There is now a circuit split over the constitutionality of the Affordable Care Act’s requirement that most people buy health insurance or face a penalty after the 11th Circuit ruled on August 12th that the requirement was unconstitutional while on June 29th the 6th Circuit upheld the law’s constitutionality. Over the past few weeks, HHS and CMS: 1) proposed a new payment structure for Medicare, under which payments for care would be bundled to reduce costs and give providers incentives to collaborate and avoid unnecessary or duplicative treatments; 2) announced that 13 states, which have already taken some action to set up insurance exchanges, will receive $185 million in grants to help their continued efforts to establish the exchanges; and 3) issued a proposed rule to govern eligibility procedures for obtaining health care coverage through state insurance exchanges.
IN THE COURTS
On Friday (8/12), a three-judge panel of the 11th Circuit Court in Atlanta ruled that the requirement that most people buy health insurance or face a penalty is unconstitutional. Two of the judges, one appointed by President Clinton and one by George H.W. Bush took the side of the 26 states that argued the individual mandate violates the Commerce Clause, while a third judge, also appointed by Clinton, dissented. Following the 6th Circuit’s June 29th decision upholding the law, this new opinion means there is now a circuit split, which many have suggested would be necessary for the Supreme Court to take the case.
The same day, the Ohio Supreme Court ruled that a proposed amendment to the state’s constitution, which would block implementation of the Affordable Care Act, can appear on the ballot this fall. The court said unanimously that ProgressOhio, a left-leaning think tank, failed to prove that backers of the amendment did not collect the valid signatures needed.
AT THE AGENCIES
On Friday (8/12), HHS announced $185 million in grants to states which have already taken some action to set up insurance exchanges. The money will be awarded to help their continued efforts to establish exchanges. California, which was the first state to pass an exchange law, will receive the largest grant of $38 million. A full list of exchange establishment grants can be found here.
On Wednesday (8/17), CMS issued a proposed rule to govern eligibility procedures for obtaining health care coverage through state insurance exchanges.
Also that Wednesday, HHS issued proposed rules interpreting a provision of the Affordable Care Act that would require health insurers to provide prospective beneficiaries with standardized information about the policies they offer beginning in March of 2012. HHS proposed an eight-page template of information on each type of insurance plan that would enable consumers to compare information from plan to plan.
On Friday (8/19), CMS announced the second round of its durable medical equipment competitive bidding program for Medicare, through which the agency expects to save $28 billion over 10 years. Durable medical equipment includes products like hospital beds, oxygen supplies, and wheelchairs. Currently, Medicare uses competitive bidding in nine cities. With the second round of the program, it will expand to 91 areas.
On Tuesday (8/23), CMS proposed a new bundled payment structure for Medicare, under which providers would be reimbursed for a patient’s entire treatment process rather than for each consultation or service. Secretary Sebelius explained, by example, that under the new payment structure a hospital would receive a single bundled payment for treating a heart attack; this payment would go toward the acute care provided, the hospital stay, and rehabilitation during recovery. The rationale for the structure is that it will improve care while reducing costs by motivating providers to collaborate and avoid unnecessary or duplicative treatments.
On Thursday (8/25), HHS announced new public health and prevention grants totaling up to $137 million. According to Modern Physician, the grants, which will be funded through the Prevention and Public Health Fund created by the Affordable Care Act, will support state and local efforts to prevent health care-associated infections, strengthen public health laboratory and immunization services, provide substance-abuse prevention and treatment, and promote tobacco cessation.
ON THE HILL
On Wednesday (8/24), the Congressional Budget Office said the Obama administration is likely to fall a year behind schedule in implementing the controversial Community Living Assistance Services and Supports (or CLASS) program.
IN THE STATES
Mississippi may be ready to launch its health insurance exchange next year. Earlier this month the state received $20 million from the federal government to be used to set up its health insurance exchange. The grant Mississippi received was among the highest of those who received grants for insurance exchanges. Gov. Barbour said Mississippi’s system would be very different than the one envisioned by President Obama.
Illinois is using a $5 million federal grant to begin setting up its insurance exchange. In the early planning stages, Illinois expects to use this money to pay consultants to determine what will be necessary for establishing the exchange.
There is a Sept. 30th deadline for Idaho to apply for a $40 million federal grant to build an insurance exchange in the state. Gov. Butch Otter’s insurance chief told an interim health care committee on Monday (8/22) that the administration is leaning towards applying for and accepting the grant.
Two weeks ago, Kansas announced that it will return a $31 million federal grant for implementing a health insurance exchange, making it the second state to reject the Early Innovator Grant.
THIRD PARTIES
According to Modern Healthcare, more survey findings, this time from Towers Watson, indicate that substantial numbers of employers will drop their insurance coverage when health exchanges launch in 2014. The results follow several other employer surveys, including the high-profile one from McKinsey & Co., which have found varying percentages of employers plan to drop coverage due to provisions of the Affordable Care Act.
Walgreens, the largest U.S. drugstore chain, is planning to start selling health insurance in a private exchange starting this fall. According to MSN Money, Walgreens may be one of many companies planning to get in on the multibillion-dollar opportunity created by the Affordable Care Act.
THIS WEEK
HHS’s Committee on Minority Health held a meeting on Monday (8/29) from 9 a.m. to 5 p.m. and Tuesday (8/30) from 9 a.m. to 1 p.m. at the Doubletree Hotel, located at 1515 Rhode Island Ave. NW. Topics discussed include increasing the health care workforce and strategies to improve the health of racial and ethnic minority populations through the development of health policies and programs that will eliminate health disparities.
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