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10-21-10 Affordable Care Act Update
October 22, 2010
Below is this week’s update on the Affordable Care Act. As always, thank you for all you do every day to support laws and policies that help cancer patients and their families.
National Association of Insurance Commissioners (NAIC) Meeting
Earlier today, the full membership of the National Association of Insurance Commissioners (NAIC) approved a proposal on how to calculate and define Medical Loss Ratios (MLR), the percentage insurers spend on benefits versus administrative costs, under the Affordable Care Act. The NAIC proposal now goes to the Secretary of Health and Human Services (HHS), who will in turn issue a federal regulation based on the proposal. Read the NAIC press release.
This is good news for patients and consumers, and we have many ACS CAN and Division staff to thank for it as they spent the last few months helping the commissioners look at the issues through the “cancer lens.” The proposal sent to the Secretary was not perfect, but on the whole it was balanced and consistent with the intent of the Affordable Care Act.
Over the past two weeks, insurers mounted an intense campaign in an attempt to change and weaken the original MLR proposal. In fact, there were more than a thousand insurance industry representatives at this week’s NAIC meeting in Florida trying to influence the final vote. Even as recently as last night, the outlook was not very good following a three hour closed-door session held by the commissioners. Consumer representatives who had traveled to the NAIC meeting were warned that the industry was likely to prevail on some key issues, including “aggregation” and “credibility” -- two very complex and technical issues that are ultimately very important for consumers. Fortunately, these predictions turned out to be wrong. Your efforts paid off and in the end the NAIC put patients first.
This experience with the NAIC is a good example of how important it is to stay on top of the regulatory process and pay attention to the details as the Affordable Care Act is implemented.
Consumer Assistance Grants Announced by HHS
HHS Secretary Kathleen Sebelius announced new Consumer Assistance Program Grants this week that will allow states to provide direct assistance to consumers with questions or concerns regarding their health insurance. To date 35 states, four territories and the District of Columbia applied for and received grants to establish programs that will provide consumers with information on everything from what plans are available to how to appeal denied claims.
For consumers in the 15 states that did not apply for grants, the HHS Office of Consumer Information and Insurance Oversight will provide assistance out of Washington, DC. In some cases, the states plan to partner with non-profit groups to provide the service to consumers. Click here for a fact sheet and summary of how each state or territory will use the new resources.
ACS CAN Comments on the HHS National Health Care Strategy and Plan
ACS CAN submitted comments to HHS on its National Health Care Strategy and Plan, a strategic plan for improving health care quality that was released to the public in September. The plan identified a framework consisting of three core principles to guide health care improvement efforts in the coming years - better care, affordable care, and healthy people/healthy communities. The plan also highlighted the importance of making the health care system safer for patients and families and providing incentives to better coordinate and manage care for individuals living with a chronic illness.
ACS CAN emphasized its support for creating a more integrated and coordinated health care system that addresses the quality of life needs of patients and families living with chronic diseases such as cancer. ACS CAN also signed onto comments submitted by the Campaign for Better Care National Consumer Coalition, a coalition of consumer organizations committed to improving care for those living with multiple chronic conditions.
ACS CAN Comments on Menu Labeling Requirements
ACS CAN recently submitted comments to the Food and Drug Administration (FDA) in response to draft guidance that will be provided to the food service industry on the implementation of the menu labeling requirements in the Affordable Care Act. Under the law, chain restaurants with 20 or more venues nationwide must post calorie information on menus, menu boards, and food tags prominently and make other nutrition information available to consumers upon request. The law also requires vending machine owners or operators with 20 or more vending machines to post calorie information for each available item. For restaurants and vending machines subject to the requirements, the law preempts any stricter state or local menu labeling measures. ACS CAN supports efforts such as these to help consumers make informed decisions about the foods and beverages they consume and promote healthier eating choices.
ACS CAN’s letter recommends that the calorie labeling and nutrition information requirements be broadly applicable across types of food establishments. The comment letter also urges the FDA to require restaurants and vending machine owners and operators to include calorie information in a clear and simple manner, and in the context of overall daily needs. ACS CAN also encouraged the FDA to make training and technical assistance available to the restaurant industry, but also to strongly enforce and ensure compliance with the law. The menu labeling requirements will likely go into effect in 2011, after final regulations are issued.
Federal Lawsuits Challenging the Constitutionality of the Affordable Care Act
There have been a number of developments with respect to several federal lawsuits challenging the constitutionality of the Affordable Care Act. Last Friday, the federal judge in the case brought by 20 states pending in the Northern District of Florida said ruled that portions of the case pertaining to the individual mandate and Medicaid expansion should go to trial on the merits. A trial date was set for December 16. On Monday the judge in a separate case pending in the Eastern District of Virginia court, filed by the attorney general of Virginia, heard oral arguments on the constitutionality of the individual mandate. The judge promised to issue an opinion before the end of the year.
These developments come of the heels of a ruling from a judge in the Eastern District of Michigan several weeks ago, who threw out the case filed by the Thomas More Law Center which had raised a similar challenge to the constitutionality of the law. Accordingly, it is quite possible that conflicting decisions on the law’s constitutionality could be handed down by federal district court judges before the end of the year. Irrespective of what happens, it seems certain that the cases will be appealed, and ultimately come before the Supreme Court.
House Energy and Commerce Committee Releases Report on Denials of Health Coverage Based on Pre-Existing Conditions
The House Energy and Commerce Committee recently released a report regarding coverage denials for pre-existing conditions in the individual insurance market. The Committee has been investigating the extent of coverage denials and exclusions for pre-existing conditions in the individual insurance market over the past seven months. A key finding from the investigation detailed in the report is that from 2007-2009 more than 651,000 people were denied coverage by the insurance companies because of their prior medical history. Read the key findings. Read “Insurers Denied Coverage to 1 in 7” from The Wall Street Journal.
Christopher W. Hansen
President
American Cancer Society Cancer Action Network (ACS CAN)