The Supreme Court granted certiorari in the challenge to the Affordable Care Act brought by 26 states and the National Federation of Independent Businesses; the District of Columbia ruled that the individual mandate of the Affordable Care Act is not unconstitutional; CMS released its Medicare Shared Savings program application, which will offer hospitals and medical groups financial incentives to reduce costs and improve quality for Medicare patients; and Ohioans voted in favor of a ballot measure that prevents any law or rule from requiring them to participate in a health care system.
IN THE COURTS
On Tuesday (11/8), the U.S. Court of Appeals for the District of Columbia upheld a lower court ruling that the Affordable Care Act's individual mandate is constitutional, marking the second time this year a federal appellate court with a majority of Republican appointees has backed the law. The lawsuit was brought by the American Center for Law and Justice, evangelist Pat Robertson's legal group. The group argued that the individual mandate is unconstitutional because it forces Americans to buy a product and violates the religious freedom of those who choose not to have insurance because they rely on God for protection from harm. In a dissenting opinion, Judge Brett M. Kavanaugh argued that the Anti-Injunction Act bars courts from ruling on "pre-enforcement" challenges.
On Monday (11/14),the Supreme Court granted certiorari in the challenge to the Affordable Care Act brought by 26 states, the National Federation of Independent Business and two individual plaintiffs from the 11th Circuit. The central issue raised by the case is whether Congress exceeded its constitutional powers when it required most individuals to carry health insurance or pay a penalty. The Court is expected to hear oral arguments in March and decide the case in June.
AT THE AGENCIES
CMS released its Medicare Shared Savings Program application for 2012 and will accept applications for the program’s April start date between December 1, 2011 and January 20, 2012. The Medicare Shared Savings Program was created by the Affordable Care Act and offers hospitals and medical groups financial incentives to reduce costs and improve quality for Medicare patients.
ON THE HILL
U.S. Congressman Phil Roe (R-Tenn.) and several other congressmen sent a letter to the Commissioner of Internal Revenue Douglas Shulman requesting that he amend an IRS regulation regarding federal health insurance tax credits. The regulation, the congressmen argue, contradicts statutory language from the Affordable Care Act. The letter explains that Section 1401(b)(2)(A) of Subtitle E of Title I of PPACA provides for tax credits to those who are enrolled in a state exchange, however the regulation expands eligibility for these tax credits to all individuals enrolled in qualified health plans who reside in states in which the federal government has established an exchange under PPACA.
Sens. Orrin Hatch (R-Utah), Mike Enzi (R-Wyo.), and Tom Coburn (R-Okla.) are expressing concern that The Center for Medicare and Medicaid Innovation (CMMI), with its $10 billion budget, is a waste of money. The senators wrote to HHS Sec. Sebelius requesting information on CMMI program spending and savings.
Even though the Super Committee is less than two weeks away from its deadline to vote on a plan to cut $1.5 trillion, on Sunday (11/13), Super Committee members indicated that they remain hung on basic issues of tax and entitlement reform.
IN THE STATES
On Tuesday (11/8) Ohioans renounced a portion of the Affordable Care Act by voting in favor of a ballot measure that read, "In Ohio, no law or rule shall compel, directly or indirectly, any person, employer, or health care provider to participate in a health care system."
In Colorado, legislation creating a statewide health insurance exchange passed the state Senate 25-12 and will now head to the state House.
In Massachusetts, a group commissioned to study rising health care costs in the state is recommending the creation of an independent oversight panel to identify reasons for price variations in care based on which hospitals or doctors are used.
On Tuesday (11/8), CMS granted Georgia some leeway in implementing the Affordable Care Act's medical-loss ratio standard, making Georgia the sixth state to get such an adjustment. PPACA requires insurance companies to spend at least 80 percent of premium dollars on medical expenses. Georgia's Insurance Department requested an adjustment to this requirement that would permit companies in the state to spend 65 percent on premiums in 2011, 70 percent in 2012, and 75 percent in 2015. Though CMS did not fully grant Georgia's request, it did adjust the ratio for the state to 70 percent in 2011 and 75 percent in 2012, with the statutory standard to apply starting in 2013.
On Tuesday (11/8), Kansas Governor Brownback announced a new proposal, called KanCare, under which the state will reorganize its Medicaid program into a managed-care program using private contractors to slow the growth of the state's health care costs.
THIRD PARTIES
According to a new Gallup poll, the percentage of adults with no health insurance has reached a high point of 17.3 percent. Gallup cautions that the new record high coincides with a methodological change – only cell-phone respondents were sampled in this survey, and cell-phone users tend to be younger.
Wal-Mart Stores Inc. is exploring the possibility of expanding the health care services it offers at its 140 in-store health clinics by partnering with outside health care companies with an eye towards treating and managing serious medical conditions like HIV, diabetes, arthritis, and clinical depression.
THIS WEEK
On Monday (11/14) at 1:15 p.m. in the Hubert H. Humphrey Building Auditorium, HHS Sec. Sebelius, CMS administrator Dr. Donald Berwick, MD, and Director of the Center for Medicare and Medicaid Innovation Rick Gilfillan, MD, will make an announcement about health care innovation under the Affordable Care Act.
On Tuesday (11/15) at 10:30 a.m. in 1100 Longworth, the House Ways and Means Subcommittee on Oversight will hold a hearing on the small business health insurance tax credit created by PPACA.
On Tuesday (11/15) from 1:30 to 3:00 p.m., CMS will host a conference call on the application process for the Accountable Care Organization program.
On Wednesday (11/16) at 10:00 a.m. the Insurance, Housing and Community Opportunity Subcommittee of the House Financial Services Committee will hold a hearing on the impact of insurance industry regulations on jobs.
To view our compilation of recent health care reform implementation news, click here.