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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
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5-18-12 Affordable Care Act Update
May 18, 2012
Federal Update
federally facilitated Exchanges
Earlier this week, the Department of Health and Human Services (HHS) released a paper on how federally facilitated exchanges will operate and generally, it reflects policy positions the department had previously disclosed. A federal exchange will have to perform all the functions required of a state-based exchange, responsibilities that were defined in the final regulation on exchanges issued in early March. The paper reiterates previously stated positions that states that do not want to operate their own exchange can enter into a partnership with the federal exchange to perform plan management functions (i.e. certification and approval of qualified health plans), provide consumer assistance services (e.g. navigators), or both. In addition, the state can perform Medicaid eligibility determinations based on information the federal exchange provides or it can have the federal exchange make the Medicaid determination using state eligibility criteria. Read the ACS CAN statement.
The one area of some concern is the decision to allow any qualified insurer to participate in the exchange for at least the first year. In other words, the federal exchange would not follow an "active purchaser" model wherein the exchange operator has the ability to negotiate directly with insurers. ACS CAN and many other consumer groups have advocated for an active purchaser model because it can lead to more competition and higher quality coverage. However, we recognize that the primary goal is to get the federal exchanges up and operating effectively in 2014. HHS has clearly indicated that they will consider an active purchaser model after 2014 if conditions warrant a change.
Separately, HHS said that the application deadline for a state-based exchange will be November 16, 2012. States that do not file an application by then will be in a federally facilitated exchange in 2014. Moreover, a state application is subject to review and if it is deemed unacceptable, those states, too, will be federally facilitated exchange in 2014.
State Update
State Exchanges
Yesterday HHS Secretary Kathleen Sebelius announced the release of grants totaling $181 million to Illinois, Nevada, Oregon, South Dakota, Tennessee and Washington to support the establishment of state health exchanges. To date, 34 states and the District of Columbia have received such grants. Read the HHS press release.
Essential Health Benefits
Society Division and ACS CAN government relations staff throughout the country are continuing to work with state insurance departments and insurance commissioners on the essential health benefits survey the Society and ACS CAN recently distributed. The survey of 31 different benefits that are vital for individuals with chronic diseases, including cancer, is an attempt to gauge the adequacy of state insurance plans that may eventually be set as the benchmark level of essential health benefits for all individual and small group plans in a state beginning in 2014, when exchanges are up and running. It is hoped that by identifying any major gaps, we can work at the state level to eliminate or lessen them before they become problematic for individuals who are fighting diseases such as cancer.
ACS CAN created the survey in partnership with the American Diabetes Association, the American Heart Association, and the National Multiple Sclerosis Society. Society Divisions and ACS CAN government relations staff have spearheaded the survey's distribution and are now following up in to collect the information by June 1.
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.