Health Care Reform Implementation Update – December 27, 2012


The extended deadline for states to submit plans to run their own insurance exchanges is now behind us. A total of 18 states submitted blueprints to run their own exchanges. The 32 remaining states have until February 15, 2013 to indicate they want to set up a partnership exchange. The states that do not submit partnership applications will have federal exchanges. HHS has now conditionally approved 11 states and the District of Columbia to run their own exchanges. Meanwhile, health care providers wait at the edge of their seats to see if the fiscal cliff talks will include a “doc-fix” to avoid the 26.5 percent cut to Medicare claims starting January 1, 2013.



The deadline for states planning to run their own health insurance marketplaces come 2014 was Friday December 14, 2012. A total of 18 states said they will plan their own exchanges. The states that submitted new blueprint applications the week of the extended deadline are California, Hawaii, Idaho, Minnesota, Mississippi, Nevada, New Mexico, Rhode Island, Vermont and Utah. Some states submitted prior to the Friday deadline, and on Friday, the government conditionally approved those of the District of Columbia, Kentucky and New York. Colorado, Connecticut, Massachusetts, Maryland, Oregon and Washington had already been approved. The 32 remaining states have until February 15, 2013 to indicate they want to set up a partnership exchange.

On Friday (12/14), Iowa Governor Branstad announced Iowa would enter into a partnership with the federal government on its health care exchange.

On Wednesday (12/12), Ohio announced it secured federal approval to participate in CMS’ State Demonstrations to Integrate Care for Dual Eligible Individuals. Ohio is the third state to be approved by CMS for the demonstration project, following Massachusetts and Washington.

On Tuesday (12/11), Utah Gov. Gary Herbert sent a letter asking the Obama administration to approve the health insurance exchange already in place in Utah.



As part of the fiscal cliff negotiations, the White House has called for a permanent fix to the sustainable growth rate as well as $400 billion in health care cuts. Rep. Phil Gingrey (R-Ga.), who serves as co-chairman of the GOP Doctors Caucus said he believes there will be some physician payment fix in fiscal cliff negotiations, likely a one-year fix.

On Thursday (12/13), House Minority Leader Nancy Pelosi (D-Calif.) held a press conference during which she said raising the Medicare age was not on the table in the fiscal cliff negotiations. She further argued that Medicare and Social Security reform do not belong in the negotiations at all.

On Wednesday (12/19), the American Medical Association sent a letter to Senate Majority Leader Harry Reid urging Congress to act immediately to avert the Medicare payment cut to physicians. A cut of 26.5 percent on Medicare claims is scheduled to go into effect starting January 1.



Early in December, 11 governors asked for a meeting with President Obama to negotiate for greater control over their Medicaid programs. The governors were interested in having the flexibility to expand Medicaid more modestly than the Affordable Care Act envisions. A few days later, Acting CMS Administrator Marilyn Tavenner and other CMS officials announced that if states do not expand their Medicaid systems pursuant to ACA requirements, they would not qualify for the full 100 percent funding under ACA either.

The Patient-Centered Outcomes Research Institute announced it is awarding more than $40 million over the next three years to 25 comparative-effectiveness research projects.

A new report by the Government Accountability Office identifies three key examples of the overlap between the CMS Innovation Center and efforts from other CMS offices. To decrease the risk of CMS duplicating payments for services, the GAO recommended CMS Acting Administrator Marilyn Tavenner direct the Innovation Center to review and eliminate areas of duplication expeditiously.

Ten Republican senators wrote the Obama administration urging it to extend the 30-day comment period and allow more review time for three recently proposed regulations: the essential health benefits rule, the health insurance market rules, and the HHS notice of benefit and payment parameters for 2014 rule. The director of the Center for Consumer Information and Insurance Oversight at CMS said he would not consider extending the comment period because interested parties need clarity to be prepared for October.

A temporary (three-year) $63-per-person fee will hit health plans serving about 190 million Americans starting in 2014. The fee, buried in a new regulation, is intended to help pay for individuals with pre-existing conditions. This fee will have to be paid by individual beneficiaries or employers.



The Kaiser Family Foundation posted a new fact sheet that examines the similarities and differences between the Massachusetts and Washington five-year demonstrations to integrate care and align financing for dual eligible beneficiaries.

Findings from a new study by The Commonwealth Fund show the cost of family health coverage rose substantially faster than income between 2003 and 2011.



On Friday (12/14), the founder of Domino’s Pizza filed a lawsuit in federal court suing the federal government over the Affordable Care Act’s mandatory contraception coverage. The founder currently offers health insurance to his employees that excludes contraception and abortion coverage.


About The Author
Tagged with:
Posted in ACA, Affordable Care Act, Articles, CMS, exchange, Health Care Reform Implementation Updates, HHS, Medicare, PPACA

Leave a Reply

Your email address will not be published. Required fields are marked *


About The Hot Button Blog
For many businesses, nothing seems more remote than the maneuvering of Beltway insiders. But what happens in Washington and in state and local government is critically important to your company and your industry. With government more involved in business than at any time since the 1930s, organizations that can negotiate the government labyrinth of politics, policy, and process will come out on top.
Subscribe To Our Posts


Cozen O’Connor Blogs