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News
3-18-11 Affordable Care Act Update
March 18, 2011
In Congress
Committees of jurisdiction for health care in both the House and Senate have been marking the one-year anniversary of the Affordable Care Act being signed into law by holding numerous hearings this week. Both chambers will be in recess next week when the anniversary takes place. The Senate Finance Committee held a hearing featuring Secretary of the Department of Health and Human Services (HHS) Kathleen Sebelius and highlighted the law’s accomplishments, including insurance market reforms that have gone into effect and the work that HHS has done to rein in increases on insurance premiums. The Senate Health Education Labor and Pensions Committee hearing included testimony from representatives from HHS to discuss the work the department is doing now to lay the groundwork for the state-based insurance exchanges that must be up and running by 2014.
The chairs of the House Oversight Committee, and Ways and Means Committee used their hearings this week as a forum to discuss concerns with the implementation of the law, as well as Medicare provisions in the law. The House Oversight Health Subcommittee held a hearing to look at the waivers HHS has granted that allow states and insurers to bypass specific requirements in the law. Representatives from HHS testified that the waivers are needed to keep the insurance market stable until the state exchanges are fully up and operating in 2014. The House Ways and Means Health Subcommittee featured testimony from Medicare Payment Advisory Commission Chairman Glen Hackbarth, who discussed Medicare payment rates to providers as well as the ACA's reductions in payments to Medicare Advantage.
Read the CQ Article: “Year One for the Health Care Law: Expecting the Unexpected”
Medical Loss Ratio Activity
The medical loss ratio (MLR) is becoming a major issue again. Last fall, the National Association of Insurance Commissioners made recommendations on this issue to HHS, which adapted the recommendations virtually unchanged. The MLR represents the percentage of premium dollars that is spent directly on medical care versus other costs such as administrative expenses. The law requires that health plans in the individual and small group markets have an MLR of 80 percent and that large group plans have an MLR of 85 percent. If a plan falls short of the requirement, the insurance company must give a rebate to consumers. ACS CAN and many other groups representing consumers, patients, and workers supported the NAIC and HHS action as a good balancing of interests among consumers and insurers.
The ACA and the subsequent regulation classify broker and agent commissions as administrative expenses in the MLR, which is putting pressure on insurers to reduce commissions and find alternative ways of assisting consumers. Brokers and agents are now aggressively lobbying the NAIC, HHS and Congress to change the law to exempt their commissions from the MLR. At the same time, the NAIC will be considering draft legislation at its quarterly meeting next week that would exempt broker and agent fees from the MLR. A version of the NAIC bill is also being circulated in the House. The proposed legislation would severely weaken the MLR requirement and eliminate the incentive for insurers and others to find more efficient ways of improving administrative systems and helping consumers. It might also have the effect of raising insurance premiums further.
ACS CAN is strongly opposed to this change. We have signed a letter to the NAIC opposing this legislation. We have also provided the field with a template letter to send to their insurance commissioners asking them to oppose the legislation at the NAIC meetings next week. A copy of the letter is available from Dave Woodmansee ([email protected]).
Center for Medicare and Medicaid Innovation (CMMI) Begins Soliciting Proposals
The new Center for Medicare and Medicaid Innovation (CMMI) began holding meetings with a mix of diverse stakeholders, including patient advocacy and provider groups, to solicit ideas for new demonstration proposals to reform our current health care delivery system. The CMMI, which is part of the Centers for Medicare and Medicaid Services (CMS), was created by the ACA to give CMS greater authority to explore innovations in health care delivery and payment to enhance the quality of care delivered to Medicare and Medicaid beneficiaries. Proposals must reflect three key priorities: 1) better care for individuals, 2) coordinating care to improve health outcomes for patients, and 3) community care models. The law explicitly mentions that the CMMI consider reform models related to improving cancer care.
On March 11th, ACS CAN presented three ideas to CMS officials to improve cancer care for patients, including a demonstration to encourage hospitals to deliver palliative care services, a proposal to integrate cancer screening and prevention services into medical home demonstrations, and a request to urge CMS to consider including more cancer patients in future delivery system models designed to coordinate care for the chronically ill.
HHS Report Highlights Seniors Benefiting from New Wellness Visit
HHS released a new report yesterday showing that in less than two months since the new wellness visit in Medicare benefit started Jan. 1,, more than 150,000 seniors and others with Medicare have received an annual wellness visit. This new visit is a no-cost preventive benefit available to Medicare beneficiaries. Beneficiaries must schedule the visit with a participating health care professional.
During the annual wellness visit, doctors and beneficiaries can develop and/or update a personalized prevention plan that takes into account medical and family history, and potential risk factors for diseases like cancer. Doctors can also provide patients with personalized health advice, as well as and referrals when appropriate to education or preventive screening and counseling services and programs.
Read more about the report:
http://www.healthcare.gov/center/reports/prevention03162011a.html#_ednref2
Litigation Update
Several lawsuits challenging the constitutionality of ACA provisions are now being slated for appeal. In the Eleventh Circuit -- which includes the state of Florida, where 26 states are among the named plaintiffs and a federal judge had invalidated the entire law -- the Court of Appeals has agreed to an expedited review of the case. Amicus filings to defend the law will be due April 4. The Society, ACS CAN, and our preventative health partners at the American Diabetes Association and American Heart Association plan to file an amicus brief in the Eleventh Circuit that is virtually the same as the one the groups previously filed in the Sixth and Fourth Circuits. Oral arguments in the Fourth Circuit (Virginia) and Sixth Circuit (Michigan) are scheduled in May. Regardless of outcome, those decisions will almost certainly be appealed to the U.S. Supreme Court, which is expected to hear the case during the spring term of 2012 and rule before its adjournment for summer recess that year.
Events, Media Coverage Mark ACA’s 1-Year Anniversary
Wednesday, March 23, marks the one-year anniversary of the signing of the Affordable Care Act into law. The date is drawing a lot of attention from the law’s supporters and opponents, and a significant amount of media coverage. Read an op-ed by Secretary of Health and Human Services Kathleen Sebelius recalling the past year, a New York Times blog post detailing some of the Affordable Care Act related hearings taking place on the Hill this week and a CQ article discussing events around the anniversary.
The Society and ACS CAN continue our efforts to educate staff, volunteers and the public at large about the provisions of the law that are important for cancer patients and their families. Please remember the new website that ACS CAN and other nonpartisan national health groups launched this month, HealthCareandYou.org, and the Society’s consumer-friendly booklet about how the ACA is helping people with cancer and their families.
Read the CQ Article: “Health Law Birthday Hoopla: Is the Party Over Yet?”
As always, thank you for all you do every day to support laws and policies that help cancer patients and their families.
Christopher W. Hansen
President
American Cancer Society Cancer Action Network (ACS CAN)