Empowering patient voices through voter registration
While roughly 83% of adults in the United States will visit a health care provider in the next year, an estimated
News
10-7-10 Affordable Care Act Update
October 8, 2010
Below is this week’s update on the Affordable Care Act. As always, thank you for all you do every day to support laws and policies that help cancer patients and their families
New Fact Sheets and Backgrounders
New fact sheets and background papers on insurance reform and the exchanges have been posted to www.fightcancer.org/healthcare/learn. The fact sheets provide brief overviews of provisions in the law that impact cancer patients. New factsheets include information on Medicaid benefits, the Indian Health Service, and prevention in Medicare.
The more in-depth background papers are designed to help advocates learn about basic concepts in the Affordable Care Act regarding private health insurance and the creation of state exchanges. New topics include issues in wellness programs, risk adjustment and employee coverage through the exchanges.
All background papers from the original “tackle box” (the binder of materials provided to participants in the July staff conference in Atlanta), in addition to this new material, are all available electronically at www.fightcancer.org/healthcare.learn.
Comments on Interim Final Rule on State Health Exchanges
On Monday, October 4, ACS CAN signed onto a consumer group letter responding to the US Department of Health and Human Services’ (HHS) request for comments regarding the insurance exchanges. The comments detail many of the important questions and principles that the federal government will need to address in order to ensure the success of the exchanges. Topics range from use and renewal of the state exchange planning grants to risk adjustment procedures and outreach activities. ACS CAN policy staff co-authored the sections on the alternative federal exchange and the requirements for qualified health plans.
California Creates Health Insurance Exchange
California Governor Arnold Schwarzenegger signed legislation on October 1 creating a state health insurance exchange, the first state in the nation to do so since the Affordable Care Act was enacted.
Schwarzenegger also signed a bill that supports immediate implementation of no-cost prevention in the state, rather than waiting until 2014.
Resolution on Grandfathered Plans
ACS CAN last month joined seven other groups representing patients, consumers and workers in urging the U.S. Senate to defeat a resolution that would eliminate the interim final rule governing "grandfathered" plans in the Affordable Care Act from taking effect. In a letter to senators on September 29, ACS CAN and the others wrote that the interim rule "strikes the right balance between protecting consumers and providing stability and flexibility for employers" and that eliminating it "would put consumers' rights in jeopardy." The Senate ultimately declined to consider the resolution, thereby ensuring its defeat.
National Prevention and Health Promotion Strategy
The US Surgeon General last week released the draft framework for the National Prevention and Health Promotion Strategy (National Prevention Strategy). The National Prevention Strategy will take a community approach to implement and identify prevention efforts that will reduce the incidence of the leading causes of death and disability such as cancer. ACS CAN will submit comments on the framework. The Affordable Care Act requires the Strategy to be completed by March 2011.
Prevention and Public Health Fund
HHS recently announced additional initiatives funded through the Prevention and Public Health Fund created by the Affordable Care Act:
• $100 million for grants to support a variety of public health programs in states and communities, such as tobacco prevention and control and addressing obesity
• $320 million to strengthen the health care workforce. Of those grants, $253 million will go to improve and expand the primary care and public health workforce. The remaining $67 million are for Health Profession Opportunity Grants that provide low-income individuals with education, training and supportive services that will help them prepare to enter and advance in careers in health care.
In the News: Child-Only Plans and Medical Loss Ratios
In recent weeks there have been a number of stories about insurers threatening to withdraw from certain markets because of new requirements under the Affordable Care Act. One issue has arisen out of the requirement that plans can no longer impose pre-existing conditions on children. Several insurers have said they will stop issuing so-called “child-only” plans because of concerns that children with serious medical conditions, many of whom were previously denied coverage, would enroll in the plans and cause insurer costs and, ultimately, premiums to rise significantly more than they would have otherwise. Insurers worry that increased premiums will lead relatively healthy children to drop coverage, making the risk pool even more expensive.
The media has also reported recently about insurers dropping plans because of new medical loss ratio (MLR) requirements, that is, the percentage insurers spend on care versus administrative costs. Under the Affordable Care Act, individual and small group market plans will have to meet a threshold of 80% MLR, and large group plans an 85% MLR. The issue was elevated by a September 30 Wall Street Journal article “McDonald’s May Drop Health Plan”” which reported that McDonald's might terminate health plans for nearly 30,000 hourly restaurant employees. McDonald’s subsequently denied the story.
As the Affordable Care Act is implemented, we may see more stories like these for various reasons, be it because of the new law, market dynamics, or a company’s desire to cut costs and reduce benefits. In regards to the issues above, it is important to remember that the underlying issues -– putting an end to denials of coverage for children with pre-existing conditions such as cancer and ensuring value for the premium dollar -– are necessary to transform our health care system. Also noteworthy is that in both cases the Administration and state insurance departments have sought to mitigate the potential harm that might arise when insurers suddenly withdraw coverage.
Politico Publishes ACS CAN Letter
Politico published a letter to the editor today from me in response to an op-ed this week by Sen. Kay Bailey Hutchison that argued that the Affordable Care Act would interfere with doctor-patient decision-making. The senator's op-ed described the U.S. Preventive Services Task Force as a government entity empowered by the new law to make decisions that have traditionally been made by patients and their doctors. While ACS CAN agrees that the PSTF should not be the only arbiter of what preventive services are covered -- and we continue to urge HHS to consider other expert recommendations when coverage determinations are made -- we disagree that the new law obstructs doctor-patient decisions.
Before the Affordable Care Act, lifesaving coverage decisions were in the hands of insurance companies instead of doctors and patients. By expanding coverage, eliminating cost barriers to care and requiring insurers to cover essential health benefits, the new law in fact empowers patients and their doctors to make the best decisions for them.
Christopher W. Hansen
President
American Cancer Society Cancer Action Network (ACS CAN)