Canine diabetes mellitus

Five states--Arkansas, Nevada. North Dakota, Oregon,and Texas--have pursued significant interim activities that have important implications with respect to health insuranceaccess and costs.Each of these states convenes its legislative sessions biennially.

Arkansas. Arkansas Health Insurance and Prescription Drugs interim committeefocused its activities on finding ways toreduce the cost of healthcare premiums. Senator Jerry Bookout (D), the committee chair, has indicated that legislationwill be introduced in 2005 to create charity clinics and health savings accounts (HSAs).

Senator Bookout says the state hospital industry supports the charity clinicproposal because it reduces healthcare costs by shifting the uninsured fromexpensive emergency departments to the lower cost clinics. One cost saving proposal forthe clinics is to distribute unused medications from nursing homes and pharmacies to the indigent population.

With HSAs, eligible employeescan put money into tax exempt accounts tohelp offset out of pocket expenses. Any unused money can be rolled over at theend of the year.

Nevada. Nevada's Subcommittee on Health Insurance Expansion has indicated itendorses a proposal to apply fora federal Health Insurance Flexibility and Accountability waiver. The waiver would allow the state to:

* Establish asmall business insurance program, providing a premium subsidy of per person per month for employees and their spouseswith family incomes below 900 percent of the federal poverty level

*Expand health insurance coverage for low-income pregnant women

* Establish a program for the medically needy

North Dakota. A bill filedfor introduction during North Dakota's legislative session would expand participation inthe state's uniform group insurance program. The bill would permit permanent and temporary private employees, along with other uninsured citizens of the state, to participate in the PublicEmployees Retirement System health insurance plan. Participating employees wouldbe required to pay a monthly premium to the state's Retirement Board.

The state's interim EmployeeBenefits Program Committee, however, has indicated that the Retirement Board has reservations about the bill and does not supportthe current draft. That opposition would limit the legislation's chances for passage during the 2005session.

Oregon. In 2003, the Oregon legislature passed HB2537 directing the Insurance Pool Governing Board to increase accessto health insurance and health care by providing affordable health benefit plansfor small employers. During the interim, the board worked to develop andimplement such a plan, called the Alternative Group Plan, and furtherproposed the Children's Group Plan.

The Alternative Group Plan will exclude mandated benefits thatwould pay for treatment of chemical dependency, diabetes self-management programs, prescriptionsfor particular drugs, maxillofacial prosthetic services, and treatment of inborn errors of metabolism.

The Children's Group Plan would incorporate a lower deductible and higher benefit structure than the Alternative Group Plan and could be sold either with the AlternativeGroup Plan or as a stand alone product. It would include all man dated benefits. The target date for enrollmentin the plans would be March 1, 2005.

Texas. During the interim, the Texas House Committeeon Insurance was charged with studying the implementation andeffect of SB 10 and SB 541, bills passed during the2003 legislative session that address the costs andavailability of health insurance. SB 10 calls for the creation of health group cooperatives to purchase employer health benefits plans.It allows two or more small and large employers toparticipate. SB 541 authorizes insurers and HMOs toissue plans that do not include state-mandated health benefits.

As the 2005state legislative season approaches, legislators in every state will begin to frame their healthcare agendas.Given the tight budgets and economic challenges facing the states, healthcare financialleaders need to be cognizant of their states pending healthcare-related legislative activities, asthese activities could profoundly affect healthinsurance access and costs.

This report was prepared for hfm by Chris Bandoli, health insurance analyst, PolicyResearch Department, NETSCAN iPublishing's Health PolicyTracking Service (HPTS). For more information about HPTS, go to www.hpts.org/info.