4/29/09: Senate Confirms New Health Secretary
Posted by the912project on April 28, 2009 · 109 Comments
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109 Responses to “4/29/09: Senate Confirms New Health Secretary”The Restoring Honor Rally August 28, 2010
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Another leftie for the administration. It must be hilarious to other countries that hate us to watch this relentless destruction of our country and values. Obama is on the fast track to run this country into the ground in record time…
No surprise here. This administration is full of tax cheats, Chicago thugs, and any other undesirable bureaucrat one cares to think about. I'm still not too worried. This party is so full of themselves, they have in the past and will end up shooting themselves in the foot before the 2010 election. Americans are starting to come down from their dizzying high of a love affair with Obama and are beginning to look closely at what the decisions of this new administration really mean to them, their families, their personal welfare and the welfare of their country as a whole…probably in that order. When faced with the facts (in this case, a tremendous worsening of our economy and clear violations of our individual freedoms) most Americans will once again realize that in their hearts, they really are conservative minded.
Like I have said before on this site, I can honestly say I feel like I'm living in the "Twilight Zone" !!!!!
No surprise here. This administration is full of tax cheats, Chicago thugs, and any other undesirable bureaucrat one cares to think about. I'm still not too worried. This party is so full of themselves, they have been and will end up shooting themselves in the foot before the 2010 election. Americans are starting to come down from their dizzying high of a love affair with Obama and are starting to look closely at what the decisions of this new administration really mean to them, their families, their personal welfare and the welfare of their country as a whole…probably in that order. When faced with the facts (in this case, a tremendous worsening of our economy and clear violations of our individual freedoms) most Americans will once again realize that in their hearts, they really are conservative minded.
Boy, does Obama know how to pick them? Is she qualified? As far as that goes, is Obama qualified?
NO. No. and No. are the correct answers. Great, now we have an Anti-abortionist at the top job!
Its like puting the fox in charge of the henhouse. Idiot
Boy, does Obama know how to pick them? Is she qualified? As far as that goes, is Obama qualified?
NO. No. No. and No. are the correct answers. Great, now we have an Anti-abortionist at the top job!
Its like puting the fox in charge of the henhouse. Idiot
How is this woman qualified to hold the office of Health and Human Services? Wait a minute, thats right, the only qualification necessary to hold a cabinet position for Obama is this….. Are you a radical liberal or have you acted like a radical liberal/socialist at any time during your political career? You have, well you are in then. To promote someone who thinks late term abortions are ok to a position with the title of Human Service is an Oxymoron. Guess this position will now be labeled….. Director of Health and INHUMANE Services. Michael Vick gets time in prison for dog fighting and abusing animals, not that I am saying he shouldn't have, and this person gets a promotion for killing babies. If that isn't backwards I just dont know what forward is anymore.
In the past couple days a new sensation has crept over me. I have found myself using the description of gang rape to describe my feelings of outrage and personal violation. This is curious to me. Anyone out there feeling the same way?
I will admit to not paying close enough attention to the proceedings of this appointment. I felt it was inevitable from the get-go. It is like one affront after another has been piled on our people and there must surely come a breaking point, no? Or are we the victim who, for self-preservation, feels it is necessary not to fight back?
What has become of this country ?. Now our tax dollars will go to kill unborn, but waterboarding people that want to kill us is wrong?, No one is safe now!
Hasn't it occurred to anyone the real problem here is leadership? We have 2 political parties. Who is leader of the GOP? And why is that person not responding to us? Leader, leader, leader —– where are you? I am tired of the dips in DC.
Well Chief Sir……My guess is obama has to have people he relates to the best! You know? The buddie thing, the more you have in common the better. His whole cabinet scares the heck out of me.
Socialism (government run medicine, business, and financial institutions) is never good for any country. Just look what has been happening in all other countries. Almost all other socialistic countries are slowly moving towards capitalism. Most of them are adapting small portions of our society. For instance take health care. Though many speak out against their health care, how would someone turn a country back to private medicine and tell its citizens that they are now going to pay for their health care when they have never had to pay for it before. I read a few days ago on http://www.americanparchment.com that there were not enough doctors to satisfy Obama's plan. That is in an already capitalistic society. Insert socialized medicine, decrease doctor's pay, give them double the patients, then would anyone want to be a doctor. We already have a large shortage of surgeons and nurses, add to it a lack of regular or specialized doctors and we are all in trouble. Obama doesn't understand.
I will rest easy now. Not only do we have an inept HS Secretary who views American Patriots terrorists and keeps the borders wide open, now we have a HSS Secretary who is in the business of killing innocent lives.
Our president has more compassion for terrorists who cut off people's heads and fly airplanes into buildings than the innocent unborn. Amazing.
Everybody stay healthy b/c it is going to get really bad in the medical field.
Was this woman not photoed giving speeches to large groups of the KKK? and to do abortion on 9 month old fetuses? Am I missing something here or does this President have a real knack for picking the absolute worse people for positions. Liers, theives, and the completely unqualifiied sounds more like 3 of the 4 horeman of the apocalypse than cabinet members!
For some reason, they seem to be the only ones that want the job. These people that are being appointed do not have any conflict in conscious, because they lack a conscious. It's much easier to get someone to do whatever you want when they have nothing keeping them from not doing it. I don't know if I am saying this correctly so I will say it like this. The Officers in Hitlers Hierarchy did not hesitate in complying with his orders because they not only believed in him, but believed like him. Hitler viewed Jews as nothing more than rats, so he surrounded himself with rat killers. I don't believe there is one person on Obamas staff that will tell him "no".
wouldn't it make sense to make a physician the HHS director? at least they would have an understanding of what they were doing. what does she know about health and human services? she was an insurance executive.
She knows how to deny coverage…
http://www.cnn.com/SPECIALS/2009/44.president/fir...
you can vote on the pres first 100
It's starting to seem like the only way people will understand is to let them have thier socialized medicine. I worked for a guy like that one time. Never would listen to people who had been in the ranching industry for years. I finally had to just let him have his way then pick him up and dust him off when it was over. That ranch is for sale now.
The president would like to comment on the Sebelius confirmation: UHHH….I….UHHHH….AHHH….ERRRR….i….UHH….Joe, would you scroll down the teleprompter please….no, thats not it…UH there it is..UHHH…ERRR….I …UHHH…already covered that…….
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Another crisis…another far left appointee. "Never let a crisis go to waste"
America will regret the day when Kathleen 'Dr Mengele' Sebelius was confirmed as HHS Secretary. Baby humans beware…Obama may have covered the image of God, but this woman intends to KILL those created in His image.
nicely done!
Nice another TAX CHEAT. Can't they find anybody who can pay there taxes. How many tax cheats does tha make in the Obama administration? Is anybody keeping track? They probably think that she is the only one who can handle the swine flu outbreak.
ANY human being who would SUPPORT PROUDLY a Dr who PRIDES his ABORTING 9 MONTH Peg women like it was a "fast food production line" is certianly no one I would ever what to claim I even knew,,,that persons presnce in any room,plane,resturant I would get up and leave as the smell of such a so called woman is as vile as the DR,,,yet Ob is so very proud,,,Notice Pelosi,Reed and others just passed her along,,,Osma Bin Laden would even get a posting in Obs admin,,,its a total discrase that they even stand near an AMERICAN FLAG,,,I think of men/women who served honrobly and lost thier life over the past 200 years for that flag to have Ob and his admi like Spector ,her stand near it like they earned something just makes me feel like I got the swine flu,,,:)
Alan Keyes on Obama's abortion views- Please send it to everybody you know~> http://www.youtube.com/watch?v=lqkMfToY9Pk
You mean the senate just confirmed Barack Obama's Secretary of Torture. It is amazing how Obama can get away with saying that America does not torture but under his leadership, torture is alive and well, with these torture chambers and death camps(abortion clinics) operating with taxpayer support all over the country. And was the queen of torture in her state with her own personal henchman in Dr. George Tiller(The Baby Killer). And Obama allows torturing babies to be out sourced overseas at taxpayers expense. Obama has earned the title, "Torturor In Chief". I know Obama wears that title proudly.
The One has been talking about values and morals lately. He's against waterboarding terrorists – sorry, man-made disaster instigators – yet has no concern for the innocents murdered by abortion. If you even read a clinical description of partial-birth abortion, it's a lot more stomach-churning than the description of waterboarding. Seriously, what the hell is wrong with Barry?
Barry only cares about money. You see, the torture croud(abortion people) gave him a lot of money during his campaign, people like NARAL, Planned Parenthood, and a host of others. So he is very beholden to them. He has no principles. It has a lot to do with where he was brought up politically in Chicago, with the pay to play. Having principles would not be the Chicago way.
This one is a double threat: cheats on taxes AND is in favor of abortion. What a crew. Next thing you know there will be a bona fide eugenicist on the team.
There is one. Secretary of State Comrade Hillary Clinton.
Oh, yeah. I forgot. She compared Margaret Sanger to Jefferson and said she admired Sanger. God help us.
Oh terrific….just terrific, just what we need, a baby murderer, a health scare, and a flyover in NewYork scoping out the distance from point A and point B so the terrorists will know……..(they call it photo op) ….not me. And to think this all happened in 1 week. God help us next week!
ANOTHER totally unqualified person in this administration in the form of , (I never met an illegal alien I didn't like,) Sebelius. Watch a national healthcare bill to be put into law soon under the guise of the Swine Flu disease. America, wake up ! You want to see how well solcialized medicine really works, look at the number of Mexicans flooding across our border tfor healthcare due to the Swine Flu. We not only give them care, we, the American taxpayer, even pay for it ! Citizens either make Washington listen to us now or it's all over, at that point we are will on our way to becoming a third world nation.
I wonder if Sebelius can get this flue aborted. She seems to have no trouble aborting human life, so this must be easier….
Stopthemusic-I am surprised that you have been given so much room to write. But kudos to you, you are
a very learned person who knows what you are talking about. Keep it up.
New Title: Secretary of Death and Inhumane Services
Motto: Pay me and I will cover your butt while you commit genocide and infanticide.
Yep, another one in the cabinet who scares me to death.
Shweewh! I thought for a minute she might have trouble getting confirmed. But we needed a Secretary of HHS in a hurry because of Swine Flu.
Never let a crisis go to waste
remember, they can't waste a crisis.
ISEEU: This post is freak'in hilarious! Love the sarcasm.
This secretary is brought to you by swine flu its everywhere!
Listening to the new Secretary is about like watching a fly stuck on fly paper!!! Does not inspire confidence at all! God help us now in the Swine flu crisis and if we have a real crisis in the days ahead. It appears to me this woman is in way, way over her head!
Putting Sebelius in as HHS Secretary is an insult to the department itself. To think that were putting a woman in who is supported by an individual who upholds doing abortions right up until full term. Correct me if I'm wrong but isn't that considered murder when last I looked?
Not for the Dem's.
It is outrageous! Abortion at any level, late, early, surgically or with a pill is murder, but I better just keep in my little hillbilly hollow (annoying red state) wavin' my tea bag and mind my own, since I am not one of the "enlightened" ones.
Muslim Demographic Good video enjoy.
tp://www.youtube.com/watch?v=6-3X5hIFXYU
Well folks, if you don't like this and other nominations work hard to support whoever is going to oppose these idiots who can also work hard for us and knows not only the system, but our values and will represent them. The liberals are polarizing us. I used to be a moderate/centrist. Not anymore. I get farther to the right every single day.
Same with me. Every move to the left our gov. takes, makes me go further right.
It's the pendulum swing Glenn has talked about.
Yes, but in reality, all things do eventually come back to the steady state—the middle, eventually.
In 1998, the NAIC decided to develop a new model law to provide for an
independent external appeals mechanism. The preliminary work has been completed
by a working group under an NAIC committee that I chair. The working group
will adopt its Issues Paper next week and is beginning the difficult task
of drafting a new model act to provide an external review for those states
that desire guidance in this area. We hope to complete the new model law
by our Summer National Meeting.
Seventeen states have passed legislation that provides for some type of
specific independent external appeals process.[2] Twenty-two states plan
to consider such legislation this year. There are at least six possible
approaches and they are discussed below. A state that is developing an
independent external appeals process can examine these processes and determine
which one, if any, would fit best in that state, or a state could combine
aspects of these approaches and create something more suitable for its
own market.
[2] The 17 states that have passed legislation are: Arizona, California,
Connecticut, Florida, Hawaii, Maryland, Michigan, Missouri, New Jersey,
New Mexico, New York, Ohio, Pennsylvania, Rhode Island, Tennessee, Texas,
and Vermont.
- In the first approach, the appropriate state entity develops a list of
independent reviewers. Once it is determined that an external appeal is
necessary, the health plan chooses a reviewer from this list. The reviewer
cannot have a financial interest or any other connection to the case. if
the list maintained by the state does not include a reviewer with appropriate
experience to conduct the external independent review, then the health
plan along with the appropriate state entity will choose a reviewer who
is mutually acceptable to perform the review. Arizona uses this approach.
- A second option involves using independent review entities that are accredited
by a private, non profit accrediting organization. The accrediting organization
is under contract with the appropriate state entity. California uses this
approach.
- In the third approach, the enrollee appeals to the appropriate state
entity. The state entity appoints an independent, impartial health entity
to perform a medical review. This approach is being used in Connecticut,
Maryland, Missouri, New Mexico, Rhode Island and Texas.
- The fourth option direct the enrollee to request an independent review
from the health plan. The health plan contracts with independent review
entities that meet statutory conflict of interest and medical expertise
requirements. Tennessee uses this option.
- The fifth method allows the state to create a panel that hears all external
appeals. The panel is composed of state employees. Panel staff perform
an initial review to determine if the panel will hear the case. If the
case is heard, the panel presents its findings to the appropriate state
entity, which issues a final determination. Florida uses this method.
- In the six approach, the appropriate state entity performs the review.
Michigan uses this approach.
Of course these are not the only available approaches. For example, states
like Vermont, which passed an external grievance review process last year,
will have to decide what approach or combination of approaches to take
when developing regulations to implement the enacted external grievance
review legislation.
Kansas is one of the 22 states that is proposing legislation to establish
an external grievance procedure this year. While the proposal is subject
to change by the legislature, I can provide a brief outline of what is
envisioned. Like many states that develop new legislative proposals we
looked at what other states had done and how well those processes appeared
to be working. The Kansas Department of Insurance has proposed to the legislature
that a person who has exhausted all internal appeals that relate to medical
necessity or experimental treatment can appeal to an external review entity.
My department will establish the contract with the reviewing entity (ies)
to ensure they have the appropriate medical expertise and have no attachment
to any health insurance issuer. All fees will be paid by the Department
of Insurance. This way there will be no financial transaction between the
reviewer and the health insurance issuer. The consumer will not be required
to pay a filing fee, or any other type of fee.
As demonstrated by the above discussion, the states have been very proactive
in establishing external grievance processes and have adopted approaches
that are tailored to the needs of each state's health care market.
B. Federal Activity
B. Federal Activity
The federal government is also active in this area. Several major bills
introduced during the 105th Congress were designed to extend certain protections
to consumers within managed care plans. All of these bills included an
external grievance process. For the purpose of today's hearing I will only
review the external processes in S. 1890 and S. 2330.
There are important similarities between the NAIC's Health Carrier Grievance
Procedure Model Act and the appeal processes established in S. 1890 and
S. 2330. All three require that an internal review conducted by the health
carrier or plan be the first step for a beneficiary or participant to resolve
a dispute. All provide for the appeal of an adverse coverage determination.
Both the NAIC model act and S. 1890 allow grievances to be filed for issues
other than an adverse determination. S. 2330 requires a plan or issuer
to establish procedures to resolve disputes regarding coverage determinations.
In addition, all of the legislative proposals require expedited appeals
to be resolved within 72 hours when the life or health of a patient are
in serious jeopardy. The three proposals require that, at this first step,
the reviewers be different from those individuals who made the initial
determination; and, in those instances involving an adverse determination,
that the reviewers have the appropriate medical expertise.
However, important differences exist. The most obvious difference is that
the NAIC Model Act does not require an external appeal of a grievance.
While a second step does exist in the NAIC Model Act, and while it was
designed to make the process as fair as possible, it is not external to
the plan. The NAIC Model Act requires that: 1) a majority of those persons
on the second review panel cannot have been involved in the previous decisions;
2) the majority must be health care professionals who have the appropriate
expertise; 3) the reviewers cannot be in the covered person's health benefit
plan where there has been a denial of service; and 4) no one reviewing
an appeal can have a financial stake in the issue. As discussed, it has
been decided by the members of the NAIC to draft a new model law addressing
external grievance review.
Grievance Register: Each health carrier is required to maintain written
records to document all grievances received during a calendar year. The
model act defines minimum information to be contained in the register and
requires the register to be maintained for the longer of three years or
until the commissioner has adopted a final report of an examination that
contains a review of the register for that calendar year.
Annual Report: Each health carrier is required to submit an annual report
to the insurance commissioner that includes: 1) the total number of grievances;
2) the number of grievances referred to the second level of review; 3)
the number of grievances resolved at each level; 4) the number of grievances
appealed to the commissioner of which the health carrier has been informed;
5) the number of grievances referred to alternative dispute resolution
procedures or that result in litigation; 6) synopsis of actions being taken
to correct problems identified.
Another significant factor of the NAIC's Health Carrier Grievance Procedure
Model Act is that it coordinates with the NAIC's Utilization Review Model
Act. Both models require health plans to disclose the clinical review criteria
used for making utilization review determinations. This ensures that both
consumers and providers know the basis of a denial and have the necessary
information to challenge the plan's decision.
There has been much discussion about the desirability of requiring a health
plan to have an independent external review process. The NAIC's model currently
does not require a health plan to submit a grievance to the review of an
external entity or state agency. In general, the grievance process required
by the NAIC's Health Carrier Grievance Procedure Model Act is a process
internal to a health carrier or plan. It does, however, require a managed
care entity or carrier that performs utilization review to convene an impartial
panel of exerts to review denials of care.
A health carrier that offers managed care plans must establish a second
level grievance review as an optional process for persons dissatisfied
with the outcome of their first level reviews. The second level review
is offered to managed care enrollees since, unlike fee-for-service patients,
they are more likely to be disputing a coverage decision before the service
is provided. At the second level review the covered person has the right
to appear in person before authorized representatives of the health carrier.
A carrier must ensure that a majority of the persons reviewing a second
level grievance involving an adverse determination are health care professionals
who have the appropriate expertise. In cases where there has been a denial
of service, the reviewing health care professional may not be a provider
in the covered person's health benefit plan and may not have a financial
interest in the outcome of the review. The requirement of a disinterested
reviewer does not apply, however, when such a reviewer is not reasonably
available. This may be the case in small states where providers, especially
specialists, are likely to have contracts with every major health plan.
A health carrier must issue the decision within five working days after
the review meeting, and that meeting must be held within 45 working days
from the time that the health carrier receives a request from a covered
person for a second level review.
Expedited Reviews: The NAIC model requires a health carrier to perform
expedited reviews if the time frame of the standard grievance procedure
would "seriously jeopardize the life or health of a covered person or would
jeopardize the covered person's ability to regain maximum function." Once
the review is started, the health carrier must reach a decision within
72 hours.
Grievance Procedures: Each health carrier is required to use written procedures
for receiving and resolving grievances from covered persons and is required
to file a copy of the procedures with the commissioner. Each carrier is
required to attach a description of the grievance procedures to the policy,
certificate, membership booklet, outline of coverage or other evidence
of coverage provided to covered persons. The procedures document is required
to include a statement of a covered person's right to contact the commissioner's
office for assistance at any time along with the commissioner's address
and telephone number.
These models were developed because the states and the NAIC recognized
that the delivery of health care services was rapidly evolving away from
fee-for-service insurance arrangements and towards various managed care
arrangements. State insurance regulators have observed this market evolution
firsthand because state insurance departments have a principal role in
regulating managed care entities. Insurance regulators appreciate the need
to strengthen protections for consumers participating in managed care plans.
For purposes of this hearing, I will discuss one of the five models —
the NAIC health Carrier Grievance Procedure Model Act. For your information,
the NAIC Health Carrier Grievance Procedure Model Act is attached to our
written testimony, and we ask that it be included in the hearing record.
No issue is of greater concern to consumers or state insurance regulators
than the appropriate resolution of consumer complaints about health plans.
The NAIC's Health Carrier Grievance Procedure Model Act requires all health
carriers, including carriers with managed care plans, to establish clear
procedures for resolving enrollees' complaints. The NAIC model act broadly
defines "grievance" and explicitly includes complaints about denials of
care or treatment. The following is a description of the elements contained
in this grievance model. Graduated Levels of Review: The model requires
all health carriers, not just managed care plans, to provide a "first level
grievance review." There are separate requirements for grievances involving
adverse determinations and grievances involving all other matters. An "adverse
determination" is defined in the NAIC model as a decision by a health carrier
or its designee utilization review organization that admission, availability
of care, continued stay or other health care service has been reviewed
and does not meet the health carrier's requirement for medical necessity,
appropriateness, health care setting, level of care of effectiveness, and
the requested service is therefore denied, reduced or terminated.
A health carrier must issue a written decision containing: the credentials
of the reviewers who participated in the first level grievance review process;
a statement of the reviewers' understanding of the covered person's grievance;
the reviewers' decision in clear terms and the rationale for the decision
in sufficient detail; a reference to the evidence or documentation used
as the basis for the decision; and where applicable, a description of the
process to obtain a second level grievance review and the written procedures
governing a second level review. In cases involving an adverse determination,
the carrier must also provide instructions for requesting a written statement
of the clinical rationale.
REGULATION OF HEALTH PLAN PROCEDURES:KATHLEEN SEBELIUS
Article from:
Congressional Testimony
Article date:
January 20, 1999
Congressional Testimony
01-20-1999
TESTIMONY OF THE SPECIAL COMMITTEE ON HEALTH INSURANCE OF THE NATIONAL
ASSOCIATION OF INSURANCE COMMISSIONERS BEFORE THE COMMITTEE ON LABOR AND
HUMAN RESOURCES OF THE UNITED STATES SENATE ON GROUP HEALTH PLAN COMPARATIVE
INFORMATION AND COVERAGE DETERMINATION STANDARDS
Kathleen Sebelius Commissioner of Insurance State of Kansas
January 20, 1999
I. Introduction
Good morning, Mr. Chairman and Members of tile Committee. My name Kathleen
Sebelius. I have just been reelected for a four-year term as the Insurance
Commissioner for the state of Kansas. Also, I have been elected Secretary-Treasurer
of the National Association of Insurance Commissioners (NAIC) where I serve
as chair of the Accident and Health Insurance (B) Committee. I am testifying
this morning on behalf of the NAIC's (EX) Special Committee on Health Insurance.
I would like to thank you for providing the NAIC with the opportunity to
testify about legislation and proposed rules by the U.S. Department of
Labor (DOL) that would establish new group health plan standards relating
to information requirements and claims procedures under Title I of the
Employee Retirement Income Security Act of 1974 (ERISA).
The NAIC, founded in 1871, is the organization of the chief insurance regulators
from the 50 states, the District of Columbia, and four of the U.S. territories.
The NAIC's objective is to serve the public by assisting state insurance
regulators in fulfilling their regulatory responsibilities. Protection
of consumers is the fundamental purpose of insurance regulation.
The NAIC Special Committee on Health Insurance ("Special Committee") is
composed of 43 state insurance regulators. The Special Committee was established
as a forum to discuss federal proposals related to health insurance and
to provide technical assistance to Congress and the Administration on a
non partisan basis. Over the past several years, members of the Special
Committee including myself have had the privilege of testifying before
your Committee on various legislative proposals.
I have been asked to testify today on claims procedures under ERISA. This
includes discussing the external grievance procedures in S. 1890 and S.
2330, both introduced in the last Congress, and discussing the proposed
regulations recently promulgated by DOL to establish claims procedures
for ERISA plans. First, I will discuss the roles of the states and the
federal government in regulating ERISA plans and the importance of maintaining
the states' ability to regulate insurance activities including mandating
grievance procedures. I will then discuss what the states have already
done to provide their consumers with grievance procedures protections and
compare the states' efforts with the external procedures laid out in S.
1890 and S. 2330. finally, I will discuss the proposed DOL regulation and
explain the need for clarification so that it does not preempt the states'
abilities to regulate insurance…. cont.. in reply post
I. The Roles of the States and the Federal Government in Regulating ERISA
Plans
The enactment of ERISA created a dual regulatory structure in this country
for health insurance and health benefits. Had ERISA not been enacted, we
might question any federal role in setting quality standards including
mandating an external grievance procedure. State insurance departments
lack jurisdiction over self-funded ERISA plans. We believe that consumers
within such ERISA plans would benefit from the same types of protections
available under state law. The NAIC has advocated, in past testimony, and
continues to advocate, that Congress amend ERISA to provide set standards
– including grievance procedures — for self-funded ERISA plans. We also
believe that DOL should exercise the regulatory authority given to it under
the ERISA statute to protect consumers within self-funded ERISA plans as
much as possible.
With respect to state-regulated insurers and health plans, we continue
to believe that the states are better able to determine what works best
in their marketplaces. The delivery of health care services is a local
activity. Health care markets are determined by geographic factors, demographics,
the level of market penetration by different types of entities, the composition
of the health care workforce, and consumer preferences, among other factors.
A single federal standard will be difficult to apply to diverse populations
and different geographic areas and may stifle innovation in local markets.
As I will discuss, the states have already recognized the importance of
providing all consumers with the ability to appeal all unfavorable determination
and have already approached the subject of independent external grievance
procedures in a variety of ways, each designed to fit the needs of a particular
state's citizens and health care market.
The issues involved in this area are contentious. Without the proper dialogue
and deliberation new federal laws or regulations may actually leave consumers
with fewer protections rather than more. As we have seen by the decisions
of some federal courts, the ability of states to enact and enforce laws
regarding grievance procedures and remedies for health insurance consumers
has been threatened and risks leaving consumers unprotected.
II. Grievance Procedures
In terms of mandating grievance procedures, we have seen a variety of activity
at the state and federal levels. The following information discusses the
specific activity at each level.
A. State Activity
The states have been involved aggressively in establishing and enforcing
state law grievance procedures under their authority to regulate the business
of insurance. Beginning in 1993, the states, with the assistance of the
members of the NAIC, have done extensive work to help ensure that the health
care provided by state-regulated health plans is of the highest quality.
In 1996, the states, through the NAIC, adopted five model acts that set
standards primarily for managed care plans on a range of topics.[1] Together
these models lay the groundwork for a comprehensive regulatory structure
at the state level for managed care health plans. The purpose of the five
models is to protect the consumer, especially when carriers and health
plans restrict a consumer's choice of providers or use incentives to direct
a consumer to particular providers.
[1] An NAIC model law becomes effective in a state only when that state's
legislature chooses to enact the model or legislation based upon the model.
A state is free to modify an NAIC model to meet the needs of consumers
and the market within the state.
The five models are the Health Carrier Grievance Procedure Model Act, the
Managed Care Plan Network Adequacy Model Act, the Utilization Review Model
Act, the Quality Assessment and Improvement Model Act, and the Health Care
Professional Credentialing Verification Model Act. The Health Carrier Grievance
Procedure Model Act provides standards for the establishment and maintenance
of procedures by health carriers to assure that covered persons have the
opportunity for the appropriate resolution of their grievances. The Managed
Care Plan network Adequacy Model Act establishes standards for the creation
and maintenance of networks by health carriers and to assure the adequacy,
accessibility and quality of health care services offered under a managed
care plan. The Utilization Review Model Act establishes standards and criteria
for the structure and operation of utilization review processes designed
to facilitate on going assessment and management of health care services.
The Quality Assessment and Improvement Model Act establishes criteria for
the quality assessment activities of all health carriers that offer managed
care plans and for the quality improvement activities of health carriers
issuing closed plans. The purpose of the criteria is to enable health carriers
to evaluate, maintain and improve the quality of health care services provided.
The Health Care Professional Credentialing Verification Model Act requires
a health carrier to establish a comprehensive verification program to ensure
that its participating health care professionals meet specific minimum
standards of professional qualification.
Now That The Government owns The banks.. Has control over Insurance companies.. Now Is The Perfect time for Health care reform , and nationalizes Health Insurance.. and Glen Beck wanted to know What Obama's Left Hand was doing.. ( keep your thoughts clean)
please call and say NO TO universal health care 202-224-2043
DC Speaks: State Insurance Regulator Insists the System Works.(National Association of Insurance Commissioners President Kathleen Sebelius)(Brief Article)
Article from:
American Banker
Article date:
May 4, 2001
Author:
Duran, Nicole
Rebutting financial services lobbyists who are seeking to federalize insurance oversight, a top state regulator said in an interview that she and her peers are still the most qualified to do the job.
Kathleen Sebelius, the president of the National Association of Insurance Commissioners, said that plans being circulated by the American Council of Life Insurers and others to establish an optional federal insurance charter would be a mistake.
"Members of the NAIC have been working together the past 12 months to improve the efficiency and effectiveness of the system of state insurance regulation," Ms. Sebelius, who is also the Kansas insurance commissioner, said in a telephone interview on Wednesday. "Meanwhile, the ACLI has spent the past 12 months dreaming up a federal bureaucracy that, from what we've seen, is a plan that relates only to life insurance."
The ACLI began querying members last month on whether they want to pursue a national charter. The American Bankers Insurance Association has floated a similar plan in the last two years.
The life insurers' draft plan mimics the dual banking system by envisioning a federal regulatory framework for national insurance companies that would coexist with an updated state regulatory system.
"The ACLI has no higher priority than the reform of state regulation and will continue to work with the NAIC" to that end, a spokesman for the group said.
Ms. Sebelius responded that "that kind of two-tiered system brings with it all kinds of questions and concerns."
For example, some health insurers are not subject to state law because federal law preempts self-insurance plans, she explained. Her office cannot help people with complaints or act against companies in such cases.
"The NAIC's primary concern is protecting consumers and ensuring the solvency of insurance companies," she said. "Any debate — whether it be at the state or federal level — must keep the interests of consumers as priority number one."
Though proponents have stressed that the benefit of a two-tiered plan is its flexibility — some companies would remain state-chartered while those that need to work across all 50 states would opt for the federal charter — Ms. Sebelius said she fears some companies have ulterior motives.
"I'm worried that there is a segment of the industry that just wants less regulation," she said. "The notion that you would shop around for your regulator in this sort of race to the bottom does not instill confidence that companies are looking for stringent regulation or more consumer protection."
Critics of state regulation have asked whether consumers really care which level of government protects them.
Ms. Sebelius said people feel more comfortable bringing their complaints to a state office. If they felt they had to track down a bureaucrat in faraway Washington, she said, they might be deterred.
"I would debate with anyone who thinks a federal system would be more responsive," she said.
She went on to say that by nature federal regulation has to be one-size-fits-all, which does not suit the insurance industry well.
"Insurance products are local products, and consumers have local needs," she said. "What works in Kansas doesn't necessarily work so well in California or New York. State insurance commissioners have the ability to be sensitive to that."
Ms. Sebelius said she understands the industry's desire for more streamlined and efficient regulation. However, she said, she believes the NAIC has proposals in the works that would improve the current system and make a federal charter unnecessary.
The NAIC last year considered an option that would have established national standards for companies that want to operate in several states but not have to abide by each state's individual requirements. The idea was ultimately dropped because the group decided it would be too complicated.
Instead, the group has gotten 47 states to agree to a uniform application process. Whether a company sets up shop in California or New York, it can fill out the same paperwork. If it wants to operate in all 50 states, it would still have to file applications with each state's insurance commissioner but could fill out one form and copy it 46 times. Currently, each state uses a slightly different form.
The recommendation was part of a nine-point reform plan the group unveiled last year.
The group hopes to get all states to agree to use the uniform application form by next month.
the above article
Copyright c 2001 Thomson Financial. All Rights Reserved. http://www.americanbanker.com
Kent Conrad AND Allen Boyd is the swing vote on whether or not Congress will be able to ram through socialized medicine.
I urge everyone to contact his office at (202)224-2043 and ask him to oppose letting Congress ram through health care reform on narrow partisan lines through "reconciliation." His office needs to be flooded with phone calls. If you can't reach him at that number try the DC line at (202)224-2043
PLEASE PLEASE PLEASE CALL TODAY
Kent Conrad AND Allen Boyd is the swing vote on whether or not Congress will be able to ram through socialized medicine.
I urge everyone to contact his office at (202)224-2043 and ask him to oppose letting Congress ram through health care reform on narrow partisan lines through "reconciliation." His office needs to be flooded with phone calls. If you can't reach him at that number try the DC line at (202)224-2043
PLEASE PLEASE PLEASE CALL TODAY
Kansas Insurance Commissioner Kathleen Sebelius won't let… ]
Article from:
The Topeka Capital-Journal
Article date:
June 12, 2002
Author:
Michael Hooper Capital-Journal
More results for:
Kathleen Sebelius
By Michael Hooper
The Capital-Journal
Kansas Insurance Commissioner Kathleen Sebelius won't let the state's largest insurance company be sold to an Indiana company without a fight.
She has appealed a judge's ruling overturning her decision to deny the sale of Blue Cross and Blue Shield of Kansas to Anthem Inc.
"We're going to keep on fighting," said Nicole Corcoran Basso, spokeswoman for the Kansas Insurance Department.
Basso said Sebelius filed an appeal with the Kansas Court of Appeals on Monday and also plans to file a motion to transfer the case to the Kansas Supreme Court.
"We would end up there anyway," Basso said, adding that regardless of how the appellate court rules, the losing party would appeal to the higher court.
She said the Kansas Supreme Court has never considered the statute regarding the sale of the insurance company.
Basso said Sebelius will file a transfer request on July 1. If the case is transferred, the matter probably won't make it to the Kansas Supreme Court docket until November. After a hearing, the Supreme Court typically hands down a decision six weeks later. So the court's ruling wouldn't come until December or January.
Sebelius said she denied the sale of BCBS to Anthem because "it would have cost Kansas families and businesses millions of dollars in increased premiums."
Those premium increases would be needed to meet Anthem's profit margins, Basso said. And those premium increases would be hazardous to Kansans, she said.
Shawnee County District Judge Terry Bullock on Friday overturned Sebelius' decision. He said premiums for the small-business group and individuals had to go up so those two pools of insured wouldn't lose money. He said state law prevents one line of insurance from subsidizing another.
Bullock also said Sebelius mistakenly denied the acquisition because she feared BCBS's surplus would be reduced too much. The judge said the surplus would have been adequate under state law.
But Sebelius maintains the takeover by Anthem would threaten the local health care decision-making Kansans depend on from BCBS of Kansas.
What's next
Nicole Corcoran Basso, spokeswoman for the Kansas Insurance Department, said the department on July 1 would file a motion to transfer the case to the Kansas Supreme Court.
Democratic gubernatorial candidate Kathleen Sebelius apologized… ]
Article from:
The Topeka Capital-Journal
Article date:
October 4, 2002
Author:
Jim McLean Capital-Journal
More results for:
Kathleen Sebelius
By Jim McLean
The Capital-Journal
Democratic gubernatorial candidate Kathleen Sebelius apologized Thursday for remarks that some think trivialized the Sept. 11 terrorist attacks.
At a forum in Johnson County on Wednesday, Sebelius said the condition of Missouri's highways was "much more terrifying" than the attacks on the World Trade Center.
She made the statement to emphasize her belief that Kansas should continue its $13.9 billion highway building program despite the state's budget difficulties.
Sebelius said she became aware of the condition of Missouri's roads when she was forced to drive back to Topeka from a speaking engagement in Ohio after air traffic was grounded by the Sept. 11 attacks.
"I just meant in terms of personal safety, I felt more jeopardized in some ways driving myself through Missouri," she explained when questioned about her remarks immediately after the forum.
But faced with mounting criticism on Thursday, Sebelius issued a public apology at the outset of a speech in Wichita.
"Before I begin my remarks, I would like to apologize to the people of Kansas and the memories of those who lost their lives on September 11th and their families and loved ones," Sebelius said.
"Yesterday, I made an insensitive remark about the tragedy of September 11th for which I am very sorry," she said. "I take responsibility for my comments. I regret them and hope we can move forward."
Sebelius' comments drew harsh criticism from Bob Hemenway, whose son, Ronald John Hemenway, of Shawnee, was killed in the terrorist attack on the Pentagon.
"I think there is something mentally wrong with her," Hemenway said. "I'd be afraid of having somebody like that for governor."
Republican gubernatorial hopeful Tim Shallenburger was muted in his criticism of Sebelius immediately after the forum. But on Thursday he charged that her remarks trivialized the attacks.
"There was massive loss of life on September 11 and we currently face the potential of more loss of life if the war on terrorism moves to Iraq," Shallenburger said in a written statement. "Sebelius has failed her first test as a leader."
Bob Beatty, a Washburn University political science professor, said Sebelius' quick apology should minimize the damage to what recent media polls indicate is her front-running campaign.
"What research has shown is that voters keep running tallies in their heads and that no one mistake — unless it's giant — is going to turn an election," Beatty said. "I think the damage from this slip is limited because it wasn't close to the election and it wasn't televised live."
Something to watch for, Beatty said, is whether Sebelius' gaffe inhibits her performance in future debate.
The Associated Press contributed to this report.
Jim McLean can be reached at
(785) 233-7470 or jmclean@cjonline.com.
Has anyone else noticed that most of the things that have been pushed through congress in the last decade include words similar to the following? "The 65-31 confirmation vote came after Democrats urged quick action so that Sebelius could get to work leading the federal response to the flu outbreak."
Urging quick action because of some crisis got us into all kinds of problems. Honestly, think about this …
Bush:
Iraq (Need to get those WMD out of that maniac's hands that we still can't find. We need to finish the job we started, but should we have gone in initially? I don't know)
Patriot Act (Need to flush out terrorists and have people loose portions of their freedoms to do it)
TARP I (Financial Crisis looms if we don't do this … it came anyway)
Obama:
Just about everything this man has gotten has been under this guise … financial mess, war, health issues.
According to him, the world is falling apart and we need to give him all power and authority in order to save us all. AND PEOPLE ARE WILLINGLY DOING THIS! This is what makes me sick.
Calling her the Health Secretary is an oxymoron. Queen of infanticide along with her boyfriend Tiller the Killer should be called the death secretary. Well the Obama administration is showing true colors, having tax evaders, porn protectors, and now murderers, wow, what next?
Next comes eugenics. They'll kill off the elderly to save Social Security, deny care to the sick and disabled to cut Medicare/Universal Healthcare costs, and target a religious segment as a scapegoat (probably Christians or other "right wing extremists").
Sound familiar? Yes, it is in fact Nazi Germany. The similarities are getting starker by the day.
Isn't that the purpose for the push for universal health care? Man, it doesn't pay to get old as the govenment will make sure you die before you qualify for medicare–that's about the only way the government can afford universal health care! Having friends in Canada, it doesn't work well up there. My friends had a son who was extremely mentally disabled and they had no one in their province could treat him. They had to seel their large property, give up the wife's livelhood as she raised terrific dogs, and move to be near a hospital that would treat the son! They did this after the son took a chain saw after the father! UNVERSAL HEALTH CARE DOESN'T WORK AND WILL SET A NEW STANDARD IN THIS COUNTRY FOR LACK OF LONGEVITY!
Well stated, but yet tragically ironic.
This woman is a demon, she has the blessings of Mr. Obama. This country is headed for worst times than are present. Next move, is to take God off everything, and to replace God with the new "Messiah's" image!!!
"in Barack we trust" ?
Well, I don't. And I'm sure most everyone that are 912er's don't. I don't think you do either Candidus
I would not doubt the U.S. Motto being changed. With Specter the defector changing stripes, the "magic" number of 60 is all too close. If 60 is reached, there will be no stopping them. They can enact legislation at will, pass it and the prez will sign it.
What can anyone say…..??..sickening, just sickening….
I totally agree with you — words cannot express how terrible this is for our country.
Have to wonder how many death warrants Sebelius will approve in regards to the unborn, the elderly, the disabled.
Remember, it's taken Obama months to set up his venomous cabinet/administration; it will only take one day to bring them down, so remember to vote.
In the meantime, on with the teaparties. Continue writing/emailing/phoning. Call them on every error in judgment. Don't let them rest!
DEAR LEADER has a position for Kathleen Blanco she is going to become his new court jester and you know this just might work.
Right now I can hear Sebelius saying "thank God for this swine crisis it just got me confirmed"
Oh great! Now we have someone who loves to kill babies as health secretary…Does ANYONE see how utterly stupid this is?
I hope when the socialize medicine all the doctors and Nurses say "I quit". Now that would be cool….
Meet one who already has.
Way to go Nancy..You are my hero!
No, don't hope that we quit! Hope that those who stay are good and caring and will stand up for the rights of the ill, the vulnerable, the weak, the disabled, the elderly! Seriously, I went back to nursing school at 47 partly because I was afraid this day was coming — I just didn't expect it so soon. We need competent, caring, Christian people in health care who will stand up to the system and stand up for people. We have a mentally impaired child, and I fear for his future precisely because of what is coming. I don't think socialized health care is a maybe, I think it will soon be a reality.
Living in a retirement haven, I asked my Dr. last week what he was going to do if obot's plans for health care becomes a reality–he wouldn't give me an answer and tried to make a joke of it. He and his wife are both internistsl. Anyone who is on medicare moving here has an almost impossible job of finding a Dr. who will take them as a patient because the Dr.s are already overloaded with Medicare patients. I fear what will happen as many of our current Drs. have already said they would be leaving. If you have a health issue that needs immediate attention, you probably will end up in the ER as getting to see the Dr. same day is pretty much impossible! We have one Endocrinologist who it takes anywhere from three to six months to get an appointment!
When I say they should say I qui. I really mean that I hope they will not participate in the GOVERNMENT health care system and do only private pay. If the Governmnet will not allow that then I hope they stay open to black market trade.
If enough doctors and nurses say no they cant implement socialized medicine. Either that or they have to make a big ole prison for doctors and nurses who refuse to play.
Wow what a coincidence- swine flu today, new HHS secretary tomorrow! Isn't that just great, at least Napolitano isn't running it I guess. She can get back to her job of unsecuring the border. Oh, and Chris Dodd threw in his two cents, "We find ourselves in the midst of a global crisis. What we've been missing in all of this is the head of the HHS Dept." I ALWAYS look for Dodd's guidance when we're in a crisis! He's just great isn't he? How many Americans have died again? Oh yeah, none. WHAT A SHAM!! While everyone's looking one way, Barack Hoodini Obama along with his congressional assistants suprise us again!! Is there nothing this man can't accomplish. Appointing a woman who has fought against any limits on abortion throughout her political career to an agency that is responsible for protecting the health of all Americans and providing essential human services, ESPECIALLY FOR THOSE WHO ARE LEAST ABLE TO HELP THEMSELVES. Who's in line for deputy HHS secretary, Jack Kevorkian? KILL THE UNBORN, INDICT THOSE THAT HAVE PROTECTED US, ENSLAVE OUR CHILDREN AND GRANDCHILDREN THROUGH DEBT, BOW BEFORE FOREIGN DICTATORS, PROTECT THE RIGHTS OF ILLEGAL ALIENS AND TERRORISTS: THAT'S CHANGE YOU CAN BELIEVE IN!!!!!
I do believe it was good old Kathleen who got funds from the baby killer. Makes you proud that we have Pro-death people throughout this administration. To bad their parents didnt have the same views on the un-born as they do.
Amen to that!
Amen, and their views on abortion and stem cell research only re-enforces the fact that these people are selfish and self-serving. The thought "what if my parents thought as I do" never crosses their minds.
Well if her performance here in Kansas is any indication, hold on to your hats folks!
How come ever since the dems controlled the whole of congress, the presidency, the house…
EVERYTHING they touch is now a crisis?!!
The problems aren't that bad…the way they handle it is the crisis.
I was thinking the same thing, it reminds me of the boy who cried wolf. When a REAL problem comes around I don't think people will take it serious. Does anyone know the statistics of how many states of emergencies have been declared?
Shhhh……. be careful what you say, they may come get you, and haul you off for a liberal training/ brainwashing camp. where you come out free from honesty, and other Godly things. : )
"I have sworn upon the altar of God, eternal hostility against every
form of tyranny over the mind of man." –Thomas Jefferson
Air Force One scaring the hell out of people now her………she is evil and Hillary loves her~ What next? What are they going to do to us next? Talk about coincidental what about taking blood from new born babies and then starting a registry….National Health Scare…they call it care!
National Events and Information
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http://www.freedoms-fight.blogspot.com
Another day, another brain dead liberal who doesn't know what's going on gets an Obama cabinet post. I guess we should be thankful it wasn't Kathleen Blanco, ex governor of Louisiana! She's really clueless.
This appointment is just another step away from the values and principals on which this country was founded. My question to Chris Dodd is when did Swine Flu become a crisis? Yes, it is a health concern right now and could, possible become a pandemic, but it has hardly reached crisis level. It seems like the libs are unable to come up with any other word to describe a situation. Maybe they need to look at a thesaurus or a dictionary.
There's that word again "crisis"…. this time so as to cram down our throats a pro-infanticide, pro-socialized Health Secretary that will mean even less Freedom for us all and end the lives of as many infants as possible.
Never let an emergency go to waste. It's too coincidental for me that this health emergency happened just when this nomination came about.
The NAIC Model Act also differs from the two federal proposals in the reporting
requirements a health carrier must undertake. In the NAIC model, all carriers
must submit their grievance procedures, including all forms, to the insurance
commissioner along with any future modifications. Neither S. 2330 or S.
1890 contains this requirement. The NAIC Model Act also establishes a grievance
register requiring a plan to maintain grievance records for six years,
but does not require access to the data by a regulator. S. 1890 does not
have a provision establishing a grievance register. Reporting requirements
also differ when an appeal is decided. The NAIC Model Act requires that
plans provide more information to the complainant than either S. 1890 or
S. 2330.
Before Congress adopts additional protections for consumers in self-funded
ERISA plans, we recommend that you review the NAIC Health Carrier Grievance
Procedure Model Act and incorporate those provisions from the model into
the federal legislation that provide stronger consumer protections.
IV. Proposed Department of Labor Regulation
A. consideration of the Proposed Regulation
In addition to the states and congress addressing grievance procedures,
the Administration is taking action on this issue. The Department of Labor's
(DOL) proposed claims handling regulation is a result of a Presidential
directive to enact consumer protections in health care. ("Employee Retirement
Income Security Act of 1974; Rules and Regulations for Administration and
Enforcement; Claims Procedures", published in the Federal Register on September
9, 1998 (Fed. Reg. at 48390-48409) (Department of Labor, Pension and Welfare
Benefits Administration, 29 CFR Part 2560, RIN 1210-AA61)). It is critical
that any proposed federal regulations not undermine the progress already
made by the states nor impede such future progress in implementing legislation
or adopting regulations that protect consumers.
The members of the NAIC Special Committee submitted comments on the DOL's
proposed claims handling regulation. We have attached our comment letter
to the written testimony. The members of the Special Committee expressed
appreciation at DOL's efforts to improve ERISA claims handling procedures
in order to provide a basic level of protection to consumers in self-funded
ERISA plans who have not had the benefit of state regulation of their health
plans. State insurance department lack jurisdiction over self-funded ERISA
plans. The members of the Special Committee believe that consumers within
such plans would benefit from the same types of protections available under
state law, and as such, the members of the Special Committee supported
improving the claims handling and information disclosure requirements under
ERISA. However, the members of the Special Committee expressed concerns
about the extent to which this proposed regulation could preempt state
law. As written, the proposed regulation applies to all ERISA plans, not
just self-funded plans.
The states have a long history of regulating the business of insurance,
including the adjudication of consumer complaints against insured plans.
States must be able to implement and enforce state initiatives directed
at insured plans, which provide greater protections for consumers and which
are not included in the proposed regulation. The ability of states to monitor,
collect and remedy complaints is crucial in their ability to regulate health
carriers.
The members of the Special Committee supported several provisions of the
DOL proposed regulation, because the proposed regulation adopts similar
standards for ERISA plans as those set out by the NAIC Models and adopted
by the states. Examples include: (1) using the more precise definition
of "adverse determination" instead of "denial"; (2) consulting with qualified
medical professionals in deciding appeals involving medical judgments;
and (3) having appeals decided by someone other than the person who made
the original claims determination.
In some areas, however, the members of the Special Committee do not think
DOL goes far enough (i.e., as far as the states do for fully insured ERISA
plans) in its protections for consumers in self-funded ERISA plans. One
example is the proposed time frames in which group health plans must notify
claimants of benefit determinations and must review adverse determinations,
including claims involving urgent care. The proposed DOL time frames are
longer than the time frames in the NAIC model acts. The NAIC would support
shortening those time frames to increase consumer protections.
Another concern is that the proposed regulation states that benefit claim
procedures may not require a claimant to file more than one appeal before
bringing a civil action under ERISA. The members of the Special Committee
are especially concerned about preemption in this area, and we believe
the regulation should provide express assurance that two-level procedures
are not prohibited when participation in the second level is optional on
the enrollee's part. The states have worked hard to achieve consumer protections
in the area of grievances. All states, with respect to managed care plans,
require an initial review — even states, with little or no managed care
penetration in their markets. The NAIC Model Act, and several states, require
a two-step process (a first and second level grievance review), upon the
enrollee's request. This structure provides an additional opportunity for
appeal before the enrollee must resort to filing a civil action against
the carrier, but this second step is voluntary on the part of the claimant.
The claimant is free to by-pass this second review and take the case to
court, if desired. We believe this provision is consistent with DOL's stated
objective of not requiring a claimant to file more than one appeal prior
to bringing a civil action under ERISA, but we would appreciate assurances
that similar provisions of the state law are not preempted under the DOL
regulation.
The members of the Special Committee agree that consumers in self-funded
ERISA plans should be granted more protections, but not at the expense
of harming those consumers already protected by stronger state laws. The
members of the special Committee strongly caution against any preemption
of state laws that provide greater protections for consumers than are provided
in the proposed regulation. In addition, the members of the Special committee
want to ensure that states, which were granted authority under ERISA's
savings clause to regulate insured plans, can continue to do so. The members
of the Special Committee strongly believe that claims handling and grievance
procedures are part of the "business of insurance." The members of the
Special Committee urge DOL to clarify its proposed regulation so that states
can continue to respond to consumers' grievances about their insurance
coverage.
B. Court Decisions Affecting the Proposed DOL Regulation
A point of interest for this Committee would be the role the courts have
played in implicitly affecting the proposed DOL regulation and affecting
the ability of the states to handle claims and grievances. The courts have
decided several ERISA cases over the past year, and some of these decisions
have improperly narrowed the insurance savings clause of ERISA, thereby
intruding on the ability of states to regulate insurance. Because of a
faulty court decision, Texas is no longer able to enforce its external
grievance procedure, although many plans have agreed to abide by the procedure
voluntarily.[3] A case currently pending before the Supreme Court, UNUM
Life Ins. Co. v. Ward, 97-1868, has the potential to determine if any state
can respond to consumer complaints or enact legislation requiring an external
grievance procedure.
[3] In Corporate Health Insurance v. Texas Department of Insurance, the
U.S. District Court for the Southern District of Texas, Houston Division,
struck down several provisions of the Texas Health Care Liability Act stating
that some of the provisions were preempted by ERISA. One of the provisions
the court struck down was the provision that established an independent
review process. The court found that the independent review procedures
in the Act were preempted by ERISA, because they imposed requirements on
plan administration and structure. As a result of this decision, the Texas
independent review procedures contained in the Act were ruled invalid,
even for fully insured plans that are regulated by the states. The case
is currently on appeal. This case raises questions over whether other states'
external review statutes will be struck down because of ERISA preemption
thereby hindering states' abilities to handle consumer complaints and grievances.
There are two specific reasons that the UNUM case is important to the states.
One reason is because the case addresses the scope of ERISA's savings clause,
which excepts state laws that regulate insurance from ERISA preemption.
The case presents the Supreme Court with an opportunity to reaffirm the
broad extent to which state insurance laws and regulations are saved from
ERISA preemption and to ensure that state can continue to regulate the
business of insurance. The NAIC has filed an amicus curiae brief in this
case, and we would be happy to supply you a copy of our brief upon request.
The second reason this case is important is because of its impact on the
proposed DOL regulation. The United States Solicitor General's amicus curiae
brief in this case is relevant in interpreting the scope of the DOL regulation.
The Solicitor General's brief supports the view that the DOL regulation
would not interfere with the states' ability to regulate the business of
insurance. The Solicitor General's brief advocates a common sense interpretation
of the savings clause and specifically recognizes the legitimate role of
dual federal and state regulation of the insurance industry as set forth
in ERISA. These views support the conclusion that the DOL regulation does
not preempt state law grievance claims procedures.
V. Conclusion
Congress expressly allowed for federal and state regulation of ERISA plans
by virtue of the savings clause. The savings clause was enacted to preserve
the states' traditional regulation of insurance, including regulation of
insurance policies purchased by ERISA plans. The members of the Special
Committee are interested in preserving the distinction between self-funded
ERISA plans, which are clearly outside the purview of state law, and insured
plans, which Congress specifically intended for the states to regulate.
The states want to ensure that their citizens who are covered by insured
ERISA plans have the ability to have their claims and grievances addressed.
In light of all these concerns, the members of the Special Committee believe
that neither Congress not the Department of Labor should attempt to micromanage
the managed care marketplace and force diverse regions and localities into
a "one size fits all" approach. Rather, states should be given the flexibility
to continue the development of innovative solutions to complex problems,
including the development of independent external grievance procedures
of health plans.
I appreciate the opportunity to testify today. The NAIC is looking forward
to working with this Committee and the Congress on this issue.
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I work with some folks from Canada, and they say that the Healthcare system is great … when you're in your 20s. As long as you're young, healthy, and are still considered an "asset" to the country, Universal Healthcare is awesome. It's only when you start to get too old to work, or have chronic conditions that people start getting the "short end" as it were.
Remember that the first victims of the Nazi Holocaust weren't the Jews, but the disabled. If you are or know someone with a condition that requires regular doctor visits, you need to be out in front opposing Universal Health Care. No matter how much you’re in debt, or what promises you’re hearing, the grass is NOT greener on the other side.
Many Doctors are no longer accepting Medicare as insurance because the government keeps lowering what they'll pay, which increases the Doctor's overhead, which then must be covered by other patients (kind of like how illegal aliens in ERs make a band-aid cost $500 for you and I).
The only thing the government can ultimately do is make it illegal NOT to accept Medicare, which will have the exact same affect as it has on every other industry the government gets its fangs into … it will go bankrupt, and become government owned.