Week of September 14, 2015
A federal judge ruled last week that the House has the right to sue the Obama administration over billions of dollars in health care spending as part of the law's risk sharing programs. However, the judge dismissed a House claim that the Obama administration had improperly moved the deadlines for new employer requirements.
The House Subcommittee on Regulatory Reform, Commercial and Antitrust Law, held a hearing last week on the Affordable Care Act (ACA) and health care competition, during which the issue of health insurance consolidation was raised. Representatives of certain hospital and physician groups testified that currently proposed health insurance acquisitions, including that of Humana by Aetna, could reduce competition. However, Dan Durham, an Executive Vice President with America's Health Insurance Plans (AHIP), testified that, "It is important to recognize that this competition among health plans occurs at the local level in specific geographic areas, and that new coverage options – including those resulting from collaboration between plans and providers – are emerging and evolving on an ongoing basis. The diversity of AHIP's membership – which includes local, regional, and national insurers – reflects the many choices consumers have when shopping for health insurance coverage in their area."
The House Energy and Commerce Committee, Subcommittee on Health, held a hearing on the expansion of the small group market from 50 to 100 employees. The impact of the small group size change is scheduled to take effect in 2016. Legislation in the House of Representatives would amend the ACA to designate employers with 51 to 100 employees as large employers, effectively preventing the expansion.
On September 3, The Department of Health and Human Services (HHS) proposed Section 1557 Non-Discrimination rule under the ACA. The proposed rule extends all civil rights obligations to the health insurance exchanges and other HHS health programs and activities. In addition, the proposed rule establishes that the prohibition on sex discrimination includes discrimination based on gender identity.
The Centers for Medicare & Medicaid Services (CMS) has posted the 2017 proposed Essential Health Benefits (EHB) benchmark plans by state. The ACA requires non-grandfathered health plans in the individual and small group markets to cover EHB within 10 benefit categories.
CMS issued $67 million in ACA Navigator grants to 100 organizations in 34 states to help consumers sign up for health insurance coverage on the exchanges in 2016. Funded organizations can provide consumers with in-person help, answer questions about plan options and financial assistance, and assist consumers in completing applications.
The Center for Medicare and Medicaid Innovation (CMMI) announced a five-year, Value-Based Insurance Design (VBID) Demonstration to begin in 2017. It would test whether or not allowing Medicare Advantage (MA) plans in seven states to target benefits to specific populations will lead to lower costs and better outcomes.
From Aetna health reform weekly