands and later returned to approve only other concessions. GM UAW members must still ratify the agreement for it to be implemented.

GM spokeswoman Renee Rashid-Merem said the automaker isn’t commenting on the VEBA negotiations, which are ongoing. UAW spokesman Roger Kerson didn’t return a phone call or an e-mail seeking comment.

Ford Changes

The Ford contract changes won the support of 59 percent of production workers and 58 percent of skilled-trades employees, the union said yesterday in a statement. The terms include elimination of annual bonuses and cost-of-living pay increases, as well as reductions in layoff benefits and in the company’s cash contribution to the VEBA for Michigan health insurance.

A key provision of the Ford accord lets the Dearborn, Michigan, automaker cut by half its cash contribution to the VEBA. Stock will make up the balance of the payments to the fund, beginning in 2010 when $3.2 billion is due, according to a March 5 report by Chicago-based analyst Brian Johnson of Barclays Capital.

Union Givebacks

Ford’s labor agreement also eliminates the so-called jobs bank, a 25-year-old program that paid UAW employees their full salary indefinitely to report to work when there were no duties to perform. GM and Chrysler LLC have eliminated their programs.

Instead, Ford union workers with more than 20 years will get 52 weeks at about 70 percent of their gross wages, so-called supplemental unemployment benefit, or SUB, pay -- or about double what they would receive in unemployment -- and 52 weeks more at half that rate.

Workers with more than 10 years and fewer than 20 get 39 weeks of full SUB pay and 39 weeks at half the rate. A worker with less than 10 years’ service gets 26 weeks at full supplemental pay and 26 weeks at half.

In the past, workers would get the supplemental pay for 48 weeks and then go into the jobs bank.