Health Care Reform Implementation Update

On Wednesday (11/10), an official with the National Governors Association told insurance executives at a conference hosted by America’s Health Insurance Plans that the challenges states face in creating health insurance exchanges, coupled with the changed political landscape, may lead a number of states to delay legislative action to create health care marketplaces until 2012. In keeping with this prediction, this week, Wisconsin’s Governor-elect Scott Walker (R) asked outgoing Governor Jim Doyle (D) to temporarily freeze any new implementation of the federal health care law, including the establishment of exchanges. After Walker is inaugurated, Wisconsin will join 20 states in the lawsuit filed in the Northern District of Florida to stop the health care reform.

Friday (11/12) was the deadline to request permission to submit amicus briefs in the case of State of Florida v U.S. Department of Health and Human Services (the 20-state legal challenge to the health care reform law). U.S. District Judge Roger Vinson granted requests by Senate Minority Leader Mitch McConnell (R-KY) and seven other Republican U.S. senators, Rep. John Boehner (R-OH), Minnesota Gov. Tim Pawlenty (R), and 35 organizations. The organizations side with the Obama administration, arguing that health reform is “essential to constraining the growth of health care spending and providing security to all Americans.” The Republican officials argue that Congress does not have the legal authority to "regulate commerce" by taxing the absence of having health insurance.

Some Republican officials at the state level have vowed to do everything in their power to resist implementation of the Patient Protection and Affordable Care Act (PPACA). Two states, Alaska and Minnesota, have refused to apply for Affordable Care Act grant funding to begin designing exchanges. Some states have refused to participate in other reform components, like insurance programs for high-risk individuals. An article in Time argued that state opposition may not have the desired effect – it may invite more federal control over the implementation of reform in states where leaders do not implement PPACA.

Sen. Max Baucus (D-MT), chairman of the Senate Finance Committee and a leading architect of the reform law, vowed Friday to introduce legislation killing a part of PPACA that imposes new tax-filing requirements on small businesses. Sen. Baucus said a provision requiring businesses to report more purchases to the IRS will impose undue paperwork on companies at a time when they can least afford it.

HHS announced Monday (11/15) a slight relaxation of rules issued in June implementing the health care legislation. Consistent with President Obama’s promise that, “if you like your health plan, you can keep it,” the law says health plans that were in existence when the law was enacted are exempt from some of its requirements. The law left to the administration the decisions of how much a health plan could change without forfeiting the exemption. The U.S. Departments of Health and Human Services, Labor, and Treasury issued a regulation in June, which said employer group health plans would lose their grandfathered status if they changed insurance companies. Only self-funded plans, mostly at large companies, would have been able to switch insurance administrators without losing the grandfathering protections. Under the change announced Monday (11/15) though, employers can now shop around and switch insurers without having to come under the new rules, as long as they do not make other big changes to their benefits.

Finally, last Wednesday (11/10), the National Commission on Fiscal Responsibility and Reform released a proposal for reducing the national debt. Among the possible solutions offered was creating a public health insurance option. The draft by the co-chairmen of the White House-sponsored National Commission on Fiscal Responsibility and Reform calls for, among other things, increasing cost sharing for enrollees of Medicare and Medicaid, lowering payments to health-care providers that participate in Medicare, and cutting payments to lawyers as part of an effort to curb medical malpractice lawsuits.

This Wednesday (11/17), the Senate Finance Committee will hold a hearing entitled Strengthening Medicare and Medicaid: Taking Steps to Modernize America’s Health Care System. Congressional Quarterly reports that members of the Senate Finance Committee are eager to ask questions of Donald M. Berwick, Administrator of the Centers for Medicare and Medicaid Services (CMS), at his first congressional hearing as Medicare chief. On Friday (11/19), the Office of the National Coordinator for Health Information Technology Policy Committee will meet to hear reports from its workgroups. Next Monday (11/22), the National Academy for State Health Policy will hold a webcast titled "State to State Exchange on Health Insurance Exchanges." The webinar is an opportunity to hear directly from two states (Maine and West Virginia) about where they currently stand on key exchange design issues.

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Posted in CMS, HHS, Medicaid, Medicare, National Academy for State Health Policy, National Commission on Fiscal Responsibility and Reform, NCQA, PPACA, President Obama, Washington, D.C.

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