Health Care Reform Implementation Update

On Monday, December 13, a federal court in Virginia ruled that key parts of the Patient Protection and Affordable Care Act (PPACA) are unconstitutional. U.S. District Judge Henry E. Hudson, a George W. Bush appointee, said PPACA’s requirement that most Americans carry insurance by 2014 or pay a fine "exceeds the constitutional boundaries of congressional power." The lawsuit, brought by Virginia Republican Attorney General Ken Cuccinelli, is the first court ruling against the law since President Barack Obama signed it in March.

Also this week, Congress passed legislation that postpones a cut in Medicare reimbursement rates to doctors for another year. The measure (HR 4994) blocks a 25 percent reduction in pay rates that was due to take effect January 1 for doctors who see Medicare patients. It instead extends current payment rates through 2011, at an estimated cost of $14.9 billion over 10 years. The American Medical Association and President Obama will be working closely with Congress to develop a more long-term solution.

On Wednesday, December 8, the Florida Senate revived a proposed constitutional amendment designed to block the portion of the PPACA that requires people to buy insurance or face a penalty. The proposed amendment for the 2012 ballot easily passed the Senate Health Regulation Committee along party lines, and is the first measure the legislature has taken up in preparation for the spring lawmaking session.

In Arkansas, legislation filed by a pair of Republican lawmakers also proposes blocking the portion of the health care overhaul that requires people to buy health insurance.

Elizabeth Edwards passed away on Tuesday, December 7. In Obama’s statement on her death, he said, "She was a tenacious advocate for fixing our health care system and fighting poverty, and our country has benefitted from the voice she gave to the cause of building a society that lifts up all those left behind."

Also this week, a few sources, including the New York Times, highlight Arizona’s decision to eliminate coverage for certain heart, liver, lung, pancreas, and bone marrow transplants. The articles highlight that the health rationing Republicans have warned the new health care law will cause is already occurring in pre-reform health care, and that in Arizona it is being carried out by Republicans.

Arizona Governor Jan Brewer said Thursday she will ask for a waiver under the federal health care overhaul so Arizona can reduce its Medicaid rolls to lower costs that Brewer and fellow Republicans say the cash-short state cannot afford. If approved, the change could mean the loss of government-funded health care for hundreds of thousands of people. Brewer also is taking two other approaches to seek relief from the health care overhaul’s mandates. One is to ask Congress to change the federal law, and the other is participation in a multistate lawsuit challenging the overhaul.

On Thursday, December 9, the Department of Health and Human Services (HHS) offered new guidance on "mini-med" health plans, making clear that only under two limited circumstances can insurers who have received waivers continue offering limited-benefit health plans. Additionally, HHS said it would require companies to alert consumers that such insurance does not meet the minimum coverage standards required under the health care overhaul law.

This Thursday, December 16, Health Affairs will hold a conference titled "Innovations in Health Care Delivery." On Friday, December 17, the the Health Information Technology Standards Committee will meet to discuss reports from its workgroups. On Monday, December 20, the Center for American Progress will hold a panel discussion titled "Moving Our Health Care System Forward: Accountable Care Organizations and Beyond."

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Posted in ACO, CHIP, CMS, HHS, Jan Brewer, Ken Cuccinelli, Medicaid, Medicare, MedPAC, NCQA, PPACA, President Obama, Washington, D.C.

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