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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
6-9-11 Affordable Care Act Update
June 10, 2011
Federal Update
ACS CAN filed comments this week with the Centers for Medicare and Medicaid Services (CMS) on the proposed Medicare regulation creating Accountable Care Organizations (ACOs). ACOs, which were mandated in the Affordable Care Act (ACA), are groups of providers that receive bonus payments for delivering more integrated and coordinated care for Medicare beneficiaries. ACS CAN’s comments acknowledge the potential of ACOs to improve the health and quality of care of cancer patients, and encourage the administration to improve the regulation to better benefit families affected by cancer.
ACS CAN’s comments also commend the administration for the regulation’s strong emphasis on providing patient-centered, coordinated care for individuals with chronic conditions, and they urge the inclusion of palliative care services as an integral component of ACOs and other proposed models. The comments also recommend that the Department of Health and Human Services more carefully consider several patient-specific issues in the regulation, such as:
Enhancing patient participation in ACO governance;
Requiring providers to deliver evidence-based cancer care;
Encouraging all ACO participants to share their claims information with their providers so treating physicians have the best information to deliver appropriate, high quality care; and,
Redefining “at-risk beneficiaries” to ensure that plans are not incentivized to avoid patients with
chronic conditions such as cancer.
Read the ACS CAN Comment letter:
State Update
The governors of six states -- California, Colorado, Maryland, Vermont, Washington and West Virginia -- have signed health insurance exchange legislation into law, and four states -- Connecticut, Hawaii, Illinois, and Oregon have bills awaiting their governor's signature. With the recent addition of Alabama, there are now four states (the others are Georgia, Indiana and Mississippi) in which governors bypassed their legislatures and established exchanges via executive order..
Litigation Update
The U.S. Court of Appeals for the 11th Circuit heard oral arguments yesterday in the government's appeal of a Florida federal judge’s decision to strike down the entire health care law. That case, in which the plaintiffs include 26 states, was decided in February, but the judgment was suspended pending appeal. At the crux of all legal challenges to ACA is the claim that requiring individuals to purchase health insurance -- the so-called "individual mandate" -- exceeds Congress' constitutional authority to regulate commerce, and yesterday U.S. Solicitor General Neal Katyal faced tough questioning from judges on the issue. The law’s challengers argue that the mandate forces individuals to engage in commerce, and that Congress may only regulate "activity," not "inactivity." Read coverage from The Atlanta Journal Constitution, New York Times, and Wall Street Journal.
Oral arguments were also held in the Sixth Circuit, where judges spent the majority of time discussing whether the plaintiffs continue to have standing to sue. In that case, an individual plaintiff who did not have insurance sued so as not to be forced to purchase it. However, it was recently discovered that she subsequently obtained health insurance through her employer after the lawsuit was filed. Read The New York Times story.
All circuit decisions will almost certainly be appealed to the U.S. Supreme Court, which is expected to hear the cases in the fall with a likely decision during spring of 2012.
Insurer to Refund Millions in Advance of Medical Loss Ratio Requirement Taking Effect
Millions of people insured by Blue Shield of California will receive a refund after the company announced it will cap its profit this year. The announcement comes as new rules are going into effect that put insurers’ profits and spending under closer scrutiny. The Affordable Care Act requires insurers to spend at least 80-85 percent of their revenues on medical care, leaving 20 percent for administrative costs, including profits. Insurers that do not meet those targets – a measure known as the “medical loss ratio” – must issue rebates to policyholders as of next year. Blue Shield said its refunds could range from $25 to $415 for individual policy holders and $110 to $130 for people with insurance through their employer. Blue Shield's announcement has raised hopes that other insurers will follow suit, though the chances of such an outcome are uncertain. Read The Washington Post story.
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)