TAHU Update Volume No. 2 Issue No. 9 May 2001
MAY GUEST SPEAKER
Mark Jackman, PhD
Life Signs sm
Mark Jackman has owned and operated Life Signs sm since 1995. Combining expertise in behavior change and exercise science, he provides holistic lifestyle coaching, fitness training and weight management services. His clients include Triangle people and organizations as well as those from other states and countries. He specializes in helping people prevent or improve health conditions such as obesity, diabetes, hypertension, musculoskeletal disorders, depression and stress.
Dr. Jackman earned his PhD at Duke University where he trained in social psychology and epidemiology and did research in occupational stress and health. Following post-graduate training in exercise science (including clinical applications) and weight management, he earned an advanced certification as a Clinical Exercise Specialist by the American Council on Exercise (ACE). He is also ACE-certified as a Personal Trainer and as a Lifestyle & Weight Management Consultant. He is affiliated with physicians and other health and mental health professionals in the Triangle.
Dr. Jackman understands health care costs in relation to health insurance, having served as Director of Strategic Planning and Market Analysis for 10 years at BCBSNC. He is a member of ACE's Appeals Panel for Professional Practices and Disciplinary Procedures governing more than 40,000 ACE-certified professionals. He is also a national author and speaker in his field.
SPONSORED BY
Interactive Medical Systems
&
Cigna Healthcare
President's Message:
John Henson, LUTCF, RHU, REBC
Our April meeting had 40 members and four guests in attendance! Dr. William Roper MD, PHD from the UNC School of Public Health was our speaker and he gave us an excellent presentation on Medical Trends and the changes that our industry will be facing in the future.
We received some great information about this year's Capitol Conference and the role that our association is playing in shaping the current Legislation that will effect medical coverage. I would like to recognize the members of our association that attended this event this year: Nancy Winter, Gene Lee, Sam King, Rufus Langley and Bill Hendrickson.
At a national level TAHU will be very well represented next year. We will have two of our members serving on the board of directors for NAHU. Rufus Langley has been appointed to be Co Chairman for Capitol Conference 2002. Doug Young has also been appointed as National Membership Chairman for 2002. Congratulations! Let's all offer Rufus and Doug our support next year.
North Carolina Symposium was very successful this year. The exhibits were very well assembled and the speakers were entertaining and informative. There were 565 NC members attending and also several from Florida who wanted to see why North Carolina's Symposiums are so successful. We had a lot of fun, met new people and had a lot of opportunities to network with other professionals. Those in attendance were also able to get all 12 of their CE Credits. What an event!
The National Convention is also approaching fast. This year it will be held in Minneapolis, Minnesota at the Hyatt Regency on June 24 through June 27. This year's theme will be "Mission Possible" and will be our NAHU President, Mike Matznick's, last event. This will also be when our NAHU President Elect, Bynum Tuttle, will be sworn in as President. We have always been proud to have someone from North Carolina to lead our national association, but two years in a row is a first. I encourage all of our members to attend this year to show our support for our past and future NAHU Presidents.
Also, this month we will be presenting awards for our local association. We will present the Rufus B. Langley, Member of the Year and Spark Plug Awards. These will be presented during our regular meeting and we will also be recognizing our Leading Producers Round Table (LPRT) Qualifiers and Honor Council recipients. Please mark your calendars to attend and show your support for our members who have worked so hard this year. This meeting will be FUN!
New Legislative News:
Nancy Winter
Crossover day for NC's General Assembly this year was April 26. Crossover is the day that the bills that are passed in one house cross over for consideration in the other. Bills that are still in committee or not passed by Crossover will not be considered, in this legislative year, unless they become a part of finance or appropriations measure. Having learned of this deadline, the kids & I decided April 25th would be a good day to watch the legislature in action. We were not disappointed. The legislators are essentially held captive until action is taken on all bills. Pizza is delivered so they can keep up their strength. Some brought their blankets. Evidently they'd been working long into the evenings for several days. Remember this fact when you ask a friend to run for a seat in the legislature.
Of course our NCAHU lobbyist Robert Paschall was there and he explained that I'd missed the real action earlier that day. S199 was passed in the Senate. S199 is essentially Governor Easley's Patients' Bill of Rights. From the NCGA website: "SENATE BILL 199 Insurance and Consumer Protection Committee Substitute Adopted 4/25/01. Short Title: MANAGED CARE PATIENTS' BILL OF RIGHTS. A bill to be entitled an act to improve access to health care advice, information, and services to covered persons under health benefit plans. It establishes standards for health plan disclosures to consumers including; patients' assistance programs, coverage for clinical trials and newborn hearing screening. The bill provides standards for independent review of noncertifications by an insurer or managed care plan, and to hold managed care entities liable for harm caused to insurers or enrollees by the failure to exercise ordinary care in making treatment decisions." Thirty-three senators co-sponsored this bill. The corresponding bill, now to be deliberated in the House, is H194. It has about 57 co-sponsors. NAHU has been watching this bill carefully. The bill itself can be viewed at the NC General Assembly site: www.ncga.state.nc.us
The house also passed H1048: Here's a good description from Bill Brannon: "HB 1048 is the most sensible piece of state insurance legislation that I have seen presented -- perhaps ever. The House Insurance Committee adopted H1048, by Rep. Redwine, MORATORIUM ON HEALTH INSURANCE MANDATES on April 19th. The bill, as rewritten, provides that an insurer shall not deliver, issue or renew a health benefit plan after January 1, 2002 that includes any additional health benefits coverage requirements beyond those in effect for health benefit plans on December 31, 2001. Except if an employer chooses to expand coverage on a health benefit plan or the policy. The moratorium on mandates would expire on January 1, 2004. During the next two years, the Legislative Research Commission would be authorized to study the issue of health insurance mandates and the cost to employers and individuals of unfunded health insurance mandates."
The other health insurance related bills that passed before crossover include the following. They can all be found via www.ncga.state.nc.us. Many bills were edited in the committees prior to approval.
H109 Reimbursement for marriage/family therapists
H348 Insurance fee repeals and increases
H360 The Health Insurance Omnibus bill
H1045 Restore workers' compensation
H593 Health insurance/licensed professional counselor
H760 Cancer insurance/wellness benefit rider
H1105 Insurance technical corrections
H351 Utilization review and grievance changes
H1109 Managed care/patient access
H1160 Health insurance/uniform credentialing
H1045 Restore workers' compensation stability
H1160 Health insurance/uniform provider credentialing
H1232 Prescription drug assistance/seniors
H1266 & S1266 Surgical nurses/ 3rd party payment
S318 Insurance producer licensing & H350 Gramm-Leach-Bliley Act Requirements
S880 & H1045 Worker's compensation/Health & disability reimbursement
S132 Colorectal cancer screening
S241 Health insurance termination notice
S321 Insurance exam law amendments
S391 Eliminate disparities in health care
S459 Insurance financial amendments
S461 Insurance information privacy
S721 NC Health Choice/No waiting period
S911 Competitive health care information
= = = = = On the Federal level = = = =
PRIVACY - It was decided, in compliance to the HIPAA law, to go ahead and let the Patient Privacy Rule take effect on April 14, 2001, and try to fix it. Parties have two years to comply with the new regulation, until April 14, 2003. It is expected that there will be legislation to delay that implementation date. There is no lack of evidence that the rules are onerous & expensive. According to a Blue Cross-commissioned study, "most" hospitals nationwide "had not yet budgeted for upgrading their systems to reflect the new" payment codes, as required by HIPAA. The study also said that the average implementation cost for a health plan will be $10 million, $9 million higher than estimated by HHS."
PROGRAMS TO DECREASE NUMBERS OF UNINSURED - A big ideological compromise seems to have taken place. Funds will likely be appropriated to help the CHIP program be extended to eligible parents. However, even more money will go toward a federal health insurance
TAX CREDIT - Many details must be worked out. It is helpful to have the NAHU model tax credit in mind as we hear the various arguments favoring one bill over another. The Heritage Foundation study recently found that the tax credits being proposed would help pay 75-100% of premiums. In some places where it is not enough to help people enter the insurance market, states can add their own credits. The Fair Care for the Uninsured Act of 2001 (HR1331) was introduced in the House April 3rd. by Richard Armey. It offers much more than the tax credits, which we studied at CAP conference, and includes "the establishment of health insurance safety nets . . . assuring health coverage for uninsurable individuals". This bill will encourage all states to adopt the high risk pool concept for the medically uninsurable.
MSA EXPANSION - April 4, 2001, Representatives William Thomas (R-CA) and Lipinski (D-IL) introduced HR1524, the Medical Savings Account Availability Act. Among other things, it would make MSAs permanent, expand the eligibility to employees in any size company, lower the minimum deductible, allow MSAs to be offered as part of cafeteria plans, and allow the MSA contribution to equal 100% of the deductible.
PATIENT BILL OF RIGHTS - LIABILITY ISSUE - Something mentioned by Congresswoman Ann Northup at the CAP Conference, and discussed in a recent National Review, was that the AMA, surprisingly, did not want to support malpractice reform as being a part of the liability issues in any patients rights bills. Instead of working with insurers and businesses in putting some kind of liability cap on ALL malpractice suits, they instead side with the trial lawyers who see no caps as the best way to protect their clients. Of interest, in talking to policy makers on this, is that the AMA now only represents only 32% of American physicians; declining from a peak of nearly 75% in the 1970's.
PHARMACEUTICAL DRUGS - The question of how to pay for them. Some interesting statistics to keep in mind in the pharmaceutical coverage debates:
- Brookings Institute article, one clot-busting drug for stroke saved an average of $4,400 per patient by reducing the need for rehabilitation and home care
- A study in the Journal of Occupational and Environmental Medicine showed that employers saved $435 per employee per month with a new medicine for migraine that reduced absenteeism
- According to a Reuters article, Princeton economist Uwe Reinhardt in a recent meeting said, "In 1999, Americans spent less per capita on prescription drugs ($358) than they did on alcohol, tobacco and entertainment admission fees ($413).
Increased spending for prescription drugs is overrated as a reason for the recent upsurge in health insurance premiums. If prescription drugs account for 15 percent of the cost of premiums and premiums are rising 20 percent per year, only 3 percentage points of the increase is attributable to prescription drugs, he said. And those who say that drug spending can be held down by lowering the industry's profit margin are also likely to be disappointed, since industry profits represent only about 1.2 percent of national health expenditures."
If you have questions, please feel free to contact me at 919-493-9405 or e-mail nancy@medsaver.org.
Membership Update
Kendra Neese
Please Welcome our newest members to TAHU:
Fran Richardson
Northwestern Group Marketing Services
P.O. Box 30995
Raleigh, NC 27622
919-755-3210
919-326-9868 fax
Don C. McDuffie
First Citizens Insurance Services
343 E, Six Forks Road
Raleigh, NC 27609
919-716-4223
919-716-2226 fax
Communications
JoAnn Davis
Monthly meetings are the 3rd Monday of each month starting at 11:45 am.
The next meeting will be held on May 21, 2001 at the Marriott (Research Triangle Park, NC – Exit 281, Miami Blvd.).
All members and their guests are invited to attend.
Guaranteed seating for the luncheon meeting is by reservation only.
Please fax to 919-477-8867 (local to the Raleigh/Durham area) to reserve your place. The week prior to the meeting you will receive a notice via fax.
Attendee: ________________________________
I (will) be attending the May meeting.
I (will) (will not) bring a guest/prospective member.
Guest name: __________________________________
There is no need to fax the response back if you are not planning on attending the meeting/luncheon
Please RSVP no later than May 16th
If you are not receiving the monthly fax, please contact JoAnn Davis @ 477-9199 or jodavis@ameritas.com.
Public Service Committee
Nancy Gibson, MHP
We are well under way in our Blood Drive for Red Cross. If you have not yet made an appointment, here are a list of the sites and the times when you may make an appointment for your donation:
Raleigh - 100 Peartree Ln (231-1602 x422)
Cary - 305-A Ashville Ave. (851-5747)
Durham - 4737 University Drive (489-6541 x386)
Appointments are scheduled every quarter hour.
Please call to make your appointment TODAY!!! This is a gift we give to our community. Thanks to all of you for your support. We encourage you to make this a community project and encourage others that you know to participate in our blood drive. It is not limited to TAHU members – so encourage your friends and clients to participate also.
Thanks for all of your support for all of our projects!
As the success of the Triangle Association of Health Underwriters largely depends upon the benevolence of corporate contributors, we are proud to honor the following organizations for their continued support of our many programs and activities:
Diamond Sponsors
2000-2001
Blue Cross & Blue Shield of NC
PARTNERS National Health Plans of NC, Inc.
United Healthcare
Wellpath Community Health Plans
Please extend your appreciation to the Triangle members representing these organizations and remember their generosity when placing coverages.
Please remember that the cost of lunch for TAHU members is $10. Guest and non-member lunches are $16.
There will be a $3 charge for lost or misplaced name badges. Please remember to turn in your badge at the conclusion of each meeting.
