Headlines: May 17, 2010

by Meg Larkin

            Now that the controversial health reform bill has become law, insurers are attempting to influence the regulations that will be used to implement the law.  Two main areas of controversy are the regulatory definitions of what is an “unreasonable” premium increase, and what is considered to be a “quality improvement activity.”  Under the new law, 80-85 percent of premiums must be spent on clinical services or quality enhancing activities.  Insurers are concerned that a narrow definition of quality improvement activities and a broad definition of unreasonable premium increase may make it more difficult for them to maintain their bottom line.  Patient advocates support a narrower definition of quality improvement activities, in order to ensure that the category does not become a catchall for initiatives that don’t actually improve patient care. 

            The legal challenge to the new health care bill has taken another step forward.  In an amended complaint, the National Federation of Independent Business has joined 13 State Attorneys General in the legal challenge to the constitutionality of the new health care law.  The move may serve to de-politicize the lawsuit, but may also enable the plaintiffs to withstand a challenge to their standing to sue.  Two individuals have also joined in the lawsuit as plaintiffs.  In spite of the new entrants into the fray, the lawsuit may still not be ripe for litigation because the individual mandate, which is central to the legal challenge, will not come into effect until 2014.

            In other insurance news, the high costs of mental health care are leading some employers to try to limit access to therapy.  However, the actions by employers may violate the mental health parity act, which was recently signed into law.  Under the law, employers must provide equal access to mental health and other health services.  In Massachusetts, the Group Insurance Commission has begun requiring lengthy phone evaluations to determine the continuing need for therapy.  The evaluations are used as a cost control measure, but because similar oversight is not used to determine the need for specialist physicians, the actions may violate the mental health parity law.

            Finally, a British study has found that working overtime may be bad for your heart. (See second story behind the link.)  The study, which looked at British civil servants found that “People who worked three to four hours longer than their daily seven-hour workday were 60 percent more likely to have one of these heart problems than people who worked no overtime.”  A Boston cardiologist quoted in the Globe hoped that the study would inspire people to look for ways to reduce stress in the workplace.

Meg Larkin is a second year law student at Boston University.  Please feel free to email her with any questions, comments, suggestions, or concerns.