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
7-14-11 Affordable Care Act Update
July 15, 2011
Federal Update
Debt Limit Negotiations
Negotiations between the president and Congressional leaders over the budget and debt limit intensified further this week, with meetings taking place at the White House every day. The outcome of these talks have the potential to impact virtually all of ACS CAN’s priorities by limiting the availability of funds for cancer research, prevention, and early detection programs as well as altering the current structure of Medicare and Medicaid.
ACS CAN sent a letter last week to the president and bipartisan congressional leadership calling on them to prioritize the fight against cancer in addressing the nation’s fiscal challenges. The letter highlights the importance of federal funding for cancer research and programs, the value of prevention, and the role Medicare and Medicaid have in covering cancer treatment for approximately fifty percent of all cancer patients.
Exchange Regulation
On Monday the Department of Health and Human Resources released the long-awaited draft regulation governing health benefit exchanges. The proposal provides a detailed framework that affords states the flexibility to tailor their health benefit exchanges to meet the needs of their populations, as the law intended. At the same time, that flexibility comes with a responsibility for states to create exchanges that meet the wide-ranging needs of people with cancer and other life-threatening chronic diseases. ACS CAN will review the rule keeping in mind the attached threshold questions that were distributed to Division advocacy staff to use in evaluating state exchange proposals. Read the ACS CAN statement on the regulation and a background paper on exchanges. Also helpful is a Kaiser Health News guide to exchanges.
Key issues for states to resolve include:
• Structuring governance boards so its members do not have conflicts of interest and its deliberations are transparent and open to public comment;
• Establishing rules for the insurance market outside the exchanges that complement those within the exchanges to prevent outside plans from selling policies under more favorable terms and cherry picking the healthiest consumers;
• Integrating state Medicaid programs into the exchanges to ensure seamless enrollment for those most in need;
• Making information such as premium rates, benefits and enrollment forms easily available to consumers;
• Providing a consistent and stable source of funding for the exchanges to insulate them from the often unpredictable legislative appropriations process; and,
• Empowering exchanges to select which plans they offer and limiting participation to high quality plans.
Attached is coverage from CQ, Politico Pro, and The Wall Street Journal.
National Association of Insurance Commissioners Action on Medical Loss Ratio (MLR)
Recently a National Association of Insurance Commissioners (NAIC) task force recommended that the NAIC endorse the Access to Professional Health Insurance Advisors Act (HR 1206), which would take broker and agent commissions out of the medical loss ratio (MLR) calculation created by the Affordable Care Act. The Affordable Care Act requires insurers to spend at least 80 percent of their premium revenue on health care claims and quality improvement costs. Beginning this year, insurers who miss the target are required to rebate the difference to policy holders. Read the Kaiser Health News article.
ACS CAN had serious concerns about the task force’s action since it did not support the NAIC’s earlier recommendation to include broker and agent commissions in the MLR. Together with other consumer groups, ACS CAN reached out to the task force members as well as the Executive Committee of the NAIC to voice our reservations. On Tuesday the Executive Committee voted to send the bill to all the commissioners for a vote without a recommendation to endorse HR 1206. Although this does not preclude the NAIC from further considering this legislation at a later time, the decision slows the bill’s momentum in Congress for now.
The MLR is one of the most important short-term consumer protections the ACA provides. There is growing evidence that the MLR is in fact having a positive effect on mitigating health insurance premium increases and it is clearly an important tool for consumers. Had the provision been in effect for 2010, insurers would have had to rebate almost $2 billion to consumers although rebates are likely to be less in 2011 because insurers are expected to reduce premiums or limit premium increases to avoid paying rebates.
State Update
Exchange Legislation
The legislative process to establish health exchanges continues in several states. To date, 11 states have passed exchange legislation since passage of the Affordable Care Act -- California, Colorado, Connecticut, Hawaii, Illinois, Maryland, Nevada, Oregon, Vermont, Washington and West Virginia. In addition, the governors of Alabama, Georgia and Indiana issued executive orders creating panels to study exchanges, while the governors of Mississippi, North Carolina, North Dakota, Virginia and Wyoming have all signed bills that allow the legislative process to move forward without yet establishing an exchange.
Report Finds States Would Spend Billions Less with Implementation of the ACA
State governments would spend $92 to $129 billion less from 2014 to 2019 with the implementation of the Affordable Care Act according to a new report from the Urban Institute and the Robert Wood Johnson Foundation. Spending reductions would result from provisions in the law dedicated to reducing the number of uninsured and increasing federal support for health programs and functions states previously covered. New federal support is expected to increase federal spending from $704 billion to $734 billion. Among the other findings, states would save $26 to $52 billion because spending on uncompensated care would fall by as much as 25 percent.
Litigation Update
Attached is ACS CAN’s updated guidance on state legislation and lawsuits contradicting the Affordable Care Act. You may also be interested in a Health Policy Brief explaining the legal challenges to health reform that the Robert Wood Johnson Foundation and Health Affairs recently published. A complete list of state legislative activities, constitutional amendments, and ballot initiatives in this regard can be found on the National Conference of State Legislators’ website at www.ncsl.org/?tabid=18906.
Medicaid
The Oregon Health Insurance Experiment
An interesting study was released recently that concludes that people with Medicaid have better access to care and utilize more health services than people who lack insurance. The research is based on a unique opportunity presented in Oregon. In 2008, the state only had a limited number of Medicaid slots available to low income uninsured adults, who federal law does not currently require be covered under Medicaid. A lottery system was created in which the state drew names from a list of 90,000 people on their Medicaid waiting list. Those awarded coverage were put into a study group where researchers examined their health care use and medical debt compared to a group of low-income uninsured individuals who were not selected. After only six months, the researchers found that the new enrollees were more likely to access and utilize health care than those in the study group who applied for the lottery but remained uninsured.
For instance, Medicaid patients in the study were:
• 55% more likely to visit their doctor;
• 15% more likely to take prescription drugs;
• 35% less likely to have out-of-pocket medical expenditures;
• 25% less likely to have medical debt; and there was a
• 60% more likelihood that women 40 and over received mammograms and a
• 45% change in the likelihood that women received pap tests within the last year.
Read or listen to NPR’s story “Medicaid Makes ‘Big Difference’ In Lives, Study Finds.”
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)