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5-26-11 Affordable Care Act Update
May 27, 2011
Federal Update
ACS CAN Senior Director of Policy Testifies on Interstate Sales of Health Insurance
Stephen Finan, ACS CAN’s senior director of policy, testified before the House Energy and Commerce Health Subcommittee Wednesday on interstate sales of health insurance. Steve testified that selling health insurance across state lines could theoretically increase competition to the benefit of consumers, but only if there are strong, uniform rules for insurers and adequate consumer protections. However, the legislation under consideration, the Health Care Choice Act (H.R. 371), would repeal consumer protections provided through the Affordable Care Act (ACA). Without these protections, there would be a "race to the bottom" among insurers, which could ultimately result in a system in which the relatively healthy could buy insurance at low rates, but higher risk people, including cancer patients, would be offered coverage with premiums that are unaffordable for most. Read Steve’s testimony and the ACA CAN press release.
Final Rule on Rate Review Issued
The Department of Health and Human Services (HHS) issued its final rule this week on rate review. Prior to the ACA, many insurance companies were able to increase their premiums without justification. Although some states have the authority to deny such rate hikes, most do not. The new rule will ensure that significant premium increases in all states are justified and made transparent to the public. Beginning September 1, 2011, insurers seeking premium increases of 10 percent or more in new plans will have to justify these increases and make the increases known to the public. In states that lack the authority to review premium hikes, HHS will conduct the reviews. The rate review protections will work in conjunction with the many other provisions of the ACA, such as the medical loss ratio calculation and the elimination of lifetime limits, to ensure that consumers are receiving value for their premium dollars. Read the HHS Press Release and the Kaiser Health News and Wall Street Journal stories.
New Exchange Grants Awarded to States
On Monday HHS issued Exchange Establishment Grants to three states -- Indiana, Washington and Rhode Island. The grants provide additional resources for states to build on the work begun through the Exchange Planning Grants issued in 2010 and 2011. Five more rounds of Exchange Establishment Grants are planned.
State Update
Vermont’s governor signed legislation today establishing a state insurance exchange that will operate as a single-payer system beginning in 2017. To date, Vermont is the only state to take this approach. Read or listen to NPR’s coverage. Also read a Wall Street Journal op-ed by Dr. Brian Gratzer of the Manhattan Institute, and a New York Times profile of a Vermont doctor who is a longtime single-payer system advocate.
With Vermont, there are now five states (the others are California, Maryland, Washington, and West Virginia) with new health exchange laws. Governors in Georgia and Indiana established exchanges via executive order. Bills passed in Colorado and Hawaii still await their governors’ signature. A few other states are nearing completion of the process, but many others states have not yet settled on an approach. In some cases, politicians, health care providers and consumers differ widely on what an exchange should look like or over how it should function. In other states, the delay stems from disagreements over which committee should handle the bill or who to appoint as members of the exchange oversight board. More than half of states will have to extend their work into 2012, pushing up against the 2012 deadline to have an exchange in place before the federal government steps in and establishes one for them. Read a CQ story about state efforts to establish exchanges.
Litigation Update
As you may remember, the U.S. Court of Appeals for the Fourth Circuit -- also known as the "rocket docket" for its speedy handling of cases -- was the first Circuit Court of Appeals to hear oral arguments in ACA challenges on May 10. This week, the Fourth Circuit made the rare move of ordering the parties to submit briefs on questions that neither challengers nor defenders of the law had raised in their main briefs. Specifically, the court asked the parties to address whether and how the Anti-Injunction Act, which forbids anyone from maintaining a lawsuit for the purpose of restraining assessment or collection of any tax, would apply to the ACA cases. It is unclear how this order will affect the resolution of the cases or the timing of a decision.
In the case in the Sixth Circuit, which is scheduled to hear oral arguments on June 1, the Obama administration appeared to concede that plaintiffs may have legal standing to challenge the law because virtually all citizens will be required to purchase insurance by 2014. The individual mandate, also known as the minimum coverage provision, is at the crux of all of the lawsuits brought against the ACA. To date, more than 30 legal challenges to the ACA have been filed in federal courts. Five have been decided on the merits, with three federal judges upholding the mandate and two striking it down. All other challenges have been dismissed for lack of standing or procedural reasons. The U.S. Supreme Court is expected to hear the case during its spring term of next year, with a decision likely before its summer recess.
Media/Polling
Experts Want Early Implementation of Key Health Reforms Allowed in the States
More than 80 percent of leaders in health care and health care policy say states should be allowed to implement key provisions of the Affordable Care Act early, according to the latest Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey. When asked to name the specific provisions, respondents identified expanded Medicaid eligibility to cover more low-income families and the establishment of health insurance exchanges with premium subsidies. The survey also asked experts about the relative power of states and the federal government over the health care system - seven out of ten favored the balance established in the Affordable Care Act or support more authority for the federal government.
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)