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December 30, 2009
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It’s tough being a most-favored nation. Anthem Blue Cross and Blue Shield of Connecticut, a subsidiary of Indianapolis-based WellPoint Inc., got a tongue lashing from that state’s attorney general for the “most-favored nation” clauses it inserts in its contacts with hospitals. The clauses insist the hospitals give no other insurance plan a discount larger than that given to Anthem. The clauses are preventing some of Connecticut’s hospitals from signing up for a new state-run insurance plan for the uninsured, called Charter Oak. It pays rates lower than those negotiated by Anthem, and many hospitals have refused to join for fear Anthem would insist that the hospitals allow Anthem to lower its payment rates to equal those of Charter Oak. Connecticut Attorney general Richard Blumenthal wrote a letter this month to Anthem asking it to promise not to insist on receiving discounts equal to Charter Oak. “I call on Anthem to break its death grip on hospitals and encourage them to join in this critical health insurance program,” Blumenthal said in a statement. Most-favored nation clauses were banned in Indiana by the General Assembly in 2007.

Even though Wall Street likes the Senate health reform bill, that doesn’t mean rank-and-file insurance professionals do. But in the Christmas spirit, Susan Rider,  president-elect of the Indianapolis Association of Health Underwriters found some positives in the latest version of health reform. She likes that there will be no government-run health plan or an expansion of the Medicare program—although she still does not like the proposed expansion of Medicaid. She likes that a cap on flexible-spending accounts of $2,500 will now rise in line with inflation. She likes that the federal Department of Health and Human Services will not set broker commissions in the newly created insurance exchanges. But she does not like much of the meat of the bill. She thinks the requirement for insurance plans to spend at least 85 percent of premiums on care (80 percent for individual policies) needs to be reduced, likewise the $6.7 billion in annual taxes assessed on for-profit health insurers and the 40-percent tax assessed on insurance policies costing $23,000 or more. Rider said the fines used to enforce the mandate that all individuals buy health insurance will be “completely ineffective” because they will allow Americans to pop in and out of insurance pools only when they need health care services.

This can’t be good for business—especially for a human resources business. Indianapolis-based consultant HR Solutions Inc. was sued in federal court last month for allegedly failing to pay commissions earned by a saleswoman and then firing her the day after she got out of the hospital after a pancreatitis attack. The saleswoman, Candi Marsch of Evansville, wants HR Solutions to shell out back pay, punitive damages and legal fees.

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