Health Care Reform Implementation Update - September 11, 2013

by Cozen O'Connor

After spending the past month in their home districts listening to constituents, this week House and Senate members are back in Washington and Congress is back in session. Though the attention of many has turned to back-to-school, back-to-football, and to remembering the events of September 11 and making difficult decisions on Syria, it is not far from anyone’s mind that open enrollment begins in less than one month. The Obama administration is immersed in an all-out push to promote the Affordable Care Act (ACA): The administration is planning a $12 million ad buy in key states, this past weekend Enroll America hosted more than 200 events across the country to promote the ACA, and the Baltimore Ravens have been recruited to help push enrollment in Maryland. Additionally, regulations implementing the Affordable Care Act continue to be released, the Centers for Medicare and Medicaid Services (CMS) has been preparing to inform insurance issuers of their statuses as Qualified Health Providers, the Committee on Energy and Commerce held an ACA hearing on September 10, Senators Rand Paul, Mike Lee and Ted Cruz headlined the “Exempt America Tour” rally on September 10, and the Medicare Payment Advisory Commission will meet to discuss Accountable Care Organizations, Medicare Advantage, dual eligibiles and Medicare Part D on September 12 and 13.


The Internal Revenue Service (IRS) issued a proposed rule for the reporting requirements employers will have to meet under Section 6056 of the ACA, which requires employers to report to the IRS information about their compliance with the employer shared responsibility requirements. Enforcement of the employer mandate was delayed earlier this summer until 2015.

In another proposed rule, the IRS detailed how employers and insurers who provide coverage will report to the government which individuals had what type of insurance and when, so the government can determine who is and is not complying with the ACA’s individual mandate.

On August 30, CMS released the third guidance letter for state Medicaid directors on potential paths for Medicaid shared savings programs. In the first two letters, CMS described the framework for Integrated Care Models and pathways that states may use to implement them in their Medicaid state plans or appropriate waivers and demonstrations. The third letter discusses reimbursement methodologies that can be adopted in the context of Integrated Care Models to incentivize improved quality and outcomes and reduce costs.

On September 6, it became public news that CMS program integrity chief Peter Budetti will leave his post as CMS’s first deputy administrator and director for program integrity.

CMS informed issuers of their qualified health plan (QHP) certification statuses on September 9. Further updates to come.


The Obama administration is planning a $12 million ad buy to promote the Affordable Care Act. The advertisements are reported to begin airing on September 30 in Arizona, Florida, Georgia, Indiana, Louisiana, Michigan, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, Tennessee and Texas, states that are largely led by Republicans and in many cases have been hostile to the ACA.


On September 6, the Congressional Budget Office (CBO) and Joint Committee on Taxation (JCT) released a score of the House bill to delay the individual and employer mandates by a year, H.R. 2668. The CBO and JCT estimate that the legislation would reduce federal deficits by roughly $36 billion over the 2015-2018 period and by roughly $35 billion over the 2014-2023 period.

The House Committee on Energy and Commerce’s Subcommittee on Health held a hearing on September 10 on the ACA’s “Implementation Challenges for States and Job Creators.”

Unions are becoming increasingly frustrated with a general lack of response from the Obama administration to their concerns as changes are made in implementation to respond to concerns of businesses, churches and other religious groups, and Capitol Hill. Unions argue that the ACA could cut employee hours, that Taft-Hartley health plans will be ineligible for subsidies because they are multiemployer plans, and that workers will be forced off their union health plans into the law’s potentially more costly insurance exchanges. On September 5, Chairman of the House Ways and Means Committee Dave Camp (R-Mich.) and Chairman of the Education and Workforce Committee John Kline (R-Minn.) sent a letter to the CBO and JCT requesting estimates on the cost of providing insurance subsidies to union-sponsored insurance plans.

Republicans on the House Committee on Energy and Commerce sent a records request to several groups that were recently named health care navigators requesting details about their organization and instructing the groups to schedule congressional briefings within the next two weeks. Rep. Henry Waxman (D-Calif.) wrote a letter arguing that these requests were an abuse of authority. On September 9, HHS sent a response to Energy and Commerce House members providing information on the navigator grant recipients.


Following the Michigan Senate’s approval of Medicaid expansion last month, the Michigan House approved Medicaid expansion last week. A bill will now be sent to Governor Snyder for signature. Governor Snyder (R) has been pushing for Medicaid expansion in his state despite previous resistance from a Republican-led state legislature. The bill would go into effect 90 days after the current session concludes in December if Gov. Snyder signs it.

On September 3, CMS agreed to allow Indiana to extend an existing program the state has for low-income residents, known as the Healthy Indiana Plan, until at least the end of 2014. Some view this as an indication that the state will expand its Medicaid program under the ACA.

On September 6, CMS approved a one-year extension of Oklahoma's Insure Oklahoma demonstration, which is an existing demonstration to help low-income adults afford health coverage. The demonstration was set to expire at the end of the year.

On September 3, Maryland health officials announced a new partnership with the Baltimore Ravens to promote Maryland’s insurance marketplace.


Enroll America organized 1,000 volunteers to hold more than 200 events across the country to promote the ACA this past weekend. The efforts focused attention on Arizona, Florida, Georgia, Illinois, Michigan, New Jersey, North Carolina, Ohio, Pennsylvania and Texas.

On September 4, the Republican National Committee (RNC) launched a new website and video that highlight local news stories on the cost of insurance under the ACA. The website also features a to-the-second countdown to the “Obamacare Train Wreck.”

On September 4 speaking in Arkansas, former President Bill Clinton urged Congress to revise several issues presented by the ACA. He highlighted an error in the law that prevents a full-time employee’s family from getting subsidized health insurance on the exchange if the individual’s policy is affordable. Clinton also criticized those states that were not taking advantage of incentives for Medicaid funds. He praised Arkansas’ private option Medicaid plan that enables some Medicaid-eligible individuals to use premium assistance to purchase qualified health plans on the state’s exchange.


On September 5, Liberty University filed a petition asking the Supreme Court to review the 4th Circuit Court of Appeals’ decision in Liberty’s case seeking to overturn the ACA’s requirement that employers provide health insurance that covers contraception.

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.

© Cozen O'Connor | Attorney Advertising

Written by:

Cozen O'Connor

Cozen O'Connor on:

Readers' Choice 2017
Reporters on Deadline

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
Sign up using*

Already signed up? Log in here

*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
Custom Email Digest
Privacy Policy (Updated: October 8, 2015):

JD Supra provides users with access to its legal industry publishing services (the "Service") through its website (the "Website") as well as through other sources. Our policies with regard to data collection and use of personal information of users of the Service, regardless of the manner in which users access the Service, and visitors to the Website are set forth in this statement ("Policy"). By using the Service, you signify your acceptance of this Policy.

Information Collection and Use by JD Supra

JD Supra collects users' names, companies, titles, e-mail address and industry. JD Supra also tracks the pages that users visit, logs IP addresses and aggregates non-personally identifiable user data and browser type. This data is gathered using cookies and other technologies.

The information and data collected is used to authenticate users and to send notifications relating to the Service, including email alerts to which users have subscribed; to manage the Service and Website, to improve the Service and to customize the user's experience. This information is also provided to the authors of the content to give them insight into their readership and help them to improve their content, so that it is most useful for our users.

JD Supra does not sell, rent or otherwise provide your details to third parties, other than to the authors of the content on JD Supra.

If you prefer not to enable cookies, you may change your browser settings to disable cookies; however, please note that rejecting cookies while visiting the Website may result in certain parts of the Website not operating correctly or as efficiently as if cookies were allowed.

Email Choice/Opt-out

Users who opt in to receive emails may choose to no longer receive e-mail updates and newsletters by selecting the "opt-out of future email" option in the email they receive from JD Supra or in their JD Supra account management screen.


JD Supra takes reasonable precautions to insure that user information is kept private. We restrict access to user information to those individuals who reasonably need access to perform their job functions, such as our third party email service, customer service personnel and technical staff. However, please note that no method of transmitting or storing data is completely secure and we cannot guarantee the security of user information. Unauthorized entry or use, hardware or software failure, and other factors may compromise the security of user information at any time.

If you have reason to believe that your interaction with us is no longer secure, you must immediately notify us of the problem by contacting us at In the unlikely event that we believe that the security of your user information in our possession or control may have been compromised, we may seek to notify you of that development and, if so, will endeavor to do so as promptly as practicable under the circumstances.

Sharing and Disclosure of Information JD Supra Collects

Except as otherwise described in this privacy statement, JD Supra will not disclose personal information to any third party unless we believe that disclosure is necessary to: (1) comply with applicable laws; (2) respond to governmental inquiries or requests; (3) comply with valid legal process; (4) protect the rights, privacy, safety or property of JD Supra, users of the Service, Website visitors or the public; (5) permit us to pursue available remedies or limit the damages that we may sustain; and (6) enforce our Terms & Conditions of Use.

In the event there is a change in the corporate structure of JD Supra such as, but not limited to, merger, consolidation, sale, liquidation or transfer of substantial assets, JD Supra may, in its sole discretion, transfer, sell or assign information collected on and through the Service to one or more affiliated or unaffiliated third parties.

Links to Other Websites

This Website and the Service may contain links to other websites. The operator of such other websites may collect information about you, including through cookies or other technologies. If you are using the Service through the Website and link to another site, you will leave the Website and this Policy will not apply to your use of and activity on those other sites. We encourage you to read the legal notices posted on those sites, including their privacy policies. We shall have no responsibility or liability for your visitation to, and the data collection and use practices of, such other sites. This Policy applies solely to the information collected in connection with your use of this Website and does not apply to any practices conducted offline or in connection with any other websites.

Changes in Our Privacy Policy

We reserve the right to change this Policy at any time. Please refer to the date at the top of this page to determine when this Policy was last revised. Any changes to our privacy policy will become effective upon posting of the revised policy on the Website. By continuing to use the Service or Website following such changes, you will be deemed to have agreed to such changes. If you do not agree with the terms of this Policy, as it may be amended from time to time, in whole or part, please do not continue using the Service or the Website.

Contacting JD Supra

If you have any questions about this privacy statement, the practices of this site, your dealings with this Web site, or if you would like to change any of the information you have provided to us, please contact us at:

- hide
*With LinkedIn, you don't need to create a separate login to manage your free JD Supra account, and we can make suggestions based on your needs and interests. We will not post anything on LinkedIn in your name. Or, sign up using your email address.