Changes To Oregon's Health Plan Led To Disenrollment

The December issue of Health Affairs (Volume 29, Number 12) includes an article detailing the findings of a longitudinal study of Oregon's Medicaid health plan and cost-sharing changes that contributed to a 77% disenrollment rate with 80,000 participants leaving the program over a two-year period.  Policymakers made changes in 2003 that increased premiums, raised cost-sharing, and imposed strict payment deadlines for members in the "Standard" version of the program.  After the changes were imposed, participants in the "Standard" plan were nearly twice as likely to have unmet health care needs compared to participants in the "Plus" plan.   The authors suggest the results are especially relevant for policymakers who may be considering increased cost-sharing in state Medicaid plans in the face of state budget shortfalls. For more information, visit:

Health Affairs: "Raising Premiums And Other Costs For Oregon Health Plan Enrollees Drove Many To Drop Out"

Texas Insurance Commission Forbids Insurer Provisions Allowing Interpretation

On December 6, 2010, the Insurance Commissioner of Texas, Mike Greeslin, formally adopted rules that remove insurers' blanket authority to interpret what their policies cover in Texas.  The Dallas Morning News highlighted the changes and explained that prior to these rules being implemented, health and disability plans often included discretionary clauses that allowed insurers the right to interpret their own policies in deciding what benefits were required to be paid.  In announcing the need for the rule, the Commissioner cited an insurance policy that stated it had "complete discretionary authority" to review all denied claims to determine whether or not policyholders should have received benefits they were seeking.  In addition to day-to-day caregiving issues, caregivers are often forced to work with insurance companies when insurance claims are delayed or denied. As a result of this new rule, consumers will now have the ability to challenge denial of benefits if they consider them unfair, either by contacting state regulators or filing a lawsuit against the company.  Both options were described as nearly impossible previously because of the discretionary clauses. Texas joins 22 other states that have enacted bans on discretionary clauses.  For more information, visit:

Dallas Morning News: "Texas' insurance commissioner forbids insurers' provisions that allowed them to interpret policies"

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Almost Two Million New Yorkers Serve As Caregivers

A recently released report used data from the 2008 Behavioral Risk Factor Surveillance System (BRFSS) survey to estimate that there are 513,023 caregivers in upstate New York who provide an average of 11 hours of care per week.  If the 1.4 million caregivers in downstate New York are included, the total number of caregivers in New York State is 1.9 million caregivers.  The analysis was conducted by Excellus Blue Cross Blue Shield and found that the majority of caregivers are women (61%) and the majority of care recipients (61%) are aged 65 and older, although 35% are in the 18 to 64 age group.  Almost one-third of respondents reported that caregiver obligations affected their employment by either forcing them to take time off or reduce their work schedules while 11% reported retiring or leaving work because of caregiving responsibilities.   The Florida Office on Disability and Health at the University of Florida has conducted analysis on data from several other states that have used the BRFSS survey (and accompanying caregiver modules) to better understand the demographics and numbers of caregivers in their state.  For more information, visit:

Excellus Blue Cross Blue Shield: "Informal Caregiving in Upstate New York"
The Florida Office on Disability and Health at the University of Florida

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