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News
1-26-12 Affordable Care Act Update
January 27, 2012
Federal Update
Summary of Benefits Coverage
This week the chief executive officers of ACS CAN, the American Heart Association, the American Diabetes Association, Consumers Union, and AARP sent a letter to the president urging him to issue a strong, final regulation on the Summary of Benefits and Coverage (SBC). Under the Affordable Care Act, insurers (and self-insured plans) are required to provide consumers with a standardized form that explains the basics of insurance and allows for direct comparison of plans using examples of "typical" scenarios.
The National Association of Insurance Commissioners, working with various stakeholders including consumers, developed a prototype and tested it with consumers, with the assistance of Consumers Union and the insurance industry's trade group, America's Health Insurance Plans. The three scenarios tested include maternity, diabetes, and treatment for Stage II breast cancer. (The breast cancer case is based on a model Georgetown University developed for ACS CAN.)
The final regulation governing the SBC provision is at the White House for a final review. Consumer groups have heard concerns that the final regulation could be weakened, including the postponement of the provision's effective date for group plans and the reduction of coverage scenarios limited to just one example. ACS CAN and other consumer groups strongly believe that the SBC is vital to enhancing consumer knowledge and understanding of health insurance. For the first time, consumers will have a document that could be enormously helpful to them in better understanding their options and making an informed decision.
In a sign that this issue is of the highest priority, this is the first time since the enactment of the Affordable Care Act that all of these organizations' CEOs have signed onto a letter regarding a specific regulation. Read the ACS CAN press release.
House of Representatives Health Committees Outline 2012 Agenda
The House Energy and Commerce Committee announced this week what health issues it will focus on this year. Committee Chairman Joe Pitts (R-PA) stated that repeal and replacement of the Affordable Care Act will continue to be a priority. The committee held multiple hearings last year addressing the repeal of a number of the law's' provisions; however, a bill specifying what would replace the entire health law if it were repealed has not been introduced. The committee plans to mark up a "replacement package" in April, providing a preemptive response to the Supreme Court decision expected in June. Policy proposals likely to be in the bill include medical liability reform, high-risk pools, and allowing health insurers to sell their products across state lines.
Essential Health Benefits Bulletin
The Department of Health and Human Services (HHS) released a bulletin on December 16 outlining its "benchmark plan" concept for the essential benefits package. The bulletin does not have the force of law -- it is simply advisory -- but the approach was a surprise. Most stakeholder groups had been expecting HHS to release a proposal that would have outlined a comprehensive benefit package and addressed issues such as the definition of "medical necessity." Moreover, the bulletin only addresses the concept of a benchmark plan, which represents a subset of a larger essential benefits proposal that has yet to be published. Though significant, the bulletin leaves many critical issues from a cancer patient's perspective unaddressed.
Since the bulletin's release, ACS CAN and other consumer groups have discussed how to respond to the request for comments on the bulletin, which are due January 31. Over the past few weeks, ACS CAN has been asked multiple times about its position on specific benefits and whether it is planning to recommend their inclusion. After careful consideration, ACS CAN has decided not to address these issues in its comment letter. Rather, ACS CAN will wait for a formal regulatory proposal to get a clearer picture of the total approach HHS envisions and so ensure that the interests of cancer patients and survivors are met. Many important issues were left unanswered in the bulletin and it is important to press HHS for more expansive explanations of how the benchmark plan will work. In the meantime, ACS CAN and numerous other consumer and patient groups plan to submit comments that only address the issues raised in the bulletin.
State of the Union: ACS CAN Activity
On Tuesday night, ACS CAN held its annual State of the Union Address Online Chat. More than 300 advocates posted nearly 1,300 comments during the President's speech. Volunteers shared their personal stories and thoughts in the spirit of helping make cancer a national priority in 2012. The next morning, ACS CAN President Chris Hansen shared his thoughts on the address in a new video.
State Update
The Robert Wood Johnson Foundation and Urban Institute released a study this week, States Progress Toward Health Reform Implementation: Slower Moving States Have Much To Gain. The report concludes that the 15 states that have made the least headway in setting up health exchanges have the highest rates of uninsured residents and would see the largest percentage drop in the rate of uninsured residents under the Affordable Care Act.
The study divides the states into three groups. The first group includes states that have passed health exchange laws or in which a governor who has issued an executive order. The second group includes states whose officials have expressed significant interest in creating a state exchange by passing "intent legislation," having legislation pending, or receiving an HHS Level One planning grant. The final group includes the 15 states that have been most resistant to the law.
Progress around the country on exchanges continues to vary widely, but this is a critical year as states are required to demonstrate "significant progress" on their exchanges by January 1, 2013 and implement the exchanges by January 1, 2014, although HHS officials have been stressing potential flexibility for states that may not make the deadline.
Reports and Polling
Public Believes Ideology Will Drive Supreme Court's Health Care Decision
The American public believes ideology will largely drive the Supreme Court's ruling on the health care law later this year according to the January Kaiser Health Tracking poll. Sixty percent of Americans polled said they believe partisan politics will influence the individual mandate portion of the ruling, while 28 percent believe ideology will not factor into the decision. Additionally, most Americans (55 percent) believe the law will still be implemented, even if the Court strikes down the individual mandate provision.
New Study Compares Health Insurance Status Among Employed and Unemployed
Less than half (48.1 percent) of unemployed adults had health insurance compared to 81.4 percent of employed adults in 2009-2010, according to a new study by the National Center for Health Statistics. Of the unemployed adults with health insurance, 41 percent had public coverage and 59 percent had private coverage. The study also found that unemployed adults were more likely to have fair or poor health and less likely to receive necessary medical care or prescriptions than adults who are employed.
Training
ACS CAN will host a webinar for staff on the Essential Health Benefits (EHB) bulletin and its potential impact on Friday, January 27, at 2:00 pm ET. The webinar will be recorded and information on accessing the recording will be shared soon after the webinar. Click here to join the training.
As always, thank you for all you do every day to support laws and policies that help cancer patients and their families
Chris Hansen | President
ACS Cancer Action Network | American Cancer Society Cancer Action Network, Inc.