HHS released proposed insurance exchange regulations, which the agency says will provide states with considerable flexibility in implementation. Democrat and Republican leaders spent last week behind closed doors attempting to negotiate a deal on the federal deficit and debt limit. Some are pushing for the main points of compromise to be in the Medicare, Medicaid and Social Security programs. These discussions continue to develop rapidly.
AT THE AGENCIES
On Monday (7/11), HHS unveiled the first of several proposed insurance exchange regulations. The agency said the two proposed regulations will provide states with considerable flexibility in the development of their insurance exchanges and will reduce their administrative burdens. One of the two proposed rules governs the establishment of exchanges and qualified health plans. The second is designed to minimize the impact on insurance companies of covering high-cost patients. The regulations would allow states to set up different types of exchanges based on their individual needs. For example, some states may want to establish an exchange with no federal help, others may choose to have the federal government set one up for them, and finally, other states may prefer a hybrid approach.
Weighing in on health insurance exchanges, PricewaterhouseCoopers (PwC) issued a report titled “Change the Channel: Health Insurance Exchanges Expand Choice and Competition,” which provides extensive research on health insurance exchanges. It draws on insight from a nationwide survey, commissioned by PwC, of 1,000 consumers and 153 health insurance executives regarding their expectations for the exchanges. Among PwC’s findings are that 52 percent of health insurance executives say their companies are planning to compete in the insurance exchanges and about one-third are considering it but have not yet decided.
The GAO released a report on Tuesday (7/12), which says the federal government’s systems for analyzing Medicare and Medicaid data for possible fraud are inadequate and underused and, as a result, billions of dollars in fraudulent claims are paid out each year.
Echoing former director of the White House Office of Management and Budget, Peter Orszag’s recent article calling the Affordable Care Act’s exclusion of tort reform the law’s biggest shortcoming, on Tuesday (7/12), House Energy and Commerce Chairman Fred Upton wrote to the Obama administration expressing his disappointment in the administration’s failure to address the subject after Obama used it as a rallying call in his state of the union address.
ON THE HILL
Forced together by fear of default, Democrat and Republican leaders spent last week behind closed doors attempting to find a compromise on the federal deficit and the debt limit. On Monday (7/11), President Obama said that he would continue to push congressional leaders for the “largest possible deal” in the deficit-reduction negotiations and that he would consider “meaningful changes to Medicare, Social Security, and Medicaid” to achieve this. Then, over the course of the week, President Obama and congressional leaders met to battle out positions on increasing the debt limit and reducing the deficit. Two of the key objects of the negotiations were Medicare and Medicaid programs. On Friday (7/15), President Obama said in a news conference that he would be willing to consider raising Medicare’s eligibility age, adopting a means test under which wealthier Americans would pay more for the program, and making cuts to pharmaceutical spending within the programs.
On Tuesday (7/12), Congressional Budget Office Director Douglas Elmendorf offered six specific possibilities for reducing health costs, stressing that his remarks were not intended to be suggestions for Congress. One of the possibilities Elmendorf presented is to reverse the financial assistances offered by the government to those with low and moderate incomes. Another option, and one which is also being discussed in negotiations at the White House, is to raise the Medicare eligibility age from 65 to 67. A third possibility, which also was discussed during last week’s negotiations, is to increase premiums or cost-sharing that Medicare enrollees pay. A fourth option is to convert the current Medicare program into one where people receive fixed payments for health insurance, similar to the plans House Budget Chairman Paul Ryan suggested. A fifth option from Elmendorf is for Medicare to place limits on the cost of care rather than generally paying whatever doctors recommend, and enrollees could use their own money to pay for care beyond that which is accepted. Finally, the government could cut back its tax exclusion of health benefits contributions paid by employers.
On Thursday (7/14), both the House and Senate introduced bipartisan legislation, which would remove restrictions on tax-exempt health spending accounts. The bill would remove a provision of the Affordable Care Act that since January has required a prescription to buy over-the-counter medicine with medical savings accounts like Flexible Spending Arrangements (FSAs) and Health Savings Accounts (HSAs).
On Tuesday (7/12), the National Association of Insurance Commissioners declined to endorse a congressional measure intended to aid insurance agents and brokers claiming their livelihoods have been damaged by the Affordable Care Act. At their conference call meeting, commissioners did not vote on whether to endorse the House measure.
IN THE STATES
Protect Your Care, a group headed by Massachusetts Gov. Deval Patrick and former Wisconsin Gov. Jim Doyle – also tied to the White House, labor, and progressive groups – is planning to oppose Ohio’s ballot initiative to block the Affordable Care Act after Ohioans for Healthcare Freedom turned in more than 546,000 signatures two weeks ago.
Pennsylvaniais still unsure whether it will establish its own health insurance exchange. When Pennsylvania Gov. Tom Corbett was attorney general he joined the multistate lawsuit to fight the Affordable Care Act. Officials from the state Insurance Department said they hope to be in a position by fall to make a formal recommendation to the governor’s office.
The state of Kansas has hired a team of attorneys to defend the state against Planned Parenthood, which filed a lawsuit against Kansas in June over a budget provision blocking $334,000 in family planning funds to the health provider.
On Tuesday (7/12), Hawaii Gov. Neil Abercrombie signed legislation that removes all references in the state’s 1974 Prepaid Health Care Act that called for termination of the Hawaii reform law upon enactment of federal health care reform legislation. Hawaii legislators were concerned that if the Affordable Care Act is repealed or amended Hawaii’s law would be jeopardized without these changes.
THIS WEEK
On Monday (7/18) at 10:00 a.m., the Center for American Progress will host a discussion titled, “Lowering Costs and Improving Quality in Health Care: Bundling as a Payment Reform Innovation” about the most effective design features for bundling Medicare payments, which it believes CMS should consider.
On Monday (7/18) at 12:15 p.m., the Alliance for Health Reform will host a briefing titled, “The Innovation Center: How Much Can It Improve Quality and Reduce Costs – and How Quickly?” to discuss the Center for Medicare and Medicaid Innovation.
On Monday (7/18) at 2:00 p.m., The Heritage Foundation will hold a panel titled, “States Moving Away from Government-Run Healthcare” in which the Governor of Maine and health care experts will discuss how Maine, Florida, and others are embracing market-based health care reforms.
On Tuesday July 19 at 3:00 p.m. the National Academy for State Health Policy will sponsor a webinar titled, “Coordinating State Implementation of Health Law” during which representatives from states will describe the challenges they have faced and solutions they have found to navigating many of the interlocking provisions of the Affordable Care Act.
As always, please feel free to contact us with any questions.
To view our compilation of recent health care reform implementation news, click here.