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ACA update week of June 22, 2015

Week of June 22, 2015

With a decision looming in the U.S. Supreme Court's King vs. Burwell case, the federal Department of Health and Human Services (HHS) has granted conditional approval to the governors of Delaware, Arkansas, and Pennsylvania to begin establishing state-based health insurance marketplaces. All three states can bring small business exchanges online in 2016, though Delaware will not be permitted to open its individual marketplace until 2017. However, any state looking to set up a state-run exchange in time for 2016 faces significant hurdles.


The White House is threatening to veto a bill that would repeal the Affordable Care Act's (ACA) medical device tax. The House bill was overwhelmingly approved by 234 Republicans and 46 Democrats, enough to override a presidential veto. The White House claims the legislation "would take away a funding source for financial assistance that is working to improve coverage and affordability."

A bipartisan group of 44 House members, led by Reps. Renee Ellmers (R-NC) and Ron Kind (D-WI), signed a letter opposing the use of funds allotted for Medicare Part D as an offset for 21st Century Cures legislation. The "pay-for" would require approximately $7 billion from Part D plans, which the letter calls "effectively a tax on America's seniors."

The House approved five bills intended to improve Medicare Advantage by providing more detailed enrollment data (H.R. 2505), improving payment rate transparency (H.R. 2507), authorizing a test of value-based insurance strategies for chronic patients (H.R. 2570), strengthening Medicare Advantage's risk adjustment model (H.R. 2582), and protecting customers whose coverage options may be unfairly limited due to current Star Rating rules (H.R. 2582).
The House Energy and Commerce Subcommittee on Health held a hearing last week examining Rep. Tim Murphy's (R-PA) re-introduced Helping Families in Mental Health Crisis Act (H.R. 2646). Murphy's bill has been adjusted since its inception in 2013, replacing mandates for court-ordered outpatient treatment with incentives, and limiting access to patient information.

The House Appropriations Subcommittee passed a spending bill for fiscal year 2016 that provides $71.3 billion, $64.4 billion, and $11.8 billion for the departments of HHS, Education, and Labor, respectively. The bill appropriates funding for the risk corridors program, but no funds from the Federal Hospital Insurance Trust Fund or the Federal Supplemental Medical Insurance Trust Fund can be used to support risk corridor payments.

From Aetna health reform weekly


ACA weekly update June 15, 2015

Week of June 15, 2015

A new Urban Institute study has found that the percentage of workers offered health insurance coverage through their employers has remained unchanged under the Affordable Care Act (ACA). Some critics warned that the law would result in an erosion in employers who offer health benefits to employees, but the study's authors predict that coverage rates will remain stable in the coming years.


Reps. Diane Black (R-TN) and Mike Thompson (D-CA) have introduced the "Commonsense Reporting and Verification Act of 2015," which would help ease some employer reporting requirements under the ACA. The bill includes provisions to reduce the collection of Social Security numbers, and to reduce administrative costs by allowing electronic communication.

Department of Health and Human Services (HHS) Secretary Sylvia Burwell testified before the House Ways and Means Committee last week on the proposed 2016 HHS budget. The discussion covered ACA implementation and the U.S. Supreme Court's upcoming decision in the King v. Burwell case, which concerns the use of subsidies on federally facilitated exchanges. Secretary Burwell indicated that the administration will review any ACA-related legislation it receives following the decision based on accessibility, affordability and quality.

Senator Bill Cassidy (R-LA) has introduced legislation that would give states three options following the Supreme Court's ruling in King v. Burwell. The "Patient Freedom Act" would allow states to either 1) continue implementation of the ACA, with subsidies, through a state-based exchange; 2) continue to apply the ACA requirements, but possibly without subsidies, in states using the federal exchange; or 3) establish a new market-based alternative to health care reform.
Senate Health, Education, Labor & Pensions (HELP) Committee Ranking Member Patty Murray (D-WA) and 30 other senators have introduced the "Affordability is Access Act" to amend the ACA and require coverage of oral contraceptives, without a prescription, once approved by the Food and Drug Administration (FDA) for over-the-counter use. The bill also calls on the FDA to approve applications by entities researching oral birth control if it determines that such oral birth control meets safety, efficacy and quality requirements for over-the-counter use.

The House Appropriations Subcommittee on Financial Services and General Government passed an appropriations bill that restricts the use of ACA implementation funds. The legislation would prohibit this funding from being used to implement the ACA's individual mandate.

Sens. Mark Warner (D-VA) and Johnny Isakson (R-GA) reintroduced legislation to provide Medicare coverage to individuals who have serious illnesses and choose to have voluntary conversations with their doctors about end-of-life care. The Care Planning Act of 2015 would reimburse health care professionals for discussions about patients' illnesses and treatment options.

From Aetna health reform weekly


ACA update week of June 8, 2015

Week of June 8, 2015

Final enrollment in 2015 marketplace plans across the country stands at 10.2 million, according to the Centers of Medicare and Medicaid Services (CMS). CMS reported earlier this year that 11.7 million had enrolled for 2015 coverage, but many never paid the premium after enrolling. The report also shows that 6.4 million Americans receive subsidies in the federally facilitated marketplaces and could stand to lose those subsidies if the U.S. Supreme Court rules against the government in the King vs. Burwell case.


The House Ways and Means Committee approved 10 individual bills addressing health policy issues. The bills passed include:

The Securing Care for Seniors Act, which would direct CMS to reevaluate and make changes to the Medicare Advantage (MA) risk adjustment model.
The Seniors' Health Care Plan Protection Act, which would delay through the end of 2018 the authority of the HHS Secretary to terminate MA contracts based on quality ratings.
The committee also approved two ACA-related bills: a bill that would repeal the ACA's Independent Payment Advisory Board and a bill that would repeal the ACA's medical device excise tax.

The Centers for Medicare & Medicaid Services (CMS) has released a final rule updating the Medicare Shared Savings Program (MSSP). The goal is to encourage the delivery of high-quality care for Medicare beneficiaries. The rule includes increased emphasis on primary care services in the beneficiary assignment methodology, and refined policies for resetting ACO benchmarks to improve patient care and generate cost savings.

House Budget Chairman Tom Price has reintroduced a bill to transition the ACA if the U.S. Supreme Court rules against the government in King v Burwell. The RESCUE America's Health Care Act would establish "individual health pools" for individuals and small employers, and provide refundable tax credits for insurance coverage. It would also repeal several aspects of the ACA, including all of the insurance reforms in Title I and provisions related to Health Savings Accounts.

The Senate Joint Economic Committee held a hearing last week "Examining the Employment Effects of the Affordable Care Act." The hearing included a discussion of the law's impact on small businesses, as well as the results of the change in the full-time definition of employment.

From Aetna health weekly