North Dakota Insurance

WASHINGTON A major obstacle to the success of the new Medicare law has evolved in recent weeks: private insurers have said that the Bush administration not to increase their role in disease, when they serve large multinational State regions, such as the White House.

Congress heavily to the increase in payments private health insurance during the past year in the hope that it would be much more Medicare recipients.

But the Blue Cross and Blue Shield plans, the backbone of the nation private health insurance, and other insurers said it was not possible for her to create networks of doctors and hospitals on Main regions like New England or the Middle West.

You want the government to appoint 50 regions, one for each state. That is the preference has explained that, in separate letters to the Bush administration, represented by the Blue Cross and Blue Shield Association and America’s Health Insurance Plans, the head of lobby for the health care industry.

A White House document describes the ideas of President Bush’s disease for revision in March 2003, “State regions of large multinationals,”and it contained a map test 10 regions.

Large health plans regions of force to serve rural areas, they avoid history, management officials say. According to this logic, if a health plan wanted lucrative Medicare business in Chicago and its suburbs, it could serve rural Illinois and Iowa and perhaps Nebraska as well.

But Alissa Fox, Policy Director for Blue Cross and Blue Shield Association, said: “The only way to ensure competition and expand living choices for beneficiaries is 50 State-based regions.”

If the administration insists on the multi-state regions, Ms. Fox said, “it is virtually impossible for most private projects to be ready for the year 2006, as Droge”Vorteile and new opportunities for insurance must be available. The amount of the contribution financial risk increases with the size of a region, she said, insurers must be larger capital reserves and exploitation in a multi-region.

Diana C. Dennett, Executive Vice President of America’s Health Insurance Plans, said his group is also strongly supported the creation of 50 regions.”

Private plans are discouraged to participate in the disease, if it is reassuring and licensing contracts with doctors and hospitals around the country in which they have never done, “said Dennett.

“In many rural areas,’’she said,” providers are not ready, contracts with Medicare Managed Care Plans,”for prices to the detriment of traditional fee-for-service Medicare program.

Several private projects available to Medicare beneficiaries in Boston, for example. But health policy experts say, these plans are not on contracts with doctors and hospitals in areas of New England.

The new Medicare law provides a large role for private plans, from the year 2006. If beneficiaries stay in traditional sick, they can obtain drug coverage subsidized by purchasing private insurance policies, prescription drugs and nothing else. Alternatively, they may be a preferred provider organization or an organization health, maintenance of drugs with doctors and hospital care.

The government must decide, Jan 1 to define how the regions. Insurers say the configuration of regions a significant effect on whether they participate.

C. John Rother, AARP Director of Policy, representing the interests of Americans for the elderly, said the debate over regional boundaries marked “a collision between economic theory and the tradition of state insurance. ”Some economists say large regions maximize competition among health plans, driving down costs. Insurers are not ok.

In accordance with the law, plans and medications prescribed preferred provider organizations must charge the same premiums for all beneficiaries in a region. An objective of this provision is to prevent insurers from discrimination sicker patients. But insurers say it is unrealistic because costs vary widely in large multi-State regions.

Michael B. Unhjem, president of Blue Cross Blue Shield of North Dakota, said he would be interested in a Managed Care Plan Medicare beneficiary in his country, where medical costs are relatively low. But he said it would be extremely difficult to create and sell “a unique product, without variance throughout the région”une premium that is higher COST-Unis.

“PPO’s are usually configured to serve local or state regions, multi-state sectors,’’said Unhjem, whose company has more than 80 percent of the insurance market PHI in North Dakota.

Three Blue Cross Blue Shield plans and different places in New York State. Deborah L. Drill, Senior Vice President of Empire Blue Cross Blue Shield, 28 of 62 counties of the state, said that his company could be the creation of a joint venture with other plans to serve the whole country. But she said she can not see how the company could care for Medicare beneficiaries in other countries.

The new law allows to reverse the decline in the number of Medicare beneficiaries enrolled in private plans. From a peak of 6.3 million, or 16 percent of beneficiaries, in late 1999, the number fell to 4.6 million, or 11 per cent, at the end of 2003. With the new law, the Bush administration believes that 33 percent of beneficiaries are in private plans in 2009.

Sickness officials and their advisers, RTI International, a nonprofit research group, headquartered in North Carolina, oppose the idea of single-state regions. Typically, they say, a region needs at least 200000 Medicare beneficiaries to support a preferred provider organization, and 11 countries are not enough, that test: Alaska, Delaware, Hawaii , Idaho, Montana, New Hampshire, North Dakota, Rhode Island, South Dakota, Vermont and Wyoming.

Richard L. Boals, president of Blue Cross Blue Shield of Arizona, said his company wanted to offer a preferred provider plan to Medicare beneficiaries, but was unable to do when he used humans in other countries.

“It would be simply too heavy to use a PPO disease state lines,’’said Boals and notes that his company has a mandate in Arizona.

United Health Group is one of the few federal health programs with a network of doctors and hospitals. But Mark F. Lindsay, a spokesman for the company, said he would not expressed a preference for large multi-State regions.

Thomas A. Scully, former administrator of the Confederation Centers for Medicare and Medicaid Services, said Medicare patients would be the advantage that “most regions”because they would then have more health plans, which to choose.

“If you want several competing projects,”Mr. Scully said:” You have to multi-State regions.