The Senate Finance Committee held a hearing yesterday titled "Healthcare Reform: Implementation So Far." Secretary Sebelius testified. They could have found all the answers just as easily by reading this weekly update.
On Thursday, March 10, HHS proposed new waiver rules designed to give states more freedom in developing their health care systems and policies. These regulations would implement the Affordable Care Act’s “waivers for state innovation” that now give states flexibility beginning in 2014. Though the regulations and the Administration’s offering of these waivers give states more flexibility, the flexibility does not mean much to most states because they do not have alternative plans to meet the required goals. For two states though, this flexibility is meaningful. In Vermont, Peter Shumlin (D) is promoting a single-payer system that would provide every Vermonter with health insurance free of charge. Vermonters had the opportunity to weigh in on the single-payer health care proposal on Monday, March 14. In Oregon, Governor John Kitzhaber (D) is designing a radical change in health service delivery the details of which are forthcoming.
Centers for Medicare & Medicaid Services (CMS) Administrator Donald Berwick has told those in health fields and the general public several times now that proposed rules for Accountable Care Organizations (ACOs), which were expected in December, would be released very soon. Speaking at the America’s Health Insurance Plans conference on Tuesday, March 8, Berwick again said the rules would be released soon and explained that HHS, CMS, the Department of Justice and the Federal Trade Commission were working together to draft them.
In the courts this week:
1) On Friday, March 11, the Eleventh Circuit granted the Obama Administration’s motion for expedited review over Judge Vinson's ruling (in the 26-state case in Florida) that provisions of the Affordable Care Act are unconstitutional. The Court has not yet decided whether the appeal will be heard by a three-judge panel or the full court.
2) In the Virginia lawsuit, six major hospital associations have filed an amicus brief supporting the Patient Protection and Affordable Care Act. Also in the Virginia lawsuit, the Obama Administration filed papers Monday, March 14 with the Supreme Court urging that there is no reason to short circuit review by appellate judges as VA Attorney General Ken Cuccinelli has requested.
This week in the states:
1) The Florida Senate voted Wednesday, March 9 to put a proposed state constitutional amendment (SJR 2) aimed at blocking the Affordable Care Act’s individual mandate on the November 2012 ballot.
2) In Kansas, Gov. Sam Brownback asked HHS Secretary Sebelius to exempt the state from the PPACA’s Medicaid “maintenance of effort” requirements and to give Kansas its $1.7 billion share of federal Medicaid funds in one lump sum.
3) In Arizona, state hospitals are making a "last-ditch effort" to save government-subsidized care for the two thirds of 250,000 childless adults that would no longer receive Medicaid as a result of the waiver granted to Arizona.
4) In Arkansas, legislation that would require state agencies to report the PPACA’s financial impact before implementation failed before the Senate Public Health, Welfare and Labor Committee on Wednesday, March 9, and will not advance to the Senate.
5) After Governor Perdue vetoed North Carolina's bill that would have required the state Attorney General to fight the Affordable Care Act and would have shielded North Carolinians from health care mandates, and the North Carolina House fell short of the three fifths majority needed to override the veto, it appeared the bill was dead. After a recess on Thursday though, House Republicans announced they planned to reconsider the health care law veto. Reconsideration is a parliamentary procedure mostly used to recall bills that need a last minute fix or to revive measures whose supporters did not have an opportunity to vote.
6) In Nebraska on Wednesday, March 9, the state legislature heard two proposals to weaken the Affordable Care Act. The first proposal would prohibit the state from forcing people to buy health insurance. The second would express Nebraska’s disapproval of the law.
7) In Illinois, Governor Pat Quinn’s proposed budget cuts Medicaid reimbursement by $552 million.
8) Hawai’i filed an amicus brief in the U.S. Court of Appeals in Virginia, joining eight other states in defending the Affordable Care Act.
9) HHS wrote to Maine to say it would help protect its fragile market for individual health insurance by waiving the requirement that insurers spend 80 to 85 cents for every premium dollar on medical care and quality improvement, allowing Maine a 65 percent standard for three years instead. Also in Maine, Rep. Richard Cebra (R) submitted "An Act to Prevent Enforcement of the Federal Patient Protection and Affordable Care Act" for consideration by the legislature.
10) The chairs of the Senate and House health committees in Texas filed legislation to replace federal health care funding in Texas and partner with states with block grants, contingent on the formation of the "Interstate Health Care Compact.
11) In Oklahoma, legislative leaders crafted a plan to let the state's Medicaid agency access an additional $15 million in federal stimulus funds to prevent further cuts on the program that provides health care to low-income Oklahomans.
12) In Tennessee, the proposal that would allow Tennesseans to opt out of the Affordable Care Act was sent to the Governor’s desk.
13) Lawmakers in Georgia took their first official steps toward complying with the PPACA by designing an insurance marketplace. A House subcommittee unanimously approved House Bill 476, which would create the Georgia Health Exchange Authority. 14) On Monday, March 14, the Minnesota Senate health care panel reviewed a bill that would bar the state from participating in the federal health care overhaul. A companion House bill has already cleared one panel.
In the wake of last week’s news that there are insufficient votes to confirm CMS Administrator Berwick, who holds his position as the result of a recess appointment, President Obama’s spokesperson said the President stands firmly behind Berwick’s nomination because “he’s far and away the best person for the job, and he’s already doing stellar work.” Dr. Berwick says he is focusing his attention on his job, not confirmation. Berwick’s deputy, Marilyn Tavenner, has emerged as a likely candidate for Berwick’s position.
CMS released a final rule outlining changes to Medicare’s enrollment and revalidation policies. The new policies are intended to reduce fraud and abuse and will apply to newly enrolling providers and those who revalidate their enrollment starting March 25. Also this week, CMS released proposed notices, which show what information insurers will be required to disclose to consumers regarding excessive premium rates. Beginning this July, insurers will have to report and explain rate increases of more than 10 percent. Rate increase will be subject to review by state regulators or HHS.
The House Energy and Commerce Health Subcommittee will introduce legislation at the end of March that would change mandatory spending to discretionary spending for parts of the Affordable Care Act. Discretionary spending is determined through the normal congressional appropriations process whereby lawmakers are forced to assess the value of the spending, whereas mandatory spending bypasses this process.
This week: On Tuesday, March 15, the House Ways and Means Subcommittee on Health held a hearing on the Medicare Payment Advisory Commission's (MedPAC) annual report to Congress on updating Medicare payment policies at which the MedPAC Chairman, Glen Hackbarth, will testify. Also on Tuesday, March 15, the House Oversight and Government Reform's Subcommittee on Health Care, District of Columbia and the National Archives held a hearing titled "Obamacare: Why the Need for Waivers?" On Wednesday, March 16, the Senate Finance Committee held a hearing titled "Health Reform: Lessons Learned During the First Year" at which Secretary Sebelius testified. On Thursday, March 17, the Senate Health, Education, Labor and Pensions Committee held a hearing titled "Health Insurance Exchanges and Ongoing State Implementation of the Affordable Care Act."
As always, please feel free to contact us with any questions.
To view our compilation of this week's health care reform implementation news, click here.