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 August 24, 2015

A new Kaiser Family Foundation Health Tracking Poll found that most Americans, across political affiliations, feel that drug costs are unreasonable (72 percent). Grabbing many of the headlines last week was the finding that drug costs have now displaced the Affordable Care Act (ACA) as the chief health care concern among Republicans, according to the poll.


Congress is now recessed until early September.


ALASKA: Legislators are suing Gov. Bill Walker over his tactics for expanding Medicaid eligibility. The governor announced in July that he would expand Medicaid by going around the legislature, which declined to go along with the governor’s proposal.  Governor Walker sent a letter to the Legislative Budget and Audit Committee informing the committee of his administration’s intent to accept federal funds for the expansion. 

ARIZONA: Community advocates and providers voiced concern last week that proposed changes to Medicaid could adversely affect access to care. The concerns were raised at two Arizona Health Care Cost Containment System (AHCCCS) public meetings held to gather feedback. The changes include a new five-year lifetime limit; co-pays for missed appointments/non-emergency ER use; and elimination of a transportation subsidy for adults earning 100 percent – 138 percent of the federal poverty level. Some are concerned the changes may adversely impact access to care while failing to yield measurable savings.

CALIFORNIA: Covered California, the state-based insurance exchange, and the California Department of Health Care Services released a report that found most of those with insurance purchased through the exchange opted to renew that coverage this year.  About 1.1 million people with insurance through Covered California were eligible to renew their coverage during the last quarter of 2014, and 92 percent did so. 

MARYLAND: The Maryland Insurance Administration announced that a public hearing has been scheduled for September 28 to gather information relating to the study of medical stop-loss insurance in self-funded employer health plans.  A bill passed this year requires the Administration to hold hearings and solicit information from stakeholders. 

NEBRASKA:  An Omaha legislator wants to give Nebraskans a new option for obtaining basic health care. Sen. Merv Riepe said his bill would enable arrangements between doctors and patients called "direct primary care." Under the arrangement, patients would pay a flat monthly fee to their family doctor, estimated in the $40 to $100 range.  In return, they get all their primary care needs met without having to file insurance paperwork, meet deductibles or make copayments.

NEW YORK: The Northeast Business Group on Health (NEBGH) concluded a series of eight regional public sessions intended to educate carriers and employers on the State Health Innovation Plan project, Advanced Primary Care and the move towards value-based payments from fee-for-service models.  These sessions raised concerns that specialists and hospitals may see fewer admissions or visits and that a recent surge of urgent care facilities may undermine primary care practices as the hub for coordinating care.

Governor Andrew Cuomo vetoed legislation giving doctors the final say in prescription disputes with Medicaid managed care plans. Advocates contend that the bill would have applied a provision to the managed care program that exists in Medicaid fee-for-service – giving doctors final decision-making authority over prescription drug treatment plans in disputes with payors. The governor’s veto message focused on the unbudgeted cost increases associated with the bill and possible adverse consequences to coordinated care reforms underway.

NORTH CAROLINA: The current legislative session continues without a consensus on the 2015-16 fiscal year budget. The legislature is operating under its second continuing budget resolution, which will expire on August 31. At that point, the legislature will need to pass either a budget or another continuing resolution. The House and Senate agreed to a $21.735 billion spending target this past week, bolstering hopes for a budget deal. 

The House voted last week to not concur with the Senate’s version of Medicaid reform.  A conference committee has been named to iron out the differences. The Senate version included numerous provisions that the House finds problematic. The Senate version would create a new Department of Medicaid, accelerate the implementation timeline for managed care, and change the funding for Community Care of North Carolina. 


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