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News
12-22-11 Affordable Care Act Update
December 23, 2011
Federal Update
On December 16, the Department of Health and Human Services (HHS) issued an advisory bulletin outlining policy direction for states on the essential benefits package. Although the bulletin does not have the force of law, it gives states important guidance as they move toward implementation of health benefit exchanges. HHS plans to publish a formal regulatory proposal, but did not indicate when. Read the HHS press release, ACS CAN's statement, and coverage from the Associated Press and Wall Street Journal. (attach WSJ)
The bulletin says a state will be able to choose a "benchmark plan" for the essential benefit package in its state. The state can choose one plan from among the following:
- The three largest plans offered to federal employees;
- The three largest plans in the small group market;
- The largest Health Maintenance Organization (HMO) plan; or,
- The three largest state employee plans.
The choice is about the benefit package only. Cost-sharing (i.e. deductibles and co-pays or coinsurance) associated with the plans are not important at this point. Cost-sharing will ultimately vary from the selected plan depending on the tier (i.e. bronze, silver, gold, platinum), but the benefits will remain constant. HHS indicated that they may allow some variation in benefits from the chosen benchmark plan, but they did not identify how much variation would be permissible or what criteria will it does not have the force of law e used in measuring alternatives. Plans can always opt to offer more generous benefit packages.
If a state opts for a plan in its small group market or the HMO option, existing state insurance coverage mandates will automatically be included since these health plans must already provide them. At this time, ACS CAN is uncertain whether state employee plans are required to include state mandates. Federal employee plans do not have to comply with state mandates, but federal employee benefits are very good and are likely to cover every mandate of medical significance.
ACS CAN is cautiously optimistic that HHS' approach will provide a good starting point for developing an adequate benefit package for all. Federal employee health plans provide good coverage for cancer patients. In addition, the largest small group market plans and largest HMOs are likely to provide good coverage. The level of benefits provided state employees is thought to be fairly good, although there are states that offer relatively small benefit packages.
ACS CAN and other consumer groups are sending a letter to HHS this week asking them to identify the specific plans in each category for each state as well as to provide a copy of each plan's contract on the HHS website, healthcare.gov.
A webinar or conference call will be scheduled next month to provide more information and materials to the field.
Litigation
This week the U.S. Supreme Court set its schedule for hearing oral arguments on the Affordable Care Act. The arguments will be spread over three days in March. On March 26, the justices will hear one hour of debate on whether challenges can even be brought to the law since the requirement that all individuals carry health insurance - the so-called "individual mandate" -- at the center of the case has not yet taken effect. The following day, March 27, will be dedicated to the constitutionality of the individual mandate, with two hours allotted for arguments. On the final day, March 28, 90 minutes have been set aside to consider the issue of whether the law's other provisions can continue to be implemented even if the individual mandate is ruled unconstitutional. Following that, the justices have allocated another hour to hear arguments on the constitutionality of the law's Medicaid expansion.
The American Cancer Society and ACS CAN, along with our preventative health partners, the American Heart Association and the American Diabetes Association, plan to file a friend-of-the court brief to point out how dependent the insurance reforms in the law are on the individual mandate, as was done at the appellate level. The brief, due January 13, will also provide the Court with the voluminous data the Society has on the link between having adequate health insurance and health outcomes.
As always, thank you for all you do every day to support laws and policies that help cancer patients and their families
NOTE: There will be no update the week of December 25. The update will return in 2012. Happy Holidays!
Chris Hansen | President of ACS CAN
ACS Cancer Action Network | American Cancer Society Cancer Action Network, Inc.