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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