We have added section headers to the update this week to help you organize your review of the week's events. Hope it helps eliminate any confusion with the update. The confusion in the health care world at large is above our pay grade to resolve.
IN THE COURTS
On Tuesday (5/10), a federal court of appeals heard oral arguments in two cases challenging the Affordable Care Act, one by Liberty University and the other by Virginia Attorney General Ken Cuccinelli. The three-judge panel signaled with questions and comments that it likely would uphold the provisions in the Affordable Care Act, which require most Americans to have health insurance by 2014 or pay a penalty. All three judges were Democratic appointees. This was the first appellate hearing on the Affordable Care Act's constitutionality.
On Wednesday (5/4), a motion was filed on behalf of 26 states urging the 11th Circuit Court of Appeals in Atlanta to uphold the Florida federal judge’s ruling that the Affordable Care Act's individual mandate is unconstitutional.
On Thursday (5/5), the American Academy of Family Physicians, the American Medical Association, and the American College of Surgeons testified before a subcommittee of the House Energy and Commerce Committee about ways to fix the Medicare physician payment formula. The groups agreed that the sustainable growth rate formula needs to be repealed. The American Medical Association suggested implementing “a five-year period of stable Medicare physician payments that keep pace with growth in medical practice costs.” The American Academy of Family Physicians suggested an increase in the primary care incentives included in the Affordable Care Act, and that primary-care physicians receive higher payments for care than other specialties. And the American College of Surgeons suggested a five-year transition period during which reimbursement growth would vary by service line, and then set a "realistic budget baseline" for future payment increases.
On Tuesday (5/3), the House of Representatives voted to disrupt the flow of federal dollars for health insurance exchanges, which are an integral part of the Affordable Care Act. Then on Wednesday (5/4), The U.S. House voted to block money for a program included in the Affordable Care Act, which would provide for construction of school-based health centers.
The House Health subcommittee voted Thursday (5/12) in favor of the Republican-backed State Flexibility Act, which would let states cut their Medicaid rolls. The bill would repeal maintenance of effort provisions in the Affordable Care Act, which prevent states from reducing Medicaid eligibility before 2014. The Congressional Budget Office estimated that if the maintenance of effort provisions are repealed, children would make up roughly two thirds or the people who lose coverage.
AT HHS AND OTHER AGENCIES
On Wednesday (5/11), HHS Secretary Sebelius announced a new initiative, which will focus on coordinating the care of dual eligibles. The initiative includes sharing information between the two programs on treatments, prescriptions, equipment orders and hospitalizations to help avoid duplications and fragmented care.
In response to the severely destructive tornadoes and storms in Alabama, Kentucky, Mississippi and Tennessee, Sec. Sebelius sent a letter to governors of these states to explain options for hastening Medicaid eligibility for those who may need healthcare services but are unable to pay.
Sec. Sebelius told members of the House Energy and Commerce Committee that over 18,000 have enrolled in the Pre-Existing Condition Insurance Plan created by the Affordable Care Act and launched in July 2010. The $5 billion program is intended to provide bridge coverage until state insurance exchanges are established in January 2014.
According to Sec. Sebelius, over 1,200 hospitals have joined the HHS's public-private partnership on hospital-acquired infections. The Partnership for Patients is funded through the Patient Protection and Affordable Care and aims to reduce preventable hospital-acquired conditions. The American Society of Anesthesiologists has joined the Partnership for Patients as well.
The College of Health Information Management Executives (CHIME) submitted comments on CMS's accountable care organization (ACO) proposed rule. CHIME expressed opposition to a privacy provision in the rule, which would allow some patients to control the sharing of their medical records. CHIME explained that "allowing ACO patients the ability to opt-out of data sharing, while maintaining their ability to see the primary-care physicians participating in an ACO, contraindicates efforts to provide accountable care."
Ninety three percent of physician group practices responding to an informal survey warned that they would not join the new voluntary program that rewards quality of care unless it is thoroughly reworked. On Wednesday (5/9), the American Medical Group Association (AMGA) wrote to CMS Administrator Don Berwick about its concerns with the accountable care organization regulations. The letter can be found here: http://thehill.com/images/stories/blogs/healthwatch/amga.pdf.
On Tuesday (5/3), the Internal Revenue Service published a request for comments on the Affordable Care Act's employer mandate. In its request, it asks what the best way for it to determine whether a company meets the 50-employee threshold and which employees should count toward the total.
IN THE STATES
On Friday (5/6), Republican lawmakers approved a massive overhaul of Florida's Medicaid system in the form of two bills. The bills would eventually shift hundreds of thousands of poor and elderly beneficiaries into HMOs and other types of managed-care plans. The bills also require that providers generate a 5 percent savings in the first year, which could save the state close to $1 billion. Republican Governor Rick Scott, who supports shifting to managed care, still has to approve the bills. The federal government, which provides over half of Medicaid’s costs, needs to sign off as well. Backers of the bill say it would save Florida money and improve patient care. Also in Florida, on Wednesday (5/4) the House and Senate approved a bill that would include on the 2012 ballot an opportunity for Floridians to vote on a constitutional amendment, which would prohibit government requirements to purchase health care insurance.
Though Washington State's Attorney General is challenging the Affordable Care Act, on Wednesday (5/11) Gov. Chris Gregoire approved proposals that establish a state health insurance exchange, extend insurance coverage to dependants under 26, and prevent insurance companies from using pre-existing conditions to deny coverage to people under the age of 19.
The Vermont legislature passed a bill, which is being called a "Universal and Unified Health System," to create a publicly funded health care system aimed to provide coverage to every Vermont resident by 2017. The bill enacts the state's health insurance exchange, which is mandated by the PPACA. According to Vermont Public Radio though, the proposal fails to answer how the single payer system will be paid for, a decision which has been put off until 2013.
On Thursday (5/5), the Maine House voted narrowly in favor of LD 1333, which would allow out-of-state insurers to sell health insurance in Maine and allow insurers to vary premium ratings based on factors such as geographic area and age. The bill has now moved to the Senate.
On Friday (5/6), Hawaii state officials unveiled a new model for providing and coordinating health care for Medicaid patients, which make up one fifth of Hawaii's residents. The "medical home model" will integrate primary health care, behavioral care and social services for Medicaid recipients.
In Colorado on Tuesday (5/3), the State House passed a health care bill that would create a new government agency to organize a pool of health care plans that businesses can buy into to give employees more options for benefit plans.
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.