Implementation Brief The Center for Medicare and Medicaid Innovation: A Year’s Progress

Posted on January 26, 2012 | No Public Comments

Improving the quality of care delivery and reducing explosive growth in healthcare costs is a cornerstone of The Patient Protection and Affordable Care Act (ACA). It reflects the shared understanding that the current silo-based approaches to care delivery that focus on settings of care (e.g., physician office, hospital) rather than care delivery across multiple providers and setting (e.g., episodic) are not working. Costs are increasing at an unsustainable pace, and evidence from leading researchers collectively points to serious deficiencies in health care quality and the disconnect between high spending and health care quality.

To foster the development of more collaborative and…

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Challenges to the Affordable Care Act: Highlights from the Supreme Court Briefs–The States and the Medicaid Expansion

Posted on January 24, 2012 | No Public Comments

About this special series: On November 4, 2011, the Supreme Court granted certiorari in two cases arising out of constitutional challenges to the Affordable Care Act (ACA). The Court is set to hear oral arguments in the (now consolidated) cases over three days, beginning on March 26, 2012. As part of our continuing coverage of the litigation, HealthReform GPS will post periodic updates as the parties and their amici file briefs in the coming weeks. Amicus briefs, filed by individuals and organizations with an interest in the outcome of the litigation, are also known as “friend of the court” briefs. In ACA litigation, numerous amicus briefs are expected on the four questions the Court will hear. For a detailed explanation of the cases and the four issues, click here.

The oral argument dates are shown below:

• Monday, March 26: Department of Health and Human Services et al., v. Florida et al.–Anti-Injunction Act – 1 hour beginning at 10 a.m.
• Tuesday, March 27: Department of Health and Human Services et al., v. Florida et al.–Minimum Coverage Provision – 2 hours beginning at 10 a.m.
• Wednesday, March 28: National Federation of Independent Business v. Sebelius, Secretary of HHS et al. and Florida et al., v. Department of Health and Human Services et al.–Severability – 90 minutes beginning at 10 a.m. AND Florida et al., v. Department of Health and Human Services et al.–Medicaid – 1 hour beginning at 1 p.m.

Spotlight on: The States’ Brief on the Medicaid Expansion Provision

The States’ Medicaid brief, filed on January 10, 2012, argues that the ACA’s Medicaid expansion crosses the line between strong political…

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Implementation Brief Update to Consumer Operated and Oriented Plan (CO-OP) Program: Final Rule

Posted on January 18, 2012 | No Public Comments

The Centers for Medicare and Medicaid Services (CMS) issued its final rule implementing the Consumer Operated and Oriented Plan (CO-OP) Program on December 13, 2011. This rule finalizes the notice of proposed rulemaking (NPRM) issued by CMS on July 20, 2011, and takes into consideration the numerous comments received during the public notice and comment period ending September 16, 2011. Established by §1322 of the Affordable Care Act (ACA), the CO-OP program develops and creates new private, non-profit health insurance issuers to offer qualified health plans (QHPs) through state Exchanges as an alternative for consumers to traditional, for-profit plans. CO-OP plans are consumer-run, and accountable to their individual membership in a way that most traditional for-profit health plans typically are not. The ACA requires HHS to award funds for start-up loans and solvency grants to eligible CO-OP applicants in order to enable each state to have at least one CO-OP. In making these awards, HHS must take into account recommendations from the Advisory Board created by ACA §1322(b)(2). Two previous Implementation Briefs provided an overview of the CO-OP program and set forth the key provisions of the proposed rule; this update describes significant changes to the proposed rule as codified in the final rule.

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Challenges to the Affordable Care Act: Highlights from the Supreme Court Briefs–DoJ and the mandate

Posted on January 13, 2012 | No Public Comments

About this special series: On November 4, 2011, the Supreme Court granted certiorari in two cases arising out of constitutional challenges to the Affordable Care Act (ACA). The Court is set to hear oral arguments in the (now consolidated) cases over three days, beginning on March 26, 2012. As part of our continuing coverage of the litigation, HealthReform GPS will post periodic updates as the parties and their amici file briefs in the coming weeks. Amicus briefs, filed by individuals and organizations with an interest in the outcome of the litigation, are also known as “friend of the court” briefs. In ACA litigation, numerous amicus briefs are expected on the four questions the Court will hear. For a detailed explanation of the cases and the four issues, click here.

The oral argument dates are shown below:

• Monday, March 26: Department of Health and Human Services et al., v. Florida et al.–Anti-Injunction Act – 1 hour beginning at 10 a.m.
• Tuesday, March 27: Department of Health and Human Services et al., v. Florida et al.–Minimum Coverage Provision – 2 hours beginning at 10 a.m.
• Wednesday, March 28: National Federation of Independent Business v. Sebelius, Secretary of HHS et al. and Florida et al., v. Department of Health and Human Services et al.–Severability – 90 minutes beginning at 10 a.m. AND Florida et al., v. Department of Health and Human Services et al.–Medicaid – 1 hour beginning at 1 p.m.

Spotlight on: DoJ Brief on the Minimum Coverage Provision

One of the four issues to be heard by the Supreme Court is whether Congress has the authority under the Constitution to require individuals to maintain minimum insurance coverage as required under Section 1501 of the ACA. The Department of Justice…

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Implementation Brief Independent Payment Advisory Board (IPAB)

Posted on January 13, 2012 | No Public Comments

Section 3403 of the Affordable Care Act (ACA) established the Independent Payment Advisory Board (IPAB), a 15-member panel of appointed experts that will recommend cost-saving measures for Medicare. In the face of controversy about its structure and powers, legislation has been introduced in the 112th Congress to repeal its establishment.

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HHS deems premium spikes unreasonable

Posted on January 12, 2012 | No Public Comments

Today, the U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced that HHS has deemed insurance premium increases in five states as “unreasonable.” HHS determined that Trustmark Life Insurance Company has proposed unreasonable health insurance premium increases in five states—Alabama, Arizona, Pennsylvania, Virginia, and Wyoming. The excessive rate hikes would affect nearly 10,000 residents across these five states. To make these determinations, HHS used its “rate review” authority from the Affordable Care Act (ACA) to determine whether premium increases of over 10 percent are reasonable. In these five states, Trustmark has raised rates by 13 percent. HHS determined that the rate increases were unreasonable because the insurer would be spending a low percent of premium dollars on actual medical care and quality improvements, and because the justifications were based on unreasonable assumptions.

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RWJF report assesses the individual mandate in a new report

Posted on January 12, 2012 | No Public Comments

Today the Robert Wood Johnson Foundation (RWJF) released a report authored by researchers from the Urban Institute called “Eliminating the Individual Mandate: Effects on Premiums, Coverage, and Uncompensated Care: Timely Analysis of Immediate Health Policy Issues.” The report examines the effect that eliminating the individual mandate—the requirement for most Americans to have health insurance or face a penalty—would have on health insurance coverage, spending, premiums and uncompensated care. Using the Urban Institute’s Health Insurance Policy Simulation Model, the researchers simulated the Affordable Care Act as enacted, as well as several alternative scenarios of health reform without the mandate.

The authors find that without the mandate:
1) Between 40 and 42 million would remain uninsured as opposed to 26 million with the mandate;
2) Private coverage would fall 11 million, covering 4 million fewer people than it would have without reform;
3) Uncompensated care spending would be much higher due to the increased number of uninsured; and
4) Individual premiums in the health benefit exchanges would increase by 10 percent in a scenario assuming high exchange participation, and by 25 percent with a low participation scenario.

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EBRI releases report on employment-based coverage of adult children to age 26

Posted on January 12, 2012 | No Public Comments

The Employee Benefit Research Institute released an article entitled “The Impact of PPACA on Employment-Based Health Coverage of Children to Age 26″ in their January volume. This report reviews the evidence as to whether the mandate to extend coverage to adult children had an effect on the percentage of young adults with coverage in late 2010 and the first half of 2011. Data from the Census Bureau’s Current Population Survey (CPS) and Survey of Income and Program Participation (SIPP) are examined, as well as data from the Center for Disease Control’s National Health Interview Survey (NHIS). The data from these three surveys suggest that the PPACA’s coverage mandate has resulted in an increase in the percentage of young adults with employment-based health coverage as a dependent.

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ACAP releases article on dual eligibles

Posted on January 12, 2012 | No Public Comments

Jane Hyatt Thorpe and Katherine Jett Hayes recently released an article funded by the Association for Communication Affiliated Plans (ACAP), “A New State Plan Option to Integrate Care and Financing for Persons Dually Eligible for Medicare and Medicaid,” which reviews barriers to clinical and financial integration in services for dual eligibles prior to passage of the ACA, identifies models used by states to integrate care through contract and waiver authorities available to CMS prior to passage of the ACA, describes two new demonstrations proposed by CMS through the Medicare-Medicaid Coordination Office and Innovation Center, and introduces a state plan option as a new model for consideration by federal and state policymakers. This new model draws on experience from existing programs and waivers to provide a permanent state plan option for a fully integrated, capitated care model that could be made available to states prior to the completion of the demonstration process begun by the Medicare-Medicaid Coordination Office and Innovation Center.

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RWJF and National Academy of Social Insurance release report on Medicaid, Exchanges, and the individual insurance market

Posted on January 11, 2012 | No Public Comments

The Robert Wood Johnson Foundation and the National Academy of Social Insurance recently released “Building a Relationship between Medicaid, the Exchange and the Individual Insurance Market,” which examines the practical and conceptual factors that underlie the federal/state relationship in dealing with the alignment of Medicaid and the State Health Insurance Exchange policy. The report lays out dimensions of collaboration between states and the federal government that could help establish a seamless continuum of coverage for those who may move between eligibility for Medicaid and for tax subsidies in the Exchange.

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