Health Reform Weekly

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

Week of June 29, 2015

The U.S. Supreme Court announced its long-anticipated decision last week in the King vs. Burwell case, ruling that consumer subsidies for health care coverage can continue through federally facilitated exchanges under the Affordable Care Act (ACA). The 6-3 decision ensures that their health care benefits will not be disrupted. Many in the health care industry hope legislators will now turn their attention to addressing the numerous ACA implementation issues that remain.

A day later, a different Supreme Court ruling recognized same-sex marriage as protected by the Constitution in all states. Expanding the definition of marriage nationally is expected to impact access to health care benefits for LGBT families. Exactly how the decision will affect issues such as same-sex domestic partner coverage and coverage under the ACA is generating expanding media coverage.


Eleven Democrats joined with House Republicans last week to pass a bill repealing the ACA’s Independent Payment Advisory Board.  The board was created to explore ways to slow rising Medicare costs. President Obama has said he will veto the bill if it passes the Senate.  The House is still short of a veto-proof majority, and its prospects in the Senate remain uncertain.

The House Appropriations Committee has advanced a $153 billion spending bill to fund the Departments of Labor, Health and Human Services (HHS), and Education.  The bill makes deep cuts to family planning programs while increasing funding to the National Institute of Health (NIH).  It also blocks discretionary funding for the ACA. 

The full Senate Appropriations Committee considered its own Labor-HHS-Education funding bill at a markup session last week.  Much like its House counterpart, the Senate bill would boost funding for the NIH and community health centers. The bill would also to prevent appropriations from being used for the ACA’s risk corridor payments to health plans.

A bipartisan bill has been introduced in the Senate that would now allow commissions paid to licensed insurance agents and brokers to be included in the calculation of medical loss ratios.  The Senate bill has been referred to the Committee on Health, Education, Labor and Pensions for consideration. 

The Congressional Budget Office (CBO) has released a report on the 21st Century Cures Act.  The bill would appropriate funds to develop drugs and other technologies that prevent and treat disease. The CBO projects that the Act would cost $106.4 billion over the next five years in appropriations provisions. 

The House Ways and Means Committee held a hearing last week examining “Rising Health Insurance Premiums Under Obamacare.”  Three state insurance commissioners and a law professor discussed the factors at play behind increasing premiums, including adverse selection, small employers moving their employees into the individual market, medical trend and increases in prescription drug costs. 


ALABAMA: Legislators are likely to return for a special session this summer to address an impasse over the state’s general fund budget.  Bills related to non-covered vision services, SB 270, and dental non-covered services, SB 296, were enacted.  A bill regarding compassionate use for access to investigational drugs (SB 357) awaits the governor’s signature. 

FLORIDA: The legislature adjourned its special session last week after passing a $78.7 billion budget, which the governor signed.  Included in the budget is $450 million in general revenue to address the loss of federal Low Income Pool funding. Senate President Andy Gardiner stated the investment of general revenue was the only fiscally responsible choice, absent an expansion of Medicaid.

NEW HAMPSHIRE: The state has approved a short-term plan to continue its Medicaid care management program as it finalizes new contracts with providers, a long-delayed Medicaid billing system and a number of substance abuse- and mental health-related initiatives. Additionally, the State Executive Council approved a four-month extension of the contracts with the two organizations handling care coordination for residents.

NEW JERSEY: The Democrat-controlled legislature has approved a budget bill that would impose a series of tax increases, including a Corporate Business Tax (CBT) surcharge.  However, Governor Chris Christie vetoed both the millionaires’ tax and the 15 percent CBT surcharge. Additionally, he cut the legislature’s $3.1 billion pension fund payment back to $1.3 billion. 

NEW MEXICO: The New Mexico Legislative Health and Human Services Committee and its Disabilities Concerns Subcommittee have announced their work plan schedule for Interim 2015.  The plan calls for an examination of topics including the New Mexico exchange, Medicaid managed care, network adequacy, and coverage of preventive health screenings. 

NORTH CAROLINA: Legislators debated Medicaid reform on the House floor last week after taking up a bill that would overhaul the state’s fee-for-service Medicaid program.  Under the bill, hospitals and regional providers would bear financial risk and manage the majority of the Medicaid population for the state.  The Senate budget includes similar Medicaid reform language but takes a different approach, relying on a mix of providers and Medicaid managed care organizations to work with the state to reform the program. 

WISCONSIN: The Office of the Commissioner of Insurance (OCI) has issued a bulletin to help ensure that all coverage policies for colorectal cancer screening tests are up to date. The bulletin directs insurance carriers to continue to annually monitor and select one or more of the updated colorectal cancer screening guidelines issued by the U.S Preventive Services Task Force, the National Cancer Institute, or the American Cancer Society.


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