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 October 12, 2015

A new analysis published by The Commonwealth Fund found that the United States continues to spend far more on health care than other high-income nations, driven by greater use of medical technology and higher prices. More frequent doctor visits and hospital admissions were not factors. In fact, with only four per year, Americans had fewer physician visits than residents of other developed countries. Americans also experienced poorer results on several key health outcomes measures.


President Obama on Wednesday signed the Protecting Affordable Coverage for Employees Act into law.  Widely supported by Democrats and Republicans, the bipartisan “fix” to the Affordable Care Act (ACA) allows states to determine whether or not to expand the small group health insurance market to firms with between 51 and 100 employees.

Senator Ron Wyden (D-OR) has released a bill meant to prevent a potential Medicare premium spike of up to 52 percent for one-third of Medicare beneficiaries.  The ranking member of the Senate Finance Committee is just one of many lawmakers—including House Minority Leader Nancy Pelosi (D-CA)—pursuing a fix to the coming Medicare Part B rate spike.

The Centers for Medicare and Medicaid Services (CMS) is pushing ahead with the third stage of rulemaking on meaningful use, an Electronic Health Records (EHR) incentive program.  

Top pharmaceutical executives expressed their concerns over the Trans-Pacific Partnership (TPP) trade deal during a meeting at the White House with President Obama.  Focused on the lack of 12-year monopoly protections for biologic medicines, the industry has spoken out against the trade pact.


ARIZONA:  Governor Doug Ducey has announced the appointment of former Speaker of the House Andy Tobin as director of the Department of Insurance. Since January, Mr. Tobin has served as director of the state Department of Weights and Measures. Tobin’s appointment is effective October 12 and is subject to confirmation by the Senate.

CALIFORNIA: Medi-Cal spent $93 million on Sovaldi in 2014, representing 2 percent of the state Medicaid program’s total prescription drug spending. According to a study in the New England Journal of Medicine, Medicaid programs nationwide spent more than $1.3 billion for the hepatitis C drug last year. The only state to spend more in total dollars than California was New York.

DISTRICT of COLUMBIA: Legislation that would cap copayments for specialty pharmacy drugs will be heard at a District Council public hearing on October 28. 
Introduced by Councilmember Mary Cheh earlier in the year, the measure had been dormant for most of the session.

GEORGIA:  The state Senate study committee held its first hearing on “surprise billing” with consumers describing cases of financial hardship caused by surprise balance billing. Representatives of the state medical association, hospital association, AHIP and employers also testified.  In its testimony, AHIP referenced its recent report which found a pattern of average billed charges submitted by out-of-network providers that far exceeded Medicare reimbursement for the same service. 

NEW HAMPSHIRE:  The Insurance Department will host its annual public hearing on health care costs and payment systems on November 6, 2015, with a focus on data and information available in 2014. 
The health insurance consulting firm Gorman Actuarial will discuss its major findings from the 2014 data submitted by health insurance companies in New Hampshire.

TEXAS: Texas has submitted a five-year extension application for its Healthcare Transformation and Quality Improvement Program (1115 Waiver), which allocates funds to the state’s hospitals and providers through an uncompensated care pool and a Delivery System Reform Incentive Payment (DSRIP) program.
The extension application requests $35 billion in uncompensated care funding, almost twice the amount provided under the current waiver and $15 billion ($3.1 billion per year) to continue the DSRIP program at its 2015-2016 demonstration year funding level.

UTAH: The legislature’s Health Reform Task Force held its first public hearing on a newly proposed Medicaid expansion plan, Utah Access Plus.
There was general agreement that the state needs to expand Medicaid. However, most of the critical testimony came from providers who will be taxed to help pay for the expansion.  Both individual physicians, whose license fee would increase by $700 annually, and hospital groups, whose tax liability would have no hard cap, opposed the proposed financial structure.  The health insurance industry would also be taxed to raise roughly $4 million under the plan. 


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Aetna Story 

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