Health Reform Weekly

A weekly compilation from Aetna of health care-related developments in Washington, D.C. and state legislatures across the country.


March 23, 2015

A new Kaiser Family Foundation poll shows the gap in favorable vs unfavorable views of the Affordable Care Act (ACA) has narrowed in recent months. With approval rates at their highest point in two years, 41 percent say they have a favorable view vs 43 percent who have an unfavorable view of the law. Despite recent publicity, the U.S. Supreme Court case concerning the legality of subsidies provided through the federal marketplace does not appear to be on the public’s radar. The poll found that 53 percent have heard nothing about the case while 25 percent have heard only a little. However, 62 percent believe that the impact on the country will be negative if the court limits subsidies to state-run exchanges only. In that event, 65 percent believe Congress should pass a law allowing the availability of subsidies to continue in all states.


Negotiations around a new Medicare sustainable growth rate (SGR) package continue on Capitol Hill. The House last week released a bill to repeal the flawed Medicare physician pay formula in favor of a value-driven payment system. Similar legislation has been introduced in the Senate. Details around how to pay for higher costs under the new payment system and a vote on the legislation are expected this week. The current payment patch expires March 31, 2015. Provisions of the package include a two-year extension of the Children’s Health Insurance Program (CHIP), and Medicare physician payments that will rise by 0.5 percent a year for five years.

Reps. David McKinley (R-WV), Jerry McNerney (D-CA) and Tom Price (R-GA) introduced legislation last week to coordinate post-acute care for Medicare patients by bundling payments. The Bundling and Coordinating Post-Acute Care Act would allow post-acute care providers to manage a patient’s care for up to 90 days, using a bundled payment initiated on the day of discharge from the hospital. The legislation aims to reduce hospital readmissions by holding providers accountable for their costs and rewarding those whose total cost of care is lower than the payment amount.

The House Budget Committee has passed the GOP’s 2016 spending bill by a vote of 22-13. It will now go before the full House for a vote. The budget calls for $5.5 trillion in spending cuts over 10 years and includes provisions to repeal the ACA’s taxes, subsidies, market reforms and mandates. It also would make reforms to Medicaid eligibility expansion, implement a Medicare premium support system beginning in 2024, and merge Medicaid and CHIP into a single program.

Similarly, Senate Budget Committee Chairman Mike Enzi (R-WY) released the Senate budget resolution last week. The resolution includes “reconciliation” instructions for the Senate Finance Committee and the Senate HELP Committee, directing them to recommend changes to laws within their respective jurisdictions. Other provisions of the budget call for repeal of the ACA, Medicare budget savings to extend the program’s solvency by five years, an extension of federal CHIP funding, and Medicaid reform based on the CHIP model.


COLORADO: The Department of Insurance has announced that it will not allow non-ACA compliant plans to continue into 2016. Last year, Colorado took advantage of federal flexibility to allow members in the individual and small group markets to keep their existing, non-ACA-compliant plans. However, DOI Commissioner Marguerite Salazar stated that everyone has now had sufficient time to adjust to an ACA-compliant plan. Colorado’s small group market does not currently include employers with 51-100 employees. Such employers will be in the small group market as of January 1, 2026, and the DOI is expected to make an announcement soon regarding whether this group will be able to renew non-ACA compliant plans.

CONNECTICUT: Modeled after the state’s Medicaid program, a bill before the General Assembly would comprehensively update the coverage requirements under the mental-health parity statutes. In addition, a provision modeled after a Massachusetts law would require inpatient hospital stays for acute treatment services and clinical stabilization services be provided for up to 14 days without prior authorization. The bill was reported out of the Insurance and Real Estate Committee as a “work in progress”, meaning that it will likely be modified on the floor of the House and Senate. The deadline to report of bills out of the committee was on March 19. The session adjourns on June 3.

MINNESOTA: Governor Mark Dayton is reporting that he has allocated $500,000 in his interim budget to fund a task force to consider future options for MNsure, the state-based exchange. In a letter to legislative leadership, Dayton noted that MNsure has experienced significant improvements since its troubled launch but that it has a long way to go. He is proposing creation of the Task Force on Health Care Financing to evaluate the future options for Mnsure, including its long-term viability, reverting to the federal exchange, revisions to public health care programs, opportunities for federal waivers, and a further reform to the state’s purchasing practices. He also acknowledged that his proposal parallels bills that are now under consideration by the legislature. Current MNsure-related legislation includes bills that would eliminate MNsure altogether and make MNsure a state agency, directly accountable to the Governor.

MISSISSIPPI: A bill mandating coverage of autism services was passed in the legislature last week and is now before the governor. He is expected to sign it. The legislation would require coverage of Applied Behavioral Analysis (ABA) up to age eight. It also would require that ABA providers be licensed by the state.

TEXAS: The House unveiled a $433 million supplemental budget last week that is dominated by $340 million in additional Medicaid spending. House Democrats are worried that the Medicaid funding is built upon funds taken away from other health care programs. Also of note, the proposed budget includes money to prevent TRS-Care from running out of health care dollars during the next biennium. The cost of TRS-Care funding for the Teachers Retirement System of Texas will likely amount to nearly $800 million. The state Senate is still working through its budget proposal. However, it is expected to include more than $4 billion in tax cuts to businesses and property owners.

WYOMING: The Wyoming legislature has adjourned for the year, after passing legislation that included a number of insurance measures. Insurance legislation of note includes: data breach regulations, an oral chemotherapy coverage mandate, and new external review standards. Proposed expansion of Medicaid eligibility, however, did not pass.


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