Health Care Reform Implementation Update – June 18, 2013

Last week the House Committee on Ways & Means Health Subcommittee held a hearing on Medicare overhaul proposals affecting post-acute care; the Congressional Budget Office (CBO) wrote to House Budget Committee Chairman Paul Ryan announcing that it will not update its 10-year budget baseline in August, which extends the low cost estimate of the Medicare Sustainable Growth Rate from February; the Medicare Payment Advisory Commission (MedPAC) released its annual Report to the Congress on Medicare and the Health Care Delivery System; proposed rules from the Centers for Medicare & Medicaid Services on exchange, SHOP, premium stabilization programs and market standards were filed; the Arizona legislature passed Medicaid expansion; and the Obama administration decided to stop its attempts to block over-the-counter access to the morning-after contraceptive pill.


On June 13, Sen. Ron Wyden (D-Ore.), who could take over the Senate Finance Committee in 2015, announced  that he is planning to tackle Medicare reform by focusing on chronic disease. He suggested that ACOs should be encouraged to specialize in particular chronic conditions.

On June 14, the House Committee on Ways & Means Subcommittee on Health held a hearing focused on reforming payment for care delivered after a hospitalization in the Medicare program.

On June 12, Sens. Marco Rubio (R-Fla.) and Orrin Hatch (R-Utah) offered several immigration amendments, one of which would limit immigrants’ access to health subsidies under the Affordable Care Act. Immigrants who came to the United States illegally and go through the legalization process would be prevented from getting these subsidies for five years after they receive green card status.

The Federal Bureau of Investigation (FBI) is beginning to pay attention to congressional staffers in its pursuit of tracking down the connection between the Medicare Advantage rate announcement and Wall Street’s early knowledge of it.


On June 13, the Congressional Budget Office wrote to Chairman of the Committee on the Budget Paul Ryan saying that it will not update its 10-year budget baseline in August. This is a positive development for providers because it means the lower price of replacing the Medicare SGR unveiled in February will run through November.

The Centers for Medicare and Medicaid Services (CMS) will be publishing a proposed rule on Exchange, Shop, Premium Stabilization Programs, and Market Standards on June 19.  The proposed rule provides financial integrity and oversight standards with respect to Affordable Insurance Exchanges; Qualified Health Plan issuers in federally facilitated exchanges; and states with regard to the operation of risk adjustment and reinsurance programs. It also proposes additional standards with respect to agents and brokers.

Surgeon General Regina Benjamin announced that she plans to leave the position she has held since 2009. The Deputy Surgeon General, Boris Lushniak, will be the acting surgeon general while a replacement is sought.

On June 10, the IRS issued final regulations to implement the ACA’s tax on indoor tanning beds. The Affordable Care Act includes a 10 percent tax on the use of tanning beds.

According to data released by CMS, since March 2011, CMS has expelled 14,633 providers from participating in Medicare due to fraud control efforts. The ACA established new screening and review requirements for Medicare participation.

A new report by the Department of Health and Human Services’ Office of Inspector General shows that if the U.S. Medicare program had paid the lowest rates negotiated by private insurers for lab tests instead of Medicare rates, $1 billion would have been saved in 2011.

On June 13, the Medicare Payment Advisory Commission issued its Report to Congress: Medicare and the Health Care Delivery System is available here.


On June 13, the Arizona legislature approved Medicaid expansion legislationOn June 17, Gov. Jan Brewer signed the legislation into law.

Democrats in the Pennsylvania legislature are doing everything they can to force a vote on Medicaid expansion. On June 10, Democrats tried to offer a Medicaid amendment to the state budget to this effect, however the House declined to allow a vote on the proposal. Meanwhile, Governor Corbett continues to negotiate with the Obama administration. On June 12, a coalition of 120 groups brought a delegation of medically vulnerable uninsured Pennsylvanians to Harrisburg to tell their personal stories and urge the legislature and Governor Corbett to expand the state’s Medicaid program.

On June 10, Colorado, which is one of only 16 states setting up its own health insurance marketplace, named 58 organizations to make up the state’s “assistance network” for health marketplace enrollment.

The Ohio Department of Insurance announced that it predicts health insurance premiums in 2014 to rise by 88 percent. The department estimated that the average individual premium will increase from $223 per month to $420 per month under the ACA. A study from Milliman last week suggested a similar outlook, arguing that individual premiums will increase between 25 and 40 percent under the ACA. The announcement was made shortly before President Obama announced the lower-than-expected premium rates in California.

On June 7, Alabama Gov. Robert Bentley signed an executive order to create a commission to review the Medicaid pharmacy program and make recommendations on how to contain the costs in the $600 million program. The commission is to report back to Gov. Bentley by December 1. The governor remains opposed to Medicaid expansion in his state.

Mississippi’s current Medicaid program is set to expire on July 1. Partisan disagreement over Medicaid expansion is keeping the state from moving forward on any Medicaid legislation, putting Mississippi’s current Medicaid population at risk. Democrats in the state want a vote on expansion. Republicans, on the other hand, want to reach a deal with Democrats on Medicaid reauthorization without voting on extension before the vote.

According to Gov. Neil Abercrombie’s office, HHS and CMS have approved Hawaii’s health insurance marketplace plans.  Hawaii’s online marketplace is called the Hawaii Health Connector.

On June 12, the Maine House passed a Medicaid expansion plan that would allow the state to expand Medicaid for three years, while the federal government covers the full cost.  At that point, legislators would have to vote to renew it.  Gov. Paul LePage has said he will veto this legislation.  The plan passed the House 97-51 – had there been two more votes in its favor, it would have had enough support to override the governor’s veto.

Oregon Gov. John Kitzhaber signed legislation designed to address regulatory issues related to biological medicine interchangeability.  While the U.S. Food and Drug Administration (FDA) oversees approval of biologic medicines, policies governing whether one product may be substituted in place of a doctor’s prescription and whether a pharmacist must notify a consumer are covered by state law.

California Insurance Commissioner Dave Jones is seeking to prohibit Anthem Blue Cross from operating on the state’s health exchange for small businesses because of its excessive, repeated rate hikes.


On June 7, President Obama made a speech in California touting the benefits of the ACA and encouraging the uninsured to enroll.  California is a crucial state for enrollment with its nearly six million uninsured individuals.  It is also the largest insurance marketplace in the United States.


On June 11, the Obama administration decided to stop its attempts to block over-the-counter access to the morning-after contraceptive pill.  The Justice Department will now begin putting into effect a judge’s order to have the FDA certify the drug for nonprescription use, rather than appealing the judge’s ruling.


Enrollment in Medicare Advantage plans increased by close to 10 percent in 2013 compared with 2012, according to a Kaiser Family Foundation/Mathematica Policy Research study released June 10.


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

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Posted in ACA, Articles, CMS, doc fix, Health Care Reform Implementation Updates, Medicaid, Medicaid expansion, Medicare, Medicare Advantage, MedPAC, SGR, SHOP, Washington, D.C.

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