109 Sable Trace Lane
Acworth Ga, 30102-7621


Phone/Fax: 678-574-8421

ACA update week of October 12, 2015

Week of October 12, 2015
A new analysis published by The Commonwealth Fund found that the United States continues to spend far more on health care than other high-income nations, driven by greater use of medical technology and higher prices. More frequent doctor visits and hospital admissions were not factors. In fact, with only four per year, Americans had fewer physician visits than residents of other developed countries. Americans also experienced poorer results on several key health outcomes measures.


President Obama on Wednesday signed the Protecting Affordable Coverage for Employees Actinto law. Widely supported by Democrats and Republicans, the bipartisan "fix" to the Affordable Care Act (ACA) allows states to determine whether or not to expand the small group health insurance market to firms with between 51 and 100 employees.

Senator Ron Wyden (D-OR) has released a bill meant to prevent a potential Medicare premium spike of up to 52 percent for one-third of Medicare beneficiaries. The ranking member of the Senate Finance Committee is just one of many lawmakers—including House Minority Leader Nancy Pelosi (D-CA)—pursuing a fix to the coming Medicare Part B rate spike.

The Centers for Medicare and Medicaid Services (CMS) is pushing ahead with the third stage of rulemaking on meaningful use, an Electronic Health Records (EHR) incentive program.

Top pharmaceutical executives expressed their concerns over the Trans-Pacific Partnership (TPP) trade deal during a meeting at the White House with President Obama. Focused on the lack of 12-year monopoly protections for biologic medicines, the industry has spoken out against the trade pact.


GEORGIA: The state Senate study committee held its first hearing on "surprise billing" with consumers describing cases of financial hardship caused by surprise balance billing. Representatives of the state medical association, hospital association, AHIP and employers also testified. In its testimony, AHIP referenced its recent report which found a pattern of average billed charges submitted by out-of-network providers that far exceeded Medicare reimbursement for the same service.

From Aetna health reform weekly


ACA update week of October 5, 2015

Week of October 5, 2015
Congress may be more willing to consider less dramatic fixes to the affordable care act. The House of Representatives and the Senate have passed a bill that would allow states to treat businesses with 51-100 employees as large employers while retaining the option to classify these groups as small employers. The bill now heads to the President's desk for his signature or veto.


One of several health care industry leaders called to testify last week at a hearing of the House Judiciary Subcommittee on Regulatory Reform, Commercial and Antitrust Law, Aetna Chairman and CEO Mark T. Bertolini said Aetna's proposed acquisition of Humana is a way to accelerate the transition from a volume-based health care system to a value-based system that improves the overall health of members. Both companies, he noted, already have a strong record of helping consumers have more "healthy days" through accountable care relationships and will build on that record together. "The Aetna and Humana transaction brings together two highly complementary businesses in a sector that will continue to be marked by significant and dynamic competition. Combining these companies will enable us to offer consumers a broader choice of products, access to higher quality and more affordable care, and a better overall experience in more geographic locations across the country."

The Department of Health and Human Services (HHS) has announced that insurers would receive $362 million in payments as part of the ACA's risk corridors program. The $362 million is far less than the $2.9 billion that insurers requested, raising questions about the long-term sustainability and usefulness of the program.

A bipartisan group of senators and representatives signed letters to the Centers for Medicare and Medicaid Services (CMS) urging the agency to rescind proposed cuts for colorectal cancer screening reimbursement rates. Earlier this year, CMS proposed rate cuts of up to 20 percent. The lawmakers indicated that colorectal cancer is a major concern for Medicare beneficiaries, and that cuts in physician reimbursements could reverse recent progress.

The House Ways and Means Committee has requested information from CMS regarding the agency's oversight of co-op insurers promoted by the ACA. In the wake of the collapse of Health Republic Insurance of New York—the largest co-op bankruptcy to date—committee members asked CMS to reveal which other co-ops have been placed under "enhanced oversight."

From Aetna health reform weekly


ACA update week of September 28, 2015

Week of September 28, 2015
The New Kaiser Family Foundation research found that single and family premiums for employer-sponsored health insurance in 2015 rose by an average of 4 percent, consistent with the modest increases seen over the past decade. But the survey also found that workers' out-of-pocket costs are rising at a much faster rate, with a 67 percent increase in deductibles since 2010.


The CEOs of Aetna and Anthem, as well as other public policy leaders, testified last week before the U.S. Senate's Judiciary subcommittee on consolidation in the health care industry. Mark T. Bertolini, Chairman and CEO of Aetna, noted in his testimony that the health care industry is undergoing fundamental changes, such as the shift to new value-based health care. Regarding Aetna's pending acquisition of Humana, Bertolini said, "Both Aetna and Humana are committed to building a first class health services business designed to deliver value-based care that keeps our customers healthy." He also noted that there still will be robust choice and competition in the Medicare market post-merger. "While this deal is primarily about Medicare, coming together will enable us to offer more consumers a broader choice of products and access to higher quality and more affordable health plan options."

The Congressional Budget Office (CBO) released a report indicating that the Restoring Access to Medication Act of 2015, which would permit consumers to purchase over-the-counter medications with Health Savings Accounts, would cost $6.6 billion over the next decade. The bipartisan bill passed the House Ways and Means committee in early September.

A bipartisan group of House lawmakers is calling for a delay in implementation of the Centers for Medicare and Medicaid Services' (CMS) new payment program, bundling hip and knee surgeries. In a letter sent to CMS Administrator Andy Slavitt, lawmakers expressed concern over the potential impact on quality and access to care.

The Government Accountability Office (GAO) recommended that CMS increase its oversight of state health care marketplaces by ensuring CMS executives are involved in IT funding decisions and system testing before public operation begins. The Department of Health and Human Services (HHS) concurred with the GAO's recommendations.

From Aetna health reform weekly