Healthcare Legislation & Policy Update

Healthcare provisions in the Stimulus package:

Democrats in Congress who wrote the bill "won broad assistance for the unemployed, including federal subsidies for continued health insurance." Amongst the plan's "three main elements" is "help for...those in need of Medicaid."

The Washington Post (2/13, A6, Murray, Kane) reports, "The bill would make a significant down payment on Obama's healthcare and energy agendas. It would provide nearly $20 billion to adopt uniform medical-records technology, portrayed as a job-creating exercise and part of the foundation for broader healthcare reform." Also, $2.1 billion goes to expand Head Start. 

USA Today (2/13, Wolf) reports that  "$21 billion will "provide a 60 percent subsidy of healthcare insurance premiums for the unemployed under the COBRA," while "$87 billion will "help states with Medicaid." An additional $19 billion goes "to modernize health information technology systems," and health research and construction of National Institutes of Health facilities will be funded with $10 billion. CQ Politics (2/12, Schatz, Krawzak) reports, "The NIH funding was a priority for" Sen. Arlen Specter. The Chicago Tribune (2/13, Oliphant, Hook) also reported on the stimulus and mentioned healthcare parenthetically.

Policy & Legislation

Medicare decides not to pay for virtual colonoscopies:

The New York Times (2/13, A18, Pollack) reports, "Medicare has tentatively decided not to pay for virtual colonoscopies, dealing a setback to a technique that some medical experts recommend as a more tolerable alternative to conventional colonoscopy in screening for colon cancer." In an online statement, the CMS said "that there was 'insufficient evidence' to conclude that virtual colonoscopy [also known as CT colonography] 'improves outcomes in Medicare beneficiaries.'"

The Times adds, "In its analysis, Medicare said many studies supporting virtual colonoscopy were done in people with a mean age around 58, so results might not fully apply to Medicare's older population." For example, "older people are more likely to have polyps. So the proportion of people who would have to have a conventional colonoscopy after a virtual one would be greater," as "a patient would typically undergo a regular colonoscopy to" remove polyps detected during virtual colonoscopy. This would ultimately "make the CT scan less cost-effective."

Mandated Autism Coverage in Utah:

The AP (2/13) reports, "Insurance companies would be required to cover autism treatment for children under a bill approved by a Utah Senate committee." The proposed legislation's sponsor, state "Sen. Howard Stephenson, R-Draper, says treatments would include behavioral correction therapy, which could take up to eight hours a day for several years."
       
According to the Salt Lake Tribune (2/12, May), the bill received much "opposition from insurance companies and a small business association. The legislation "would require insurance to pay up to $50,000 a year for early behavioral therapy, which typically involves one-on-one instruction at least 25 hours a week." Known as "Clay's Law," the bill "now moves to the Senate floor." The Tribune noted that "Utah has one of the highest rates of autism, with 1 in 133 children affected, compared to the national rate of 1 in 150." Currently, "eight other states require similar coverage." Utah's Deseret News (2/13, Thalman) also covers the story.
 
Mandating Increased Transplant Coverage in Washington State:
 
The Seattle Times (2/12, Song) reported that lawmakers in the Washington state Senate "have introduced two related bills outlawing a special waiting period for transplant coverage that even insurers widely concede is unfair." The proposed "measures amount to the most concerted push yet in Washington to overturn what critics say are antiquated exclusions for transplant coverage." In fact, "the rules date to the 1980s, when organ transplants were much riskier procedures than they are today."

Washington's "three largest health insurers -- Regence, Premera Blue Cross and Group Health Cooperative -- support banning the special waiting period." The insurers, however, seem against "eliminating the cap on transplant benefits," which oftentimes falls well below the lifetime benefit cap, "saying that it could drive up premiums for all." Premera does support raising its cap from $250,000 to $35,000, and "adjusting it upward annually for inflation," stated Jodi Coffey, a spokeswoman for the insurer. But the company "does not believe that the cap should go away entirely."