Health Care Reform Implementation Update December 22, 2011

During the past two weeks, the Supreme Court scheduled dates for the health care arguments in March, HHS outlined guidelines for the states on essential benefits requirements, CMS announced the selection of 20 health systems and 12 physician groups to participate in a “Pioneer” Accountable Care Organization initiative, and Rep. Paul Ryan and Sen. Ron Wyden released a bipartisan Medicare proposal.


On Monday (12/19), the Supreme Court said that arguments in the health care lawsuit are set to begin March 26.  Though most cases are allotted an hour for argument, the Court scheduled five and a half hours for the health care case.  The central part of the arguments will occur on Tuesday March 27 and will focus on the minimum-coverage provision.  A decision in the case is expected by the end of June.


On Friday (12/16), HHS released a bulletin outlining the benefits insurers must offer under the Affordable Care Act.  The guidelines are vague on details, which will give states more flexibility to implement the reform law.  HHS seeks feedback to the guidelines before it releases a final regulation on these essential benefits requirements in the near future.  The announcement sparked criticism from a number of interest groups.  Consumer advocates expressed concern that Americans would be offered substantially less comprehensive insurance than the law's drafters intended.  Employers and insurers were concerned about the alternative – that states might make benefits packages so comprehensive they would be prohibitively expensive.

On Monday (12/19), CMS said it selected 20 health systems and 12 physician groups to participate in a "Pioneer" accountable care organization initiative.  Pioneer ACOs differ from other ACOs in that they can reap a greater share of savings but take on more risk.  The groups range from small and rural to big and urban and include the Dartmouth-Hitchcock Medical Center and the University of Michigan Medical Center.

In its first year of operation the CMS Center for Medicare and Medicaid Innovation developed a dozen new initiatives to reform the health care system.  Among them are new payment models, ACO initiatives, mentorship programs, and plans to turn health centers into medical homes.  The Commonwealth Fund published a report highlighting the center's work, describing the 12 initiatives.

On Monday (12/19), the Department of Justice said that the Affordable Care Act helped it to recover about $2.4 billion through health care fraud cases in the past year.

New data released by the federal government indicates that the Affordable Care Act has enabled up to 2.5 million young adults to receive health insurance, and that the percentage of Americans 19-25 years old without health insurance has decreased from 34 percent to 29 percent since the beginning of 2010.

HHS issued the final rule governing the Consumer Operated and Oriented Plan program (Co-Op Program) to provide loans for the creation of consumer-governed, private and nonprofit health insurance issuers to offer health plans in state health insurance exchanges.


On Thursday (12/15), House Budget Committee Chairman Rep. Paul Ryan (R-Wis.) and Sen. Ron Wyden (D-Ore.) released a bipartisan Medicare proposal.  The congressmen outlined the proposal in a pamphlet.  The model would transition Medicare for those under 55 into a system in which individuals are given subsidies, called premium supports, to choose among competing private health insurance plans.  The plan would also keep traditional Medicare as a permanent option for seniors.  Under the proposal, the government would only subsidize an amount equal to the bid proposed by the second-cheapest plan, and if an individual would prefer a more expensive plan, he or she can pay the difference.

The House of Representatives approved a payroll tax extension, which includes a two-year fix to the physician payment formula.  It would temporarily prevent the looming 27.4 percent Medicare payment cut to physicians and provide a 1 percent payment update to doctors for the next two years.


On Thursday (12/15) CMS announced its rejection of Florida’s request and on Monday (12/19) announced its rejection of Michigan's request for adjustments to the medical-loss-ratio standard requiring health plans to spend 80 cents of every premium dollar on medical care.

On Thursday (12/15), a legislative committee gave the Colorado Health Benefits Exchange board approval to apply for an $18 million federal grant.

To view our compilation of recent health care reform implementation news, click here.