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Assembly Bill 210: Power to the Commissioner and the Rolling Back of Insurance Protections

HealthWatch Wisconsin has been following Assembly Bill 210 (AB 210), introduced by Rep. Petersen (R-Waupaca). AB 210, relates to the "implementation of health insurance reform, providing an exemption from emergency rule procedures, and granting rule-making authority." 

Rule Making Authority: This bill gives Wisconsin's Commissioner of Insurance (OCI) rule-making authority (equivalent to the delegation of legislative authority the state budget granted Department of Health Services Secretary Dennis Smith). The draft provides the Commissioner with the authority to promulgate rules as emergency rules that may remain in effect for one year, and may be extended. Further, these emergency rules may be promulgated without the usual finding of emergency required under current law.

Re-defining "Small" Business: The bill repeals the existing definition of "small business," instead saying that small means "one to one hundred employees." The difference? This would result in a larger number of plans being subject to the lower medical loss ratio percentage of 80% (as opposed to the stricter 85%) in health reform.

Internal and External Appeals: In the bill, OCI is able to roll back the improvements made to Wisconsin's existing internal claims and appeals processes and external review, for starters, claiming to be more "consistent" with health reform. In reality, the bill strips Wisconsin law back to the bare minimum federal requirements.

Independent Review Organizations (IROs): Current Wisconsin state law contains extensive requirements for IROs under Wisconsin law. AB 210 repeals current law provisions and sets out parallel requirements for IRO certification which are not as detailed as those in current law.

Finally, the bill provides "for a repeal of all health reform insurance law changes should the law be held unconstitutional."

Bill Provisions Not Required by Health Reform: While the bill is being described as the "implementation of health reform bill," there are numerous provisions in the bill not at all required by the Affordable Care Act. A few are called out here.

• Rate filings: Unlike the health reform law, AB 210 allows the Office of the Commissioner to refuse to disclose rate filing information if the office determines that information to be proprietary.
• Review process: Internal and external review processes are required under health reform, but the repeal of existing statutes that comply and are more generous is not required.
• Definition of “small employer”: Health reform allows "small business" to mean 50 employees" if a state would like to implement that definition.
• Rule-making: Health reform does not require a commissioner be given authority to promulgate rules as emergency rules (without a finding of emergency), which remain in effect for one year, and may be extended.
• Potential finding of unconstitutionality: This exemption is not required under health reform.

Headlines

Ten Considerations for States in Linking Medicaid and the Health Benefit Exchanges
Carolyn Ingram, Suzanne Gore, Shannon McMahon, CHCS, Inc., 15 August
"States face many challenges in addressing the Medicaid expansion provisions in the Affordable Care Act (ACA). Foremost among them is forging effective linkages between publicly funded programs and the newly established health benefit exchanges (HBEs)."

'Ankle Phone Call' Could Save Time and Money in the ER
Shefali Kulkarni, KHN Blog, 15 August
"Well if you do, maybe you should call ahead to the emergency room instead of immediately driving over."

State will switch to public workers for FoodShare program
Jason Stein, Milwaukee Journal Sentinel, 12 August
"In a deal that preserves millions of dollars in federal aid to Wisconsin, Gov. Scott Walker's administration will drop hundreds of private contractor employees who work for the state's food assistance program and hire scores of public workers as replacements."

Health care mandate ruled unconstitutional
Andrew Harris, Bloomberg, 12 August
"The 2 to 1 ruling conflicts with an earlier decision by a federal appeals panel in Cincinnati, which upheld the individual mandate. The provision exceeds Congress’s power to regulate commerce, the U.S. Court of Appeals in Atlanta ruled yesterday, affirming in part a lower court in a lawsuit filed by 26 states."

BadgerCare not done, advocates say
Jon Swedien, Eau Claire Leader Telegram, 11 August
"State and regional health advocates are working to spread the word that despite changes to BadgerCare Plus, Wisconsin's low-income health care program is still open to children, families and pregnant women."

Will Wisconsin's Scott Walker Implement Health-Care Reform?
Sarah Kliff, Washington Post, 11 August
"Wisconsin’s closely tracked recall election may have wrapped up, but don’t stop paying attention to the Badger State."

BadgerCare Plus tour stops in Eau Claire
WEAU, 9 August
"A group advocating the importance of signing up for BadgerCare Plus for families rolled into Eau Claire Tuesday."

State agency defends passing up $9 million in grants
Greg Neumann, WKOW, 5 August
"A rejection of federal grant money by the State of Wisconsin is causing some health advocacy groups to cry foul."

Medicare prescription drug costs unlikely to rise in 2012
International Business Times, 5 August
"The average monthly premium for Medicare’s prescription program is not expected to go up next year, the agency said Thursday."

DHS declines to seek $9 million of potential health care grants
Jon Peacock, Wisconsin Council on Children and Families, 4 August
"The DHS response is that it doesn't pursue grants that duplicate existing efforts, aren't needed, haven't received enough planning, or might lead to ongoing programs that would later require state funding."

Officials fear health care cuts
Jake Miller, Wausau Daily Herald, 4 August
"Local health care officials fear a bipartisan Congressional committee tasked with cutting another $1.2 trillion from the budget will reduce Medicare and Medicaid reimbursement rates paid to hospitals. The end result: People with private insurance would cover the difference, officials said."

State declines to request or back $9 million in health grants
Jason Stein, Milwaukee Journal Sentinel, 3 August
"Health Services Secretary Dennis Smith hasn't signed onto grants that would have focused on fighting drug and alcohol abuse; assessing health impacts of public policies; and signing up state residents who qualify for state health programs, officials at the agency and other health groups said."

For health insurance exchanges, devil's in the details
Jason Millman, Politico, 1 August
"Exchange governance boards will be busy between now and January 2013, when Health and Human Services must determine whether a state’s exchange passes muster. Building an exchange — an online marketplace where consumers can shop and compare health plans — will require information technology expertise, as well as an intimate understanding of how insurance markets operate."

Lawmakers eye super committee
Scott Wong & Jennifer Haberkorn, Politico, 1 August
"Publicly, most lawmakers say they have no desire to be named to the so-called super committee tasked with finding an additional $1.5 trillion in cuts to the deficit by Thanksgiving. But behind the scenes, some are already beginning to jockey for seats on the 12-member bipartisan panel, which many see as a historic opportunity to overhaul the Tax Code and entitlements."
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