March 30, 2015
Last week marked the 5th anniversary of the Affordable Care Act (ACA), which was signed into law on March 23, 2010. The occasion spurred a fresh round of praise from the Obama administration and scorn from the GOP. The source of unrelenting controversy, the law continues to get mixed reviews from researchers and the public. One recent study credits the ACA's tax credits with expanding insurance coverage nationally, while another new analysis predicts that half of those families that received federal subsidies for marketplace coverage last year have a "nasty tax surprise" in store.
In other news last week, the Robert Wood Johnson Foundation released its 6th annual county health rankings, a report that shows early death rates are falling except in the poorest areas of the country. Taking income inequality into account for the first time, the report found that early death rates are higher in low-income counties where smoking rates are higher, and where exercise and treatment adherence rates are lower.
The Senate did not vote on the House-passed Medicare sustainable growth rate (SGR) package before it adjourned for a two-week recess last week. Senate Majority Leader Mitch McConnell (R-KY) stated the chamber would quickly take up the measure when it returned. The House passed the bill on March 26 by a vote of 402-12-5. The White House has officially endorsed the House's SGR package, which includes a two-year extension of the Children's Health Insurance Program (CHIP).
By a vote of 219-208, the House approved the GOP-backed budget bill last week. The budget calls for $5.5 trillion in spending cuts over 10 years, and includes provisions to repeal the ACA's taxes, subsidies, market reforms and mandates. It also would make reforms to Medicaid eligibility expansion, implement a Medicare premium support system beginning in 2024, and merge Medicaid and CHIP into a single program. Similarly, the Senate voted on Friday to pass itsbudget resolution by a vote of 52-46. Provisions of the budget call for repeal of the ACA, Medicare budget savings to extend the program's solvency by five years, an extension of federal CHIP funding, and Medicaid reform based on the CHIP model.
The Senate also approved two Medicaid-related amendments as part of the budget bill. The first would create a deficit-neutral reserve fund to help improve health outcomes of medically complex children in Medicaid and lower costs of caring for them. The measure also would allow for the creation of nationally designated networks in Medicaid. The vote was 96-0. Separately, an amendment was cleared to establish a deficit-neutral reserve fund to protect Medicaid beneficiaries from benefit cuts. That amendment was approved 94-3.
The Senate last week approved a Republican amendment that would establish a deficit-neutral reserve fund to protect Medicare benefits for individuals, as well as bar Congress from considering legislation that would "accelerate the insolvency" of the Federal Hospital Insurance Trust Fund. A second amendment, put forward by Democrats, would have prevented the Senate from considering any legislation to privatize Medicare, cut benefits or increase out-of-pocket spending for prescription drugs without a sign-off from 60 senators. It failed on a procedural vote, 46-53.
Last week, Reps. Brett Guthrie (R-KY) and Tony Cardenas (D-CA) introduced a bill that would keep the small group market confined to business with 50 or fewer workers, blocking implementation of the ACA provision expanding the requirement to 100 workers. HHS is considering whether to go ahead with the expansion in 2016, which actuaries have warned would raise premiums for some groups in the expansion population. However, advocates for the ACA's small business SHOP exchange are urging the administration to proceed with implementation to help stabilize the struggling exchange.
States GEORGIA: A bill that would require coverage for autism treatment disorder services is the subject of last-minute negotiations, with the current session due to conclude on April 2. Discussions revolve around long-term budget dedication for resources to this coverage.
From Aetna health reform weekly