Weekend Update

Congress will be in session again this week as the Hill’s Floor Watch explains.

OPM Director John Berry’s term of offfice ends today. Executive Gov reports that the interim OPM Director will be Elaine Kaplan who has been serving as OPM’s General Counsel during Mr. Berry’s directorship.  President Obama recently nominated Ms. Kaplan to a judgeship on the U.S. Court of Federal Claims.

The Washington Post reported on last week’s FEHBP oversight hearing  as did Fierce Healthpayer.com. The Post article notes that “Rep. Darrell Issa (R-Calif.) [who chairs the House Oversight and Government Reform Committee that oversees the FEHBP] and Del. Eleanor Holmes Norton (D-D.C.) both expressed concern about cherry-picking by regional PPOs if those plans are allowed to participate in the benefit program.”  The FEHBlog heard Mr. Issa suggest at the hearing that OPM initiate a pilot program. 

Govexec.com reports that the federal employee unions are lambasting the President’s budget proposals relating to federal employment compensation and benefits.  Of course, the President’s FEHBP budget proposals were a topic of discussion at the oversight hearing last week. The article notes that 

Obama’s budget would shift costs of the Federal Employees Health Benefits Program to require employees to pay more in order to save the government $8.4 billion over a decade while also seeking to modernize the program. The Office of Personnel “would be given authority to make adjustments to premiums based on an enrollee’s tobacco use and/or participation in a wellness program,” the proposal said. Union officials said they worried the government could charge higher rates to sick or obese employees.

This horse, however, already as left the barn as the Affordable Care Act permits exactly such adjustments to be made to group and individual health insurance premiums. The ACA regulators recently issued proposed regulations implementing this law for 2014 which healthcare.gov trumpets as protecting the interests of consumers.

Reuters reports a very troubling development. Reuters reports that a Nevada jury socked United Healthcare affiliates with a $524 million damages judgement in a case brought by two women who contracted Hepatitis C due to the unsafe injection practices of their gastroenterologist.  United Healthcare was drawn into the case because the doctor was in a UHC affilates’s provider network. Counsel and Heal News notes that  “The defense of the insurance companies was hurt when the judge refused to let them show evidence that their administrators had not uncovered any proof of wrongdoing in the doctor’s office or that the administrators had followed accepted practices.” Bloomberg News further reports that the defendants could not introduce evidence that the doctor is being put on trial for second degree murder. Bad cases do make bad law. Health plans need to proclaim the independent contractor relationship that exists between their network providers and themselves and publicize their accreditation procedures. (For all I know UHC took these steps but cases like this should lead health plans to engage in risk management analysis.)