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 September 23, 2013

The U.S. Census Bureau’s annual look at income, poverty and health insurance in America shows that the percentage of people who are uninsured dropped somewhat in 2012, though not at a statistically significant rate. The percentage of people without health insurance dropped from 15.7 percent in 2011 to 15.4 percent or 48 million Americans in 2012. The biggest factor in the decline may have been increasing enrollments in Medicare, which now covers 15.7 percent of Americans. In a related development, new research from the Commonwealth Fund found that access to quality health care for poor Americans varies dramatically across the states. The report, “Health Care in the Two Americas,” suggests that 86,000 fewer people would die prematurely and tens of millions would receive timely preventive care if the gap were closed.

In other news, critics of the Affordable Care Act (ACA) are saying that decisions by some of
the country’s biggest employers to push employees toward private health insurance exchanges is an unintended consequence of the law. Last week Walgreen’s announced it was sending 160,000 employees to exchanges for coverage while Home Deport announced it was sending about 20,000 part-time workers to the exchanges for coverage.


The Republican-led House passed a stopgap bill September 20 that would fund the government through mid-December while defunding the ACA, setting the stage for a possible showdown with the Democrat-controlled Senate. Time is running short for lawmakers to enact a funding measure before the current fiscal year expires Sept. 30, making a government shutdown entirely possible. Passed by a 230-189 vote, the House bill would fund government agencies at an annual rate of $986.3 billion through Dec. 15.  Majority Leader Harry Reid (D-NV) said the Senate would consider the bill sometime during the week of Sept. 23. Senate Democrats have pledged to strip out all but the government funding portion of the bill before sending it back to the House just days prior to the end of the fiscal year. Congress has to enact a funding bill by September 30 to avoid a government shutdown.


The Department of Insurance (DOI) recently convened the rate review transparency team, as part of the Phase II implementation of the rate review grant announced in September 2012, with a focus on rate review transparency for consumers. The DOI outlined three key goals for 2013-14: 1) holding community meetings throughout the state to provide an overview of rate review practices; 2) development of a Rate Review Companion Guide to explain the threshold rate review process; and 3) adding a search engine to the DOI website to help access carrier rates. Assistant Director Alix Shafer also outlined the next steps in achieving effective rate review status in the small group market. The agency will issue a regulatory bulletin similar in content to the individual market rule that was promulgated last year. The DOI believes it has the authority to establish a small group effective rate review process through a bulletin but will still need approval from the federal government.

Attorney General George Jepsen announced that he will introduce legislation in 2014 that would require medical practices to disclose to patients if they charge “facility fees”.  In a press release, the attorney general stated that patients “deserve to know, in advance of any treatment or service, exactly what fees will be charged and for what services.”   He is calling his legislation the Facility Fee Disclosure Act and said it would require “any off-campus hospital-based provider that charges a facility fee to disclose in writing the amount of a patient’s potential financial liability – including the specific amount of any facility fee.”  He further stated that it would require “off-campus hospital-based providers prominently display written notices indicating that the office is part of a specified hospital and charges separate facility and professional fees.”

DELAWAREDepartment of Insurance Commissioner Karen Weldin Stewart officially announced last week the carriers participating on the Delaware Health Insurance Marketplace, better known as Choose Health Delaware.  This joint announcement with the Department of Health and Social Services unveiled the 19 qualified heath plans to be offered in the Individual and Small Business Health Options Program (SHOP) marketplaces.  The rates for three carriers: Highmark BCBS of Delaware, Coventry Health, and Coventry Health & Life; were published on the department’s website.

MAINE:  House Speaker Mark Eves and Assistant Senate Majority Leader Ann Haskell announced they intend to introduce another Medicaid expansion bill in January, ensuring that the issue will remain a pivotal 2014 election year agenda item.  Few expect there will be a sufficient number of legislative supporters to overcome an expected veto by the governor, which happened twice this year. But consumer groups continue to use every opportunity to keep the issue on the front-burner, hoping to sway public opinion.  Additionally, a legislatively convened study group on implementing a state-based exchange is set to convene its first meeting this week to review operational details for the October 1 rollout of the federally facilitated exchange.

NEW HAMPSHIRE: Medicaid managed care enrollment is underway in New Hampshire with beneficiaries receiving enrollment notifications offering the choice of the three plans under contract with the state. Recipients who fail to choose a plan will have one assigned for them. The commission established during the legislative session to recommend whether New Hampshire should expand Medicaid began deliberating last week, focusing its discussions on the values most important to the decision.  The panel is required to make a recommendation by Oct. 15. If approved, Medicaid expansion is expected to cover an estimated 49,000 poor adults. The commission met throughout the summer, hearing from a variety of stakeholders.

NEW YORK: New York State of Health, the state’s exchange brand, soft launched its customer call center last week in anticipation of the October 1 rollout date for the exchange portal.  There has not yet been any statewide promotion of the exchange or its portal, but the state did e-mail more than 40,000 enrollees of existing state-subsidized health insurance products, including Healthy New York, to alert them to the call center opening.  Initial reports indicate that the call center has been receiving 700 calls per day, with New Yorkers interested in products, prices, and subsidy eligibility information.

OHIO: The Ohio Ballot Board has unanimously approved a citizen-initiated statute that would expand Medicaid, as incentivized under the ACA, if also approved by the legislature. Proponents of the issue now need to collect 115,574 valid voter signatures before the end of the year in order to put the issue before the General Assembly. Lawmakers would then have four months to consider and act on the expansion of Medicaid.  If that fails, then proponents of the issue will need to collect another round of signatures for the language to be considered by voters on the November 2014 ballot.

TEXAS: Governor Rick Perry sent a letter directing the Texas Department of Insurance to establish strict rules to regulate navigators trained to help Texans purchase health coverage in the new health insurance marketplace.  To help uninsured Texans use the complicated new system, the federal government awarded nearly $11 million in August to local organizations charged with hiring and training navigators. Navigators, who will help consumers input their financial information and pick a health plan in the exchange, must undergo 20 to 30 hours of training, pass a certification test and renew their certification annually.

VERMONT: The flag bearer for single-payer health care in the state, the Vermont Department for Children and Families, has adopted a final rule conforming state law to the provisions of the ACA and clearing a potential pathway to a single-payer bill.   The changes and additions in the final rule include a comprehensive revision and renaming of existing health care programs and the creation of new health care categories in order to expand affordable coverage to more individuals and children.  The rule codifies policy and procedural changes to the Medicaid and CHIP programs related to eligibility, enrollment, renewals, public availability of program information, and coordination across health-benefits programs in line with the ACA and Vermont legislation.  It also revises Medicaid and CHIP program eligibility rules into a single, consistent and updated code.



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