The Obama administration achieved a major victory this week in the Sixth Circuit. Not only did the appeals court come down in favor of the Affordable Care Act, but the deciding vote was cast by a Bush appointee. Though the Sixth Circuit gave the Obama administration a green light, other groups continue to fight the law provision by provision. Two hundred seventy health care groups wrote to Congress urging repeal of the Independent Payment Advisory Board, Republicans on the Senate Finance Committee filed a number amendments to the Korea free-trade agreement aimed at repealing particular PPACA provisions, and in response to criticism, HHS backtracked on its announcement that it would begin using “mystery shoppers” to investigate whether primary care physicians based decisions of whether to take on new patients on the type of insurance they have.
IN THE COURTS
On Wednesday (6/29), a federal appeals court in Cincinnati upheld the Affordable Care Act in what is the Obama administration's largest judicial victory yet. The decision was a victory for the administration not only because the Sixth Circuit came out on its side, but also, one of the judges who voted this way was a Bush-appointee. Opinions are also expected soon from panels in the Fourth Circuit in Richmond and the Eleventh Circuit in Atlanta. Most legal experts, however, expect that the Affordable Care Act’s constitutionality will be determined in the Supreme Court.
AT THE AGENCIES
The Obama administration announced last week that so-called "mystery shoppers" would be calling primary care doctors to determine if the doctors were accepting new patients, whether they would accept private insurance while declining Medicare or Medicaid, and how long it would take to schedule an appointment. In response to significant criticism however, HHS announced it would not undertake the survey for the time being.
CMS announced at a press briefing Thursday (6/30) two new rules it will mandate under the Affordable Care Act. Expected to save $12 billion over 10 years, the rules aim to reduce administrative burdens with respect to patient eligibility and claims status.
On Tuesday (6/28), CMS announced that a total of 478,272 people have taken advantage of the Affordable Care Act's 50 percent prescription discount for seniors in the Medicare "doughnut hole." CMS also released a state-by-state breakdown of the numbers, which can be found here: http://www.healthcare.gov/news/factsheets/donuthole06282011a.html.
Iowa and North Dakota have applied to HHS for adjustments to new rules governing how insurers must spend their money. The Affordable Care Act requires plans in the individual market to spend 80 percent of premiums on medical costs; however, HHS can temporarily allow different standards where a state proves that the mandated threshold would destabilize its market. Iowa requested a 60 percent standard in 2011, followed by 70 percent in 2012, and 75 in 2013. North Dakota requested a 65 percent standard in 2011, 70 percent in 2012 and 75 percent in 2013. HHS said it will need another month to decide whether to approve these requests.
ON THE HILL
On Friday (6/24), 270 health care groups sent Congress a letter urging repeal of the Independent Payment Advisory Board (IPAB), which is a panel of experts, appointed by the president and with the power to cut Medicare payments. The organizations that signed the letter are composed of doctors, other health care providers, employers, drug and medical device manufactures and disease-specific advocates. One day earlier, Kathleen Sebelius wrote an opinion piece for Politico in which she defended and clarified the role of IPAB.
In a Kaiser Family Foundation poll, the results of which were released last week, half said they would trust an independent panel of full-time experts with members appointed by the president and confirmed by the Senate "a fair amount" or "a great deal."
Republicans on the Senate Finance Committee have filed several amendments to the Korea free-trade agreement aimed at repealing Affordable Care Act provisions.
IN THE STATES
On Wednesday (6/29), a bill to save money and transform health care in Oregon won final passage in the state senate. It is now headed to the governor's desk.
Mississippiis gearing up to establish a health insurance exchange. This week, the Mississippi Insurance Department completed its 13-city tour of information sessions. The Insurance Department is looking to educate and solicit feedback.
On Thursday (6/30), the Michigan Senate approved legislation under which a new one percent state tax would be assessed on paid health care claims. The tax would be paid quarterly by insurers offering fully insured plans and by third-party claims administrators in the case of self-funded plans.
ArkansasInsurance Commissioner Jay Bradford said he plans to ask the state Legislature for the authority to set up a state health insurance exchange. Though the state Insurance Department has been planning for the exchange using a $1 million grant, legislation authorizing its setup stalled in the legislature earlier this year due to objections to health reform.
Last week, in response to a state law that prevents Medicaid payments to groups that provide abortions, Indiana announced that it would no longer accept Medicaid patients unless they could pay for their own services. This week in Indiana though, U.S. District Judge Tanya Walton Pratt ruled that the state defunding law violates federal Medicaid rules. Medicaid patients in Indiana can again visit Planned Parenthood.
THIS WEEK
On Thursday (7/7) from 9:00 a.m. to 5:00 p.m., HHS will hold a public meeting of the Technical Advisory Panel on Medicare Trustee Reports. The Panel will discuss 10-year projection methods and assumptions in projecting Medicare health spending for Parts A, B, C, and D and may make recommendations to the Medicare Trustees on how they might more accurately estimate health spending in the short run.
The Obama administration is scheduled to release a proposed health insurance exchange regulation on Thursday (7/7), however there are rumors that the regulation may not be released until the following week or later.
As always, please feel free to contact us with any questions.
To view our compilation of recent health care reform implementation news, click here .