Health Care Reform Implementation Update - June 27, 2013

by Cozen O'Connor
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The countdown is on now. Less than 100 days until the Affordable Care Act’s (ACA) main provisions go into effect, and Organizing for Action and Enroll America kicked outreach efforts to the uninsured into high gear last week. Also in the past week, Sens. McCaskill and Coburn lobbied their peers for support of the Hospital Payment Fairness Act, which addresses the wage-index adjustments made by the ACA; the House Ways and Means Health Subcommittee held a hearing on the Medicare Trustees Report and the sustainability of the Medicare program; Sens. Donnelly and Collins proposed a bill that would change the full-time employee standards for purposes of the ACA; the Michigan Senate adjourned for the summer without voting on Medicaid expansion; and the Mississippi legislature was called in for a special session beginning June 27 to take up the Medicaid issue.

 ON THE HILL

One of the Affordable Care Act provisions, which its critics call the “Bay State boondoggle,” requires that urban hospitals get Medicare wage reimbursements at least as high as those going to rural hospitals in the state. The provision benefits nine states, with Massachusetts faring the best, and has caused other states to lose tens of millions of dollars each year since it has been in effect. Sens. Claire McCaskill (D-Mo.) and Tom Coburn (R-Okla.) are supporting legislation that would undo the effects of this ACA provision. The two have been sending letters to other senators in an effort to encourage them to support the Hospital Payment Fairness Act of 2013. Legislation to undo the provision has also been introduced by House Ways and Means Health Subcommittee Chair Kevin Brady, and Reps. Pat Tiberi (R-Ohio), Peter Roskam (R-Ill.), Vern Buchanan (R-Fla.), Aaron Schock (R-Ill.), Tom Reed (R-N.Y.), Mike Kelly (R-Pa.), Jim Renacci (R-Ohio) and Morgan Griffith (R-Va.). The House Republicans’ bill would amend title XVIII of the Social Security Act to apply budget neutrality on a State-specific basis in the calculation of the Medicare hospital wage index floor for non-rural areas. Some affected parties prefer solutions that are not offered by either piece of legislation.

On June 20, the House Ways and Means Health Subcommittee held a hearing on the 2013 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds. In the hearing, Congressman Brady (R-Texas) expressed concern that those in their early 50s could not be guaranteed Medicare. Congressman McDermott (D-Wash.) pointed out that people have always expressed this concern over the course of his 25 years serving. Dr. Edward Blahous explained that the Medicare Trustees Report projected Medicare would have enough money until 2026, two years later than originally projected.

On June 19, Sens. Joe Donnelly (D-Ind.) and Susan Collins (R-Maine) proposed a bill that would change the ACA requirement that employers offer coverage to employees working more than 30 hours per week to 40 hours per week instead. The sponsors argue that a 40-hour/week threshold better matches our  definition of full-time employee.

 House Oversight Committee Chairman Darrell Issa (R-Calif.) subpoenaed documents on a federal attempt to boost consumer oriented and operated plans (CO-OPs), which are nonprofit health plans that compete with traditional health insurance. Rep. Issa is seeking details on how participants were reviewed and accepted for participation in the CO-OP program.

 On June 18, the House voted to impose a nationwide ban on abortions after 22 weeks of pregnancy over Democratic  opposition to a bill they view as representing a significant Republican attempt to restrict abortion rights. 

House Resolution 763 to repeal the annual fee on health insurance providers enacted by the Patient Protection and Affordable Care Act, which was originally introduced in February by Rep. Boustany (R-La.) and Rep. Jim Matheson (D-Utah) now has 222 cosponsors.

 AT THE AGENCIES

On June 26, the Department of Health and Human Services (HHS) issued a final rule explaining the eligibility requirements for individuals seeking an exemption from the individual shared responsibility provision of the ACA. Individuals may receive exemptions through a health insurance marketplace or the tax filing process depending on what type of exemption they seek.

On June 24, HHS launched a new version of Healthcare.gov in an effort to familiarize Americans with the process of signing up for health insurance in the online marketplaces. The website features a chat service, through which individuals are available to answer questions.

The Center for Medicare & Medicaid Services (CMS) Innovation Center hosted webinars last week on Round Two of the Health Care Innovation Awards. Slides from the webinars can be found by scrolling to the bottom of the page here.

On June 19, the Government Accountability Office (GAO) released reports examining CMS efforts to establish federally facilitated health insurance partnerships and federal and state efforts to establish SHOP exchanges. The reports cast doubt on the timely kickoff of health insurance marketplaces under the ACA. Notwithstanding the reports, on June 20, Gary Cohen, the director of the Center for Consumer Information and Insurance Oversight at CMS, said that the health insurance marketplaces were on track to open at the scheduled time.

On June 20, HHS announced that 77.8 million consumers saved $3.4 billion up front on their premiums as insurance companies operated more efficiently. As part of the announcement, HHS also said that consumers across the country will save $500 million in rebates, with 8.5 million enrollees due to receive rebates. The savings are due to the Affordable Care Act’s Medical Loss Ratio rule, which requires insurers to spend at least 80 cents of every premium dollar on patient care and quality improvement. 

IN THE STATES

The Centers for Medicare and Medicaid Services approved Florida’s plan to move a majority of its Medicaid population into managed care.

 On June 17, the former administrator of CMS, Don Berwick, formally launched his campaign for Massachusetts governor.  Berwick previously served as acting administrator of the CMS but was never confirmed by the Senate.

On June 20, the Republican-led Michigan state Senate adjourned for the summer without voting on Medicaid expansion, which Michigan Gov. Rick Snyder had been pressing. According to the Michigan Free Press, Gov. Snyder will not try to legally force the Senate to return from summer vacation for a vote.

On June 20, mayoral candidate Anthony Weiner proposed making New York City a laboratory for a single-payer system if he is elected. As a Congressman, Weiner advocated for Medicare-for-all style health care.

The Mississippi Legislature will return in special session on June 27 to try to fund and re-authorize the Division of Medicaid before it expires on June 30 at midnight. Mississippi’s Medicaid program was not funded or reauthorized for the new fiscal year because of disagreement in the state House over voting on Medicaid expansion. Democrats wanted to vote on expansion, while Republicans wanted to reach a deal with Democrats on Medicaid reauthorization without voting on expansion before the vote.

IN THE WHITE HOUSE

Last week, the fundraising advocacy group that was born out of Obama’s election campaign, Organizing for Action, began rolling ads that highlight provisions of the Affordable care Act.  Enroll America, which is made up of a coalition of insurers, health providers  and activists, launched outreach efforts to raise awareness of the Affordable Care Act and encourage individuals to enroll. Enroll America plans to target the uninsured through door knocking, television and radio advertising, and partnerships with churches, civic groups, hospitals and celebrities.

IN THE COURTS

On June 17, the Supreme Court issued a long-awaited ruling, coming out 5-3 with its decision that “pay for delay” arrangements, where drug companies pay competitors to temporarily keep their products off the market, are not shielded from antitrust attack but also are not presumptively unlawful.

IN THIRD PARTIES

Robert Wah, a DC-area reproductive endocrinologist and ob-gyn was nominated by The American Medical Association as the president-elect.

On June 19, Avalere health released an analysis of new premiums under the ACA, which shows premiums in nine states coming in below the Congressional Budget Office’s estimates.

The association that represents U.S. safety-net hospitals, previously the National Association of Public Hospitals and Health Systems, announced on June 20, that it was changing its name to America’s Essential Hospitals.

A poll released on June 19 by the Kaiser Family Foundation shows that only about one in 10 uninsured people have heard "some" or "a lot" about ACA exchanges.  Half of those surveyed said they have heard nothing at all about them.

To view our compilation of recent health care reform implementation news, click here.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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