Federal Update
Hearing on Repealing Grandfathered Plans and Medical Loss Ratio Provisions
The House Energy and Commerce Committee Health Subcommittee held a hearing this afternoon focused on draft legislation that will be introduced soon to roll back consumer protections for plans designated as "grandfathered" -- individual health insurance plans and employer-based health insurance plans already in existence when the Affordable Care Act was signed into law on March 23, 2010. The legislation would exempt grandfathered plans from adopting important insurance reforms included in the Affordable Care Act no matter how much the plan cuts benefits or increases premiums over time -- theoretically providing them grandfathered status indefinitely. Consumer protections that would not apply to these plans include prohibitions on rescinding insurance after a policy holder becomes ill, lifetime and annual caps, pre-existing condition restrictions, and cost sharing for preventive services.
Legislation already introduced that would repeal the medical loss ratio (MLR) provision included in the Affordable Care Act was also discussed. The MLR provision requires insurers in the individual and small group markets to spend 80 percent of premiums on medical care and quality improvement activities, and requires larger plans to spend 85 percent of premiums.
ACS CAN opposes both legislative proposals because they would eliminate some of the most important consumer protections that ACS CAN advocated for in health care reform. ACS CAN joined other consumer groups in signing a letter to the Subcommittee's chair and ranking member expressing our concerns.
Community Health Centers
The Health and Human Services Department (HHS) announced last week the release of $700 million in Affordable Care Act funding to build, expand and improve community health centers. For many families, community health centers provide a major source of care that ranges from prevention to treatment. These funds will help expand quality care to millions of people nationwide.
State Update
Society Division and ACS CAN staff in several states are preparing to attend upcoming "listening tours" that regional HHS directors are convening throughout the country to gauge public reaction to recently released proposed regulations for health insurance exchanges. Five stops are planned, with the first two scheduled for New York City on September 21 and Chicago on September 26.
The meetings are by invitation only, and while no formal presentations or testimony are allowed, ACS CAN is preparing talking points for field staff who will be attending. The talking points focus on four main topics:
1) The governance board make-up of state exchanges and possible safeguards to help prevent consumers and patients from being in the minority as compared to representatives of the insurance industry.
2) The new "partnership" concept that HHS has recently proposed to run exchanges as a team with federal and state elements combining to run a state exchange in those states where they are not prepared to operate their own.
3) The details of how the federal exchange is going to look and how it will be structured.
4) The process for resolving disputes over eligibility between Medicaid and the exchange.
Litigation Update
On Tuesday, a federal judge in Pennsylvania ruled that the Affordable Care Act's requirement that individuals purchase insurance -- the so called "individual mandate" -- is unconstitutional. U.S. District Judge Christopher C. Conner said Congress exceeded its powers under the federal Constitution in enacting the mandate.
To date, three federal circuit courts of appeals have ruled out of more than thirty lawsuits filed across the nation challenging the Affordable Care Act. In the Sixth Circuit, the panel upheld the mandate as within the authority of the Congress, while the 11th Circuit struck down the individual mandate but left the rest of the law intact. In the Fourth Circuit, the appeals court dismissed the cases on procedural grounds and did not rule on the merits of the mandate. The US Supreme Court is expected to have the final word in these disputes, with court watchers predicting it will accept one of the cases during its upcoming October term, with a decision in the spring.
New Census Numbers Show Increase in Uninsured
The number of Americans without health insurance rose from 49 million to 49.9 million in 2010, according to a Census Bureau report released Tuesday. Due to population growth, the percentage of uninsured - 16.3 percent - is not statistically different from 2009. The report also found that the poverty rate rose to 15.1 percent in 2010, up from 14.3 in 2009, causing many Americans to switch from employer-sponsored to government-sponsored health care. Read coverage in The Hill for more.
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)