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 July 21, 2014

The Congressional Budget Office (CBO) released its
2014 Long-Term Budget Outlook last week, noting that long-term budget deficits will continue to grow but that spending on health-care programs has slowed sharply in recent years. According to revised budget projections, the estimated cost of Medicare and Medicaid for the 10-year period beginning in 2010 has dropped by $1.23 trillion. However, the precise reasons for the slowdown are not clear, and the CBO notes that its projections “involve substantial uncertainty.” And, despite the slowdown, the CBO is predicting national spending on health care will increase from 16.2 percent of GDP in 2012 to about 22 percent of GDP by 2039.

Aetna Chairman, CEO and President Mark T. Bertolini noted in an
op-ed article in USA Today last week that the nation needs to address the rising cost trend by focusing on the elimination of waste in the system. Bertolini also notes that beyond better physician communication and collaboration, payment reform will be the single most important driver in reducing all categories of waste.


A bill aimed at reversing the impact of the U.S. Supreme Court’s recent contraception coverage decision failed to pass in the Senate last week.
The Protect Women's Health from Corporate Interference Act failed by a vote of 56-43. Introduced by Sens.  Patty Murray (D-WA), Mark Udall (D-CO) and Barbara Mikulski (D-MD), the bill would have prevented employers from refusing to comply with the health care law’s preventive services requirement. Majority Leader Harry Reid (D-NV) gave a procedural vote of “no” on the bill, allowing him to bring the bill back to a vote at a later date.

The White House posted a solicitation last week for a new contractor to oversee the website
. Accenture was originally awarded a one-year, no-bid contract in January, but their contract is scheduled to expire in early 2015. Bids are due August 18. The requirements stipulated in the request include helping to construct major back-end components of the site that insurers need to get paid accurately.

The Centers of Medicare and Medicaid Services
(CMS) announced $7 billion in awards last week for 15 companies to oversee massive reforms of Medicare, Medicaid and CHIP to help reduce costs and improve quality. The “Research, Measurement, Assessment, Design and Analysis” contract asks vendors “for a wide range of analytic support and technical assistance activities” in support of ACA models and demonstration programs. The contract stipulates that the scope of activities of the new models can include all areas of health care research, such as costs, service delivery models, and financing and payment approaches.


CALIFORNIA: Several former and current members of the state legislature have come out in opposition to Proposition 45, the Insurance Rate Public Justification and Accountability Act. The ballot measure would require that health insurance rate changes for the individual and small group markets be approved by the insurance commissioner before taking effect.
  The California Democratic Party’s executive board, composed of 300 local activists and committee members, voted recently to endorse Proposition 45.  Coming on the heels of that endorsement, a number of legislators began voicing opposition to the measure, including former California Senate and Assembly Health Committee legislative leaders Elaine Alquist, Helen Thomson, Dr. Marty Gallegos and Dario Frommer, and also from former Assembly Speaker Fabian Nunez.  Current legislators opposed to the proposal include Sen. Richard Roth, Assembly members Raul Bocanegra, Susan Bonilla, Tom Daly, Adam Gray, Isadora Hall III and Henry Perea.

In other news, a Commonwealth Fund survey recently released found that California has cut the number of uninsured residents from 22 percent to 11 percent in one year.  Nationally, the survey found the number of uninsured Americans fell from 18 percent to 13.4 percent in the same time period.

: Amy Dowd, the executive director of Your Health Idaho, has resigned.  She is leaving to become the CEO of the New Mexico Health Insurance Exchange and will take over from interim CEO Mike Nunez. The Idaho exchange board is scheduled to meet soon to discuss potential candidates to replace Ms. Dowd. The board also is expected to discuss whether the state will be able to move forward with plans to assume greater operational control in time for the next open enrollment period.

The Division of Insurance (DOI) has issued a new report that found behavioral health patients face hospital emergency department delays not typically faced by non-behavioral health patients. The report compares the utilization review records of insured patients who were treated in emergency departments for behavioral health (BH) and non-behavioral health (NBH) conditions.  The report concluded that most NBH patients were discharged from emergency treatment within 24 hours while many BH patients waited two days or longer.  The report highlighted three observations on the experience of the nine health plans included in the study:  Unlike NBH patients, many BH patients are evaluated by an external emergency service provider (ESP) when they arrive to the emergency department; many BH patients face long delays in the emergency department as hospitals, ESPs, and health carrier staff attempt to locate BH inpatient beds; NBH patients do not commonly face similar delays in emergency because they receive treatment in other specialty areas until beds in the appropriate specialty become available.  As a result, the DOI indicated that it will make a number of changes to its BH regulations.

NORTH CAROLINA: The State Senate redrafted a bill last week that would have implemented the governor’s Medicaid reform plan.
 The legislature is looking to reform Medicaid to provide more budget stability, but the House and Senate differ on the approach needed to reform the program. The Senate’s substitute bill is a significant departure from the House version and calls for full-risk Medicaid managed care statewide beginning in 2016. The new Senate bill calls for competition between Medicaid managed care organizations and provider-led plans.  The bill is expected to pass the Senate and return to the House for consideration.  Prospects are very good that the House will wish to make changes.  Advocates on all sides will continue to work on Medicaid reform.  The bill is expected to end up in conference committee and coincide with the adjournment of session – expected within the next two weeks.


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