icon-address.png

109 Sable Trace Lane
Acworth Ga, 30102-7621

icon-phone.png

Phone/Fax: 678-574-8421

ACA weekly update March 30, 2015

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.

Federal

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

 

ACA weekly update March 23, 2015

March 23, 2015

A new Kaiser Family Foundation poll shows the gap in favorable vs unfavorable views of the Affordable Care Act (ACA) has narrowed in recent months. With approval rates at their highest point in two years, 41 percent say they have a favorable view vs 43 percent who have an unfavorable view of the law. Despite recent publicity, the U.S. Supreme Court case concerning the legality of subsidies provided through the federal marketplace does not appear to be on the public's radar. The poll found that 53 percent have heard nothing about the case while 25 percent have heard only a little. However, 62 percent believe that the impact on the country will be negative if the court limits subsidies to state-run exchanges only. In that event, 65 percent believe Congress should pass a law allowing the availability of subsidies to continue in all states.

Federal

Negotiations around a new Medicare sustainable growth rate (SGR) package continue on Capitol Hill. The House last week released a bill to repeal the flawed Medicare physician pay formula in favor of a value-driven payment system. Similar legislation has been introduced in the Senate. Details around how to pay for higher costs under the new payment system and a vote on the legislation are expected this week. The current payment patch expires March 31, 2015. Provisions of the package include a two-year extension of the Children's Health Insurance Program (CHIP), and Medicare physician payments that will rise by 0.5 percent a year for five years.

Reps. David McKinley (R-WV), Jerry McNerney (D-CA) and Tom Price (R-GA) introduced legislation last week to coordinate post-acute care for Medicare patients by bundling payments. The Bundling and Coordinating Post-Acute Care Act would allow post-acute care providers to manage a patient's care for up to 90 days, using a bundled payment initiated on the day of discharge from the hospital. The legislation aims to reduce hospital readmissions by holding providers accountable for their costs and rewarding those whose total cost of care is lower than the payment amount.

The House Budget Committee has passed the GOP's 2016 spending bill by a vote of 22-13. It will now go before the full House for a vote. 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, Senate Budget Committee Chairman Mike Enzi (R-WY) released the Senate budget resolution last week. The resolution includes "reconciliation" instructions for the Senate Finance Committee and the Senate HELP Committee, directing them to recommend changes to laws within their respective jurisdictions. Other 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.

From Aetna health reform weekly

 

ACA weekly update March 16, 2015

March 16, 2015

The recently concluded marketplace open enrollment results show that 11.7 million Americans signed up for coverage in 2015. The numbers also reveal that 87 percent of those signing up through Healthcare.gov qualified for an average tax credit of $263 per month. Subsidies to consumers for health coverage bought through the federal marketplace are at risk, as the U.S. Supreme Court weighs whether the subsidies are illegal. The Department of Health and Human Services (HHS) report states that Florida has the most to lose, with nearly 1.5 million residents qualifying for tax credits. In addition, 1 million Texans qualify for tax credits. The report also shows that more than 4.1 million people under age 35 bought health care coverage in the recent open enrollment process – an improvement in the number of young people who signed up vs last year. But the number of minorities buying coverage dipped somewhat.

In other news, the Congressional Budget Office last week cut its forecast of what the federal government will spend on health care in the coming years, reducing the size of the federal deficit.

Federal

Negotiations began in the House of Representatives last week on repeal of the Medicare Sustainable Growth Rate (SGR) formula. In addition to replacing the formula used to determine Medicare physician reimbursement rates, the legislative package could include a two-year extension of the Children's Health Insurance Program (CHIP), a provision on ICD-10, and inclusion of Medicare extenders. Only a portion of the cost of repeal would be paid for, as well as the cost of a small update in payments to providers and the Medicare extenders that normally ride with the "doc fix." The negotiations include staff for Speaker John Boehner (R-OH), Minority Leader Nancy Pelosi (D-CA) and the committees with health jurisdiction.

Sens. Tammy Baldwin (D-WI) and John Thune (R-SD) have reintroduced a bill that would expand the use of Medicare data under CMS's Qualified Entity program. The program allows organizations to access and analyze Medicare claims data for select purposes. The Quality Data, Quality Healthcare Act would allow organizations to analyze Medicare data and redistribute it to authorized users, such as health plans and providers, so they can make informed decisions. The bill would also allow data analyzers to charge a fee to subscribers for their work. Rep. Paul Ryan (R-WI) has backed similar legislation in the last two years.

The U.S. Supreme Court last week ordered the 7th Circuit Court of Appeals to reconsider its decision in a case brought by the University of Notre Dame concerning the Affordable Care Act's (ACA's) contraception requirement. The university asked the high court to review the case after the appeals court ruled that the school's beliefs were not violated by the third party accommodation available to nonprofits with religious objections to the contraception requirement. The order comes after the Supreme Court's ruling in Burwell v. Hobby Lobby, in which it ruled that closely held for-profit companies are exempt from the requirement if they have religious objections. The 7th Circuit will now rehear the case in light of that ruling.

CMS last week announced a new "next generation" model ACO that will seek to lower cost and improve quality through enhanced coordination of care and patient engagement. The new models will encourage patient engagement by offering rewards when a person gets care from an ACO provider. The agency expects between 15 and 20 ACOs to participate, with a minimum of 10,000 beneficiaries each. The first round of applications will be due June 1, with the goal of launching within six months.

From Aetna health reform weekly