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While roughly 83% of adults in the United States will visit a health care provider in the next year, an estimated
News
1-18-13 Affordable Care Act Update
January 18, 2013
Policy Update
Proposed Rule Medicaid, CHIP and State Based Health Exchange Coordination
Under the Affordable Care Act (ACA), millions of Americans will gain access to affordable health coverage through health insurance exchanges and improvements in Medicaid and the Children's Health Insurance Program (CHIP). To provide a seamless experience for the consumer, these programs should have consistent standards and systems to meet consumers' health care needs, improve quality, and lower costs. This week, the Department of Health and Human Services (HHS) released a proposed rule that would lay out a structure and options for coordinating Medicaid, CHIP, and exchange eligibility notices and appeals; provide additional benefits and cost-sharing flexibility for state Medicaid programs; and codify several provisions included in the ACA and the law reauthorizing CHIP. ACS CAN is reviewing the proposed changes to determine if there are areas where we should comment from the cancer perspective.
Network Adequacy for Health Insurance Plans
Health plans are increasingly relying on provider networks as a marketing tool for improving market share and controlling costs. Insurers are raising the rate of cost-sharing when participants go out-of-network for care, sometimes as high as 50 percent. Moreover, the networks sometimes change frequently as providers are added or dropped. The ACA requires health plans in the exchanges to have "adequate networks," but the final regulations issued by HHS largely leave it to the exchanges and the states to determine what is adequate, in large part because needs and resources vary considerably among the states. The issue is potentially very important to cancer patients who may have to go out of network to get the best treatment. Unfortunately, consumers who go out of network currently have few protections or rights. Thus, ACS CAN will advocate for strong networks and consumer protections as states and exchanges begin to grapple with developing standards for plans. Georgetown University prepared the attached issue brief for ACS CAN to assist our staff and volunteers in gaining a better understanding of the issues that we will want to address as states begin to develop standards for network adequacy.
Network Adequacy FINAL Jan. 13.docx
State Update
State-Based Health Insurance Exchanges
The White House announced earlier this week that it would waive or extend the deadline for any state that expresses an interest in creating a state based health insurance exchange. HHS had initially stated that it would determine whether states were prepared to operate their own exchange by January 1 of this year. If a state cannot meet the statutory and regulatory requirements for an exchange, HHS will oversee a federally facilitated exchange in that state although at this time it is unclear how and when HHS will determine whether a state has the capacity to properly establish and operate its own exchange. ACS CAN will continue to work with HHS and other consumer groups to understand how operational decisions will be made for each state.
Medicaid
Under the ACA, people who earn up to 133 percent of the federal poverty level will be newly eligible for health coverage through state Medicaid programs, with the federal government picking up 100 percent of the cost through 2016 and reducing it incrementally to 90 percent in 2020 and years thereafter. State participation is voluntary due to last year's Supreme Court ruling on the ACA. States that increase access to Medicaid coverage but fall short of covering people at 133 percent of the federal poverty level will not be eligible for the new federal money according to HHS.
ACS CAN believes that health outcomes regarding cancer are hugely dependent upon health coverage and access to care. For this reason, ACS CAN is urging state leaders to "opt in The federal funds have already been authorized for states to use to increase access to lifesaving cancer prevention and early detection measures, treatment, and follow up care through Medicaid so it makes good health and economic sense to provide more people with health coverage through the Medicaid program.
ACS CAN's work is starting to pay off, with 19 states and the District of Columbia indicating they will opt to increase access to Medicaid coverage. Among those states is New Mexico, where a highly focused effort led to the inclusion of the new federal funds in the governor's recently unveiled budget. Tens of thousands of residents in New Mexico will be able to obtain coverage through Medicaid as a result. The New Mexico campaign included grassroots action, media advocacy, and direct lobbying, and it sets a great precedent.
Reports and Polling
Recommendations for Reducing Health Care Spending
The federal government could save $1 trillion over a decade through a series of policies limiting health care spending, according to a new Commonwealth Fund report. The savings would include $528 billion from Medicare and $369 billion from Medicaid. The report also projects that state and local governments might save an additional $242 billion, mostly because of slower growth in their share of Medicaid costs.
Proposed policies include replacing the current Medicare physician rate formula with a system that would hold physician payments steady for a decade; reduce administrative costs; and offer a new Medicare integrated benefit plan. It also would expand or modify a number of initiatives that federal officials are already experimenting with, basing those payments more on value rather than volume, including enhanced primary care and bundled payments. Cost estimates are ambitious, working off the assumption that all policies would be in place by 2013.
As always, thank you for all you do every day to support laws and policies that help cancer patients and their families. If you have any questions, please don't hesitate to contact Carter Steger, Senior Director, State and Local Campaigns, at [email protected], (202) 661-5727, or Keysha Brooks-Coley, Associate Director, Federal Affairs, at [email protected], (202) 661-5720.
Chris Hansen | President
ACS Cancer Action Network | American Cancer Society Cancer Action Network, Inc.