Young adults can stay on their parents’ insurance longer, and birth control costs must be covered for those looking to avoid having any kids at all, under new laws that take effect Friday in Wisconsin.

Also starting in the new year, state workers and employees at the University of Wisconsin can receive domestic partner health insurance and other benefits. The new mandate that insurance plans cover autism will take effect for most on Friday when group policies are renewed. That law change started in November, but most policy holders won’t start paying for it until now.

The new insurance mandates were approved by the Democratic-controlled Legislature and Gov. Jim Doyle this year. Advocates who pushed for requiring birth control and autism coverage argued it was over due, even though the new mandates are expected to increase costs for all policy holders.

“It’s another year in the march toward increasing health insurance premiums,” said J.P. Wieske, director of state affairs for the Council for Affordable Health Insurance, a national advocacy group whose membership includes insurers, health care providers, actuaries and insurance brokers.

No one seems to know how much the changes will cost. Neither the state Office of the Insurance Commissioner nor the Wisconsin Association of Health Plans, which represents 18 member health plans across the state, has estimates.

“Every indication is that the mandates have increased costs and cost expectations will be higher for 2010,” said Phil Dougherty, senior executive officer of the Wisconsin Association of Health Plans.

The association didn’t oppose any of the changes but instead worked with the governor and state lawmakers on ensuring that the laws do what was intended, Dougherty said.

There was opposition from anti-abortion and Catholic groups to requiring contraceptives to be covered under health insurance policies. Opponents argued that birth control is not medically necessary and insurance companies should not be forced to pay for what is a personal decision.

The Wisconsin Catholic Conference is lobbying lawmakers to provide an exemption for religious organizations.

“The law does not give adequate deference to our religious values and our religious liberties,” said John Huebscher, executive director of the conference. “It would force dioceses and other Catholic organizations that buy insurance to pay for something they object to.”

Three of the state’s five Catholic dioceses purchase private health insurance, which would be required to include contraceptive coverage, he said. However, their policies aren’t up for renewal until later in 2010, so the hope is the Legislature will provide for the exemption before then.

Those three dioceses in Milwaukee, Madison and Green Bay insure about 6,000 clergy, staff and other employees, Huebscher said. The other two in La Crosse and Superior are self-insured and not bound by the law, he said.

Planned Parenthood opposes any exemptions because that will limit women’s access to birth control, said the group’s legal and policy analyst Nicole Safar.

“An exemption really defeats the purpose,” she said.

Mandating birth control coverage will dramatically increase its access, Safar said. She cited a 2001 report by the state Office of the Insurance Commissioner that showed about one in five of the most popular insurance plans with prescription drug coverage in Wisconsin did not cover contraceptives.

Wisconsin is joining 24 other states that already require birth control to be covered, according to the National Conference of State Legislatures. Two additional states require insurance companies to offer contraceptive coverage as an option to employees, but it can be declined.

Federal law requires insurance coverage of contraceptives for federal employees.

Under another insurance change taking effect in Wisconsin, adults up to age 27 could remain on their parents health insurance plans unless they have access to cheaper plans through their employers.

Current law does not address how long a child can remain on their parent’s coverage, leaving it up to individual insurers to decide.

Supporters of increasing the age, including Doyle and the Wisconsin Association of Health Plans, said the law will help young people who either can’t afford health insurance when they first start working or aren’t offered it.

There were no estimates from the state or the insurance industry as to how many people may be affected.

To qualify, the young adults have to be single, not eligible for insurance through their employer, or be able to get on their parents’ plan for less money than through their work.

About 20 states require insurance companies to offer parents coverage of adult children, according to the Council for Affordable Health Insurance.

The domestic partner benefits are being extended to unmarried partners of state employees who live together, share expenses and meet other requirements. It is open to unmarried couples of the opposite sex as well as same-sex couples.

As of Tuesday, 710 people and 57 dependents have signed up for the health insurance, according to the Department of Employee Trust Funds. Another 300 state workers have signed affidavits saying that they qualify for the benefits, indicating that they may sign up later.

Another 179 university employees added a domestic partner to their health insurance as of Dec. 21.

The health insurance benefit is separate from other rights that all same-sex couples became eligible for in the state starting in August. Under that law, couples had to sign a registry in order to receive a host of rights already afforded married couples, including hospital visitation and inheritance.

Federal

Owing to multiple blizzards in Washington, Congress started its President’s Day recess a full week early and conducted no official business last week. However, there was some legislative drama as Senate Majority Leader Harry Reid pulled the rug out from under Finance Committee Chairman Max Baucus by scrapping the Baucus jobs bill (without warning), which contained many health insurance items, and replacing it with a stripped down, narrow jobs bill. Whether the health items Baucus originally inserted with Republican help will make it back to the table remains fuzzy. Among the health items that have been dropped are: the COBRA eligibility extension (to May 31); the “doc fix” (to October, 2010) of Medicare reimbursement rates; and the favorable statutory direction to CMS to calculate the 2011 Medicare Advantage rates “as if” the doc fix were in place.

States

California health insurance The Office of Patient Advocacy released a report card on the state’s HMOs last week. Aetna received 3 out of 4 stars. The goal of the report card is to allow consumers to compare how well health plans use personal medical records and help address conditions such as asthma, arthritis and diabetes.

COLORADO: Governor Bill Ritter held a press conference to announce what he calls “the next round of reforms that represent common sense.” His legislative package includes bills to preclude insurance companies from charging different rates due to a person’s gender, ensure that women have access to breast cancer screening, assure plain language is used in insurance forms, standardize insurance applications and explanations of benefits, and encourage greater use of online tools to enroll people in public programs. Apart from the Governor’s proposals, a bill that would establish a public option was also introduced.

CONNECTICUT: In a short legislative session of only three months, the Insurance & Real Estate Committee wasted no time in putting forth an agenda that includes many concept drafts for repeat legislation from previous sessions. These include prohibiting health insurance copayments for preventive care, limiting prescription drug copayments, prohibiting Social Security disability payment offsets, and exempting the Municipal Employees Health Insurance Plans from the premium tax on small group premiums. In addition, the committee reintroduced legislation that includes nearly a dozen new health benefit mandates. The Council for Affordable Health Insurance, an independent think-tank, says that health insurance mandates could increase premiums in Connecticut by more than 50 percent overall.

GEORGIA: A bill was proposed last week that would impose significant restrictions on insurers’ ability to rescind health insurance policies. Aetna, through the Georgia Association of Health Plans and AHIP, met with the legislator sponsoring the bill to express concerns with the bill.

INDIANA: The legislative session is at halftime, and the insurance agenda is now limited. Most insurance issue bills are officially dead, including a bill that would have prohibited health plan provisions requiring a contracted provider to accept more than a certain number of patients; coverage for dialysis treatment regardless of whether the facility is contracted or not and without certain benefit restrictions; and a bill that would have allowed out-of-network assignment of benefits. However, Aetna is expecting that a bill requiring insurer and HMO annual reporting of premium cost composition, including administrative costs, may be resurrected. A bill that restricts dental insurers and HMOs from establishing fee schedules for non-covered services passed the Senate, with our amendment to accommodate most of the key concerns expressed by opponents of the bill. As the bill stands, dental insurance plans may impose fee schedules for covered services, regardless of whether the plan actually pays for the services rendered.

KANSAS: An amended version of S.B. 389 related to dental services passed the Senate Financial Institutions and Insurance Committee on February 11. The amended bill prohibits any contract between a health insurer that offers a health benefit plan and a dentist from containing a provision that requires the dentist to accept a fee schedule for services unless the service is a covered service. Committee amendments added to the definition of a “health benefit plan” the following: any subscription agreement issued by a non-profit dental service corporation; any policy of health insurance purchased by an individual; the state children’s health insurance plan; and the state medical assistance program under Medicaid. We will continue to update you as this bill progresses and hope to make favorable changes as the bill moves through the House.

MASSACHUSETTS: Governor Deval Patrick filed a 40-page bill that proposes giving the insurance commissioner the power to hold public hearings on rate adjustments and essentially cap health care price increases. Rate increases for individuals would be held to the rate of medical inflation; those sold to employers with 50 or fewer workers could not exceed one and a half times the level of medical inflation. The legislation would also impose a two-year moratorium on any new health benefit mandates. Legislative leaders praised the intent of the governor’s plan but declined to promise support. Strong opposition is expected from medical provider groups. The Governor simultaneously announced emergency regulations to take immediate effect that will require health insurers to submit proposed small business rate increases for review by the state 30 days before they take effect. Several other proposed provisions include a requirement that insurers offer at least one coverage plan with a limited network of health care providers costing at least 10 percent less than health plans with access to more physicians. The Massachusetts Association of Health plans is lobbying in support of a bill introduced by Senate Insurance Chair Richard Moore that would create a cheaper health insurance product for small employers by capping payments to providers at just 10 percent above Medicare rates. The Massachusetts Medical Society is against that proposal.

MISSOURI: An autism coverage mandate bill was amended and “perfected” by the Senate and then sent to the Government Accountability and Fiscal Oversight Committee from which it must emerge before returning to the floor of the Senate. In addition to two mandate-related amendments, a third amendment to the bill allowing for limited cross border sales of health insurance also passed. In its current form, the bill contains a mandated offering of the coverage in the individual market. Coverage is limited to treatment ordered by a licensed physician or psychologist whose treatment plan the carrier is entitled to review every six months. Coverage for applied behavior analysis (ABA) is limited to $52,000 annually (down from the $72,000 as introduced) for persons under age 21. Meanwhile in the House, a bill containing significant language relating to the credentialing of autism service providers also passed. The bill also contains a mandate to offer coverage in the individual market and to groups of fewer than 25. Groups of 25 to 50 would be entitled to an exemption from the mandate if they could demonstrate an increase in premiums tied to the mandate. The bill limits annual coverage of ABA ($36,000 for children ages 3-9; $20,000 for children ages 9-21). Aetna will continue to monitor the status of these mandates, but it appears fairly clear at this point that something will pass on the issue of autism.

NEW JERSEY: Last week Governor Chris Christie declared a fiscal state of emergency calling a special session of the legislature to lay out his plan for dealing with state’s current $2.2 billion budget shortfall. His plan calls for significant cuts or eliminations across 375 state programs and withholding $500 million of state education aid. Of note on the program side is a $12.6 million reduction in Charity Care funding to hospitals, which pays for care to uninsured residents. In legislative action, the Assembly Financial Institutions and Insurance Committee held a three-hour public hearing on out-of-network reimbursement. Much of the hearing focused on the markedly higher billing practices of ambulatory surgery centers and one non-par hospital. Aetna presented testimony regarding its experience with the non-par hospital, citing their disparate year-over-year increase in charges compared to other similarly situated hospitals. Chairman Schaer indicated the committee will work over the next several months to craft a solution.

NEW YORK: With Democratic Senator Hiram Monserrate officially expelled from the Senate, the Democratic majority (31-30) now faces an uphill battle getting the 32 votes needed to pass legislation. However, both the Senate and the Assembly moved forward with a public hearing on the Executive Budget proposal for health, including the section mandating the prior approval of rate adjustments. The Health Plan Association testified on behalf of the industry. If enacted, Governor Paterson’s proposal for an 85 percent medical loss ratio and a prior approval hearing process for all rate adjustments would essentially amount to government control of health insurance, undermining the private health insurance market in New York. Price controls would weaken health plan solvency, hurt providers and virtually eliminate innovation and efficiency. At the same time, the proposal ignores the underlying cause of the increasing cost of health insurance — the increase in the actual costs of health care services.

OKLAHOMA: The second session of the 52nd Oklahoma Legislature convened in Oklahoma City on February 1. Legislators quickly turned to the state’s $1.3 billion budget deficit described by Governor Brad Henry (D) in his eighth and final state of the state address and FY 2011 executive budget. During his address, the Governor focused on his plans for resolving the $1.3 billion budget deficit through precise budget cuts. His only reference to health insurance was to encourage the expansion of Insure Oklahoma, a program developed by the state in partnership with small employers to provide affordable health coverage. The legislature is scheduled to adjourn on May 28 but only after addressing a range of legislation including several bills of interest to Aetna.

SOUTH DAKOTA: A dental fee schedule bill (S.B. 108) unanimously passed the Senate Commerce Committee and is expected to be taken up by the full Senate early this week. The bill prohibits any contract between a health insurer that offers a health benefit plan and a dentist from containing a provision that requires the dentist to accept a fee schedule for services unless the service is a covered service. Aetna will continue to follow the bill’s progress as it progresses.

TENNESSEE: Several bills have been proposed that would make changes to the state’s external review law. Aetna and other industry representatives will be meeting with the Tennessee Department of Commerce and Insurance regarding its proposed changes to the external review law. The bill proposed by the TDCI most closely mirrors the model legislation proposed by the National Association of Insurance Commissioners.

UTAH: The Speaker of the House has introduced a health reform bill addressing health information technology, individual and small group market reforms and transparency. The overarching theme of the reforms is micromanagement of rates and rating factors, and a broadening of the Insurance Commissioner’s authority. The transparency provisions apply plan designs and benefit descriptions submitted by carriers, and would require providers to make available, upon request, a price list for services on both an inpatient and outpatient basis.