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 29, 2013

President Obama is moving forward with plans to sell the benefits of the Affordable Care Act (ACA) to young Americans with the help of celebrities and his wife, Michelle. But it may be tough to establish momentum, given recent hurdles for implementation of the law. Republican members of the House are calling for steep budget cuts and cuts to ACA funding if they are to agree to any plan to raise the nation’s debt ceiling. And, a new poll released last week shows that a group of once loyal Democrats is turning against the health reform law. A new Washington Post-ABC News poll found that support for the ACA among moderate and conservative Democrats has fallen from 74 percent in 2010 to just 46 percent today. It remains to be seen whether shrinking Democratic support will have any practical impact in the House or Senate, but the trend is not making it any easier to sell the law to the public.


The Senate Small Business and Entrepreneurship Committee held a hearing last week titled, “Implementation of the Affordable Care Act: Understanding Small Business Concerns.” The witnesses included both supporters and critics of the ACA. J. Mark Iwry, Senior Advisor to the Treasury Secretary and Deputy Assistant Secretary for Retirement and Health Policy, testified that the ACA will provide increased bargaining power and reduced administrative costs to small businesses. He also highlighted the ACA’s role in providing tax credits and standardized information to assist small employers in comparing options for coverage. Chiquita Brooks-LaSure, Deputy Director for Policy at the Center for Consumer Information and Insurance Oversight (CCIIO), testified about the role of the SHOP exchanges. Sen. Tim Scott (R-SC) raised concerns about the impact of the ACA’s health insurance tax on small employers. Sen. Mike Enzi (R-WY) highlighted concerns about the ACA’s definition of a full-time employee and the impact this will have on employees’ hours.

The House took the first step last week to advance legislation reforming the way physicians are paid under the Medicare program. In a move reflecting bipartisan cooperation, the House Energy and Commerce Subcommittee on Health approved a draft bill to reform the payment system. The bill would repeal the Sustainable Growth Rate formula and provide for alternative payment models to the current fee-for-service system. The legislation does not include provisions to offset the costs of this proposal. Several Democratic members of the subcommittee emphasized that budget offsets, when they are addressed later in the legislative process, should not impose higher costs on Medicare beneficiaries. The full House Energy and Commerce Committee is planning to meet this week to mark up the legislation. 


COLORADO: Governor John Hickenlooper has appointed Marguerite Salazar to serve as the new Commissioner of Insurance, describing her as a savvy executive who understands regulatory reform and the insurance industry. Salazar most recently worked for the U.S. Department of Health and Human Services, where she served as the Region VIII Director since May 2010. As Regional Director, she was primarily responsible for the implementation of the ACA throughout the six-state Rocky Mountain Region.

CONNECTICUT: The Center for Medicare & Medicaid Innovation (CMMI) has offered an optional extension to the 16 design states that are developing State Healthcare Innovation Plans (SHIP), which are intended to transform the payment and health care delivery systems in each respective state. As a result, Connecticut has filed for an extension of 60 days, which moves the deadline for submission of the SHIP from November 1 to January 1, 2014. Vicki Veltri of the Office of the Health Care Advocate, who is leading the SHIP submission for Connecticut, has indicated that the extension will “allow additional time for the development of a draft SHIP that reflects additional consumer and other stakeholder input received through early August.” The extra time will also allow additional technical assistance and the integration of the recommendations from a state taskforce. Aetna and other carriers in the state are among the stakeholders participating in working groups assisting with the development of the SHIP Care Delivery, Payment Reform and Health Information Technology.

ILLINOIS: Governor Pat Quinn signed legislation last week enacting ACA-related Medicaid expansion that will provide health care coverage to potentially 342,000 Illinois residents who are currently uninsured. The law also provides for other program changes, including Medicaid managed care, mental health services and nursing home rate reforms. The new law is expected to save the state $953 million in uncompensated care costs over the next 10 years and bring in $4.6 billion in federal funding over the next three years.

OKLAHOMA: The legislature adjourned earlier this month without addressing changes needed in the Insure Oklahoma program, which could mean the loss of federal funding and health care coverage for 9,000 to 9,500 Oklahomans by year-end. The state has been warned if it didn’t change Insure Oklahoma to comply with the ACA by Dec. 31, 2013, the program would lose federal funding. Two legislators attempted to make changes to the program to ensure it meets federal standards, but no action was taken on the bill before the end of the legislative session. Oklahoma State Rep. Cory Williams was quoted as saying he doesn’t see Gov. Mary Fallin calling a special session to fix Insure Oklahoma. But he said that if a special session is called, the state needs to take action on it. A special session may be called to address tort reform that has been found unconstitutional. Insure Oklahoma was created for low-income residents and includes an employer-sponsored insurance program, in which premium costs are shared by the state, the employer and the employee, and an individual plan that allows people who can’t access employer benefits to buy health insurance directly through the state.

TEXAS: While Texas will not expand Medicaid eligibility as encouraged under the ACA, enrollment in the state’s health program for indigent children and the disabled is still expected to swell in 2014. The Texas Health and Human Services Commission projects 240,000 children currently eligible for Medicaid who are not participating will enroll in 2014 and 2015, as families seek coverage to comply with the ACA’s individual insurance mandate. And state officials think other new requirements under the law could result in an additional 200,000 people enrolling in Medicaid. An increase this large is expected to mean challenges for health care providers already stretched thin. Texas has the highest rate of uninsured residents in the country.



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