Wednesday, May 5, 2010

Humana: ASES incapable of becoming single payer in health reform - Puerto Rico Daily Sun - Timely news about Puerto Rico, the Caribbean and the world

Humana Health Plans opposed Tuesday a Senate bill that would take health insurance companies out of health reform and allow the Health Insurance Administration, known as ASES, to directly negotiate and contract the hospitals, pharmacies and doctors that serve program participants.
Humana’s director of Government Affairs, Héctor A. Mujica, questioned ASES’s ability to become a single payer, as he said health reform’s financing has fallen primarily on the health insurance companies providing service.
“Even though the contract states that ASES will advance the monthly premiums to the insurance companies, such premiums, as in previous years, are not paid on time, forcing insurance companies to continue making payments to health care providers to prevent the collapse of the system. Will ASES be able to confront the situation of being the only health reform insurer?” he asked during a Senate hearing.
But the Justice Department, in written remarks, said many of the concerns addressed in Senate Bill 1403 are taken care of in the health reform overhaul proposed by Gov. Fortuño during his budget speech last month. The governor said health reform would become the “Mi Salud” or My Health program, which includes the availability of a health insurance plan for private companies.
Mujica also expressed concerns that ASES is “light years” away from fully becoming automated. He noted that ASES officials recently said it would take them at least 18 months and that the recent government layoffs will make it more difficult for such a plan to be implemented.
He said most health care providers oppose the repeal of the health insurance companies out of health reform as well as making ASES the single payer. “It is evident that there is no trust in the government’s ability to pay, according to contractual obligations,” he said.
The legislation, he said, will cause the immediate layoffs of some 1,500 associates whose jobs would be eliminated if ASES becomes a single payer. “We asked ourselves, what would be the impact on the thousands of providers who decline to contract directly with the government?” he asked.
The health insurance executive expressed concerns that the Medical Assistance Program will be eliminated and that the evaluation on eligibility will go to the Treasury Department. He said ASES expressed concerns that the federal government may not award funds to an agency that is not compatible with the Health Department.

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