In the wake of the 6th Circuit’s decision to uphold the constitutionality of the Affordable Care Act in the Thomas More Law Center’s lawsuit, the Thomas More Law Center has filed a petition for certiorari. A new report from CMS’ Office of the Actuary has received much publicity this week. The report said that the rate of growth in U.S. health care spending is expected to increase so that by 2020, health care spending will reach $4.6 trillion, and the government will pay close to half of these costs. HHS officials suggested this week that the next set of regulations it proposes will answer questions about enrollment and eligibility for Medicaid under the Affordable Care Act.
IN THE COURTS
On Wednesday (7/27), the Thomas More Law Center, a Michigan-based legal group, filed a petition for certiorari appealing the 6th Circuit Ruling upholding the Affordable Care Act. The 6th Circuit was the first appellate court to decide whether the Commerce Clause authorized Congress to force private citizens to purchase health insurance under penalty of federal law. Two other Circuit Courts, the 4th and 11th, are expected to reach decisions fairly soon, and other cases are moving through the courts as well. It is unclear how many of these cases will be petitioned to the Supreme Court before its next term begins on October 3.
AT THE AGENCIES
A new report from the Centers for Medicare and Medicaid Services’ Office of the Actuary found that the rate of growth in U.S. health care spending is expected to increase so that by 2020, health care spending in the country will reach $4.6 trillion. The government will pay almost half of these costs. The report also says that by 2014, when many of the reform law’s provisions take effect, spending growth will rise to 8.3 percent. The rise in costs can be attributed to a growing and aging population, more seniors enrolling in Medicare, and the expansion of Americans’ access to Medicaid and private insurance under the Affordable Care Act. The lead author of the report, Sean P. Keehan, said that even though the law is expected to extend insurance coverage to nearly 30 million people, it will only cause the rate of growth to increase slightly. While the law’s supporters highlight these statistics, opponents point out that one of the law’s promises was that it would reduce costs.
The director of the HHS office that administers Medicaid said on Wednesday (7/27) that questions regarding enrollment and eligibility would be answered in the next set of regulations it issues.
In response to a request from HHS, a new report from the Institute of Medicine (IOM) recommends that eight preventive health services for women be added to the services health plans will cover for free to patients under the PPACA: Screening for gestational diabetes; screening for human papillomavirus (HPV) testing, as part of cervical cancer screening for women over age 30; counseling on sexually transmitted infections; counseling and screening for HIV; contraceptive methods and counseling to prevent unintended pregnancies; lactation counseling and equipment to promote breast-feeding; screening and counseling to detect and prevent interpersonal and domestic violence; and yearly well-woman preventive care visits for recommended preventive services.
ON THE HILL
On Thursday (7/28), witnesses at a House subcommittee meeting presented deeply different views of the Affordable Care Act’s impact on small businesses. Brian Vaughn, who owns four Burger King franchises in Georgia, said that the reform law will force him to turn all of his workers into part-time employees. Timothy Jost, a law professor at Washington and Lee University, said that “There is every reason to believe that the [health care law] will not dramatically change the scope of employer coverage in the United States.” Jost said that most studies, including those by Booz Allen Hamilton, The Lewin Group, The Urban Institute, Mercer, and Towers-Watson, predict coverage to remain unchanged for the most part.
Sen. Barrasso (R-Wyo.) introduced legislation, which would give all Americans the opportunity to apply for a waiver from provisions of the Affordable Care Act. The waivers discussed in Barrasso’s bill would be just like the ones HHS has granted to some 1,400 companies and unions. Sen. Barrasso says that to be fair, all Americans, and not just a select few, should have an opportunity to escape the law’s mandates.
THIRD PARTIES
On Wednesday (7/27), a report from the UnitedHealth Center for Health & Reform Modernization released a report that shows rural Americans are more likely to suffer from chronic health conditions and also more likely to face greater difficulty accessing quality health care than those in urban environments. The center found that there are only 65 primary care physicians per 100,000 rural Americans, which is 40 less than the 105 per 100,000 for urban and suburban Americans.
In a new poll by the Kaiser Family Foundation, 48 percent of respondents said, “reducing spending on government programs and services” should play a significant part in a deal for reducing the deficit; 33 percent said it should play a minor role. While only 23 percent said that a tax increase forall Americans should play a major role in the deal, 50 percent said it would be okay for the rich to pay higher taxes under the deal. Additionally, 62 percent said they would not support spending reductions in Social Security, 59 percent said they would not support cuts to Medicare, and 48 percent said they would not support cutting Medicaid.
According to a report from the National Federation of Independent Business, which surveyed small businesses one year after the PPACA’s passage, 12 percent of small businesses have had or expect to have their health insurance plans cut since the passage of the reform law.
IN THE STATES
This week, the Kaiser Family Foundation published a brief on states’ progress in implementing health insurance exchanges to date. According to the brief, more than a third of states have begun laying foundations for exchanges that would meet the Affordable Care Act’s requirements. Legislatures in 13 states have passed laws to establish exchanges. Utah and Massachusetts created exchanges prior to 2011, though additional legislation may be necessary for them to comply with the health reform law requirements. Other states enacted legislation that allows them to continue investigating whether or how to establish an exchange. North Dakota and Virginia each passed laws stating their intent to create an exchange and delegated responsibility for planning for the exchanges, including developing recommendations for the state legislature, to the state insurance and health and human services agencies. Mississippi and Wyoming decided to study the feasibility of creating an exchange. Some states whose legislatures have not passed bills establishing exchanges are reporting that they feel the time-crunch as deadlines approach.
In Idaho, the state is “grandfathering” the health insurance plan of its own employees. In effect, this means that the state is going to implement the provisions of the Affordable Care Act more slowly than others, and also that the state may not impose sharp increases on workers’ monthly premiums.
Legislation was recently approved in Illinois that would set up a 12-member legislative study committee to recommend a structure for the Illinois Health Benefits Exchange, a competitive health care marketplace. The committee will examine issues including operation, structure, and amount of power of the exchange. The committee must submit its report to the Illinois General Assembly and the governor by September 30th. Illinois may be able to receive full funding from the federal government through 2014 if its exchange is approved by June 2012.
On Tuesday (7/26), Ohio formally added to its November ballot an opportunity for Ohioans to vote on The Ohio Healthcare Freedom Amendment, which seeks to prohibit any federal, state, or local law from forcing Ohio residents, employers, or health care providers to participate in a health care system.
On Monday (7/25), the Louisiana state health department identified five companies to run a $2.2 billion privatization of the state’s Medicaid insurance program for low-income children and adults. The program will shift more than two-thirds of the state’s 1.2 million Medicaid recipients to a system of coordinated-care networks intended to save taxpayer money and provide better care through coordination among doctors, hospitals and other medical professionals.
MinnesotaGov. Mark Dayton signed into law a health and welfare spending bill that cuts or delays $435 million in payments to HMOs. The cuts were part of a budget reform package that ended a 20-day shutdown of the state government.
THIS WEEK
On Monday (8/1) at 12:30 p.m. in B338-B340 Rayburn, the Alliance for Health Reform will sponsor a briefing on health IT's impact on health care and delivery and the administrative side of the Medicaid program.
On Tuesday (8/2) at 10:00 a.m. in Dirksen 430, the Senate Health, Education, Labor and Pensions Committee will hold a hearing on health insurance premiums under the Affordable Care Act.
On Wednesday (8/3) at 10:00 a.m. in Dirksen 215, the Senate Finance Committee will hold a hearing on improving care to those eligible for both Medicare and Medicaid.
As always, please feel free to contact us with any questions.
To view our compilation of recent health care reform implementation news, click here.