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News
1-4-13 Affordable Care Act Update
January 18, 2013
Federal Update
As noted in an earlier communication, Congress passed a measure on New Year's Day to temporarily avert the most immediate consequences of the so-called "fiscal cliff." We are pleased that federal funding for cancer research, cancer prevention and early detection programs, and key provisions of the Affordable Care Act (ACA) important to cancer patients, as well as federal support for Medicare and Medicaid coverage that is vital to many people with cancer, have been spared for now, and we will work to ensure that the voices of people with cancer and their families are heard as the debate continues.
Policy Update
ACS CAN Submits Comments on Two Major Proposed Regulations
ACS CAN submitted comment letters last month to the federal government on the proposed regulations for essential health benefits and the state insurance market reforms. The biggest concern in the essential health benefits regulation is ensuring cancer patients access to all medically appropriate prescription drugs. The information provided by the Department of Health and Human Services so far suggests that most benchmark plans have good coverage, but we and many other patient groups are very concerned that some patients in critical need of certain drugs may not have complete access. There are a number of other important concerns that are raised in our comment letter, as well. Read the essential benefits letter.
The insurance market reform proposal is equally important because it lays out the specifics of how some of our highest priorities for reform, such as guaranteed issue and no pre-existing condition restrictions, will actually be implemented in the states. Our biggest focus was directed at how the premium surcharge for tobacco users will be implemented. The ACA states insurers may assess a surcharge of up to 50 percent on tobacco users, but HHS solicited comments on specific operational questions such as who should be defined as a "tobacco user" and how that status should be determined. ACS CAN drafted template language for other consumer groups to use in responding to these questions. Read the insurance market reform comments.
Proposed Regulation on Employer Responsibility
Last week, the Treasury Department issued a proposed regulation for the employer responsibility provisions of the ACA (i.e., the employer mandate). Under the law, employers with more than 50 full-time workers must contribute to the cost of "affordable" health insurance and cover at least 95 percent of their workers or be subject to penalties. The proposed regulation lays out the ways in which employees will be counted, how affordability is determined, how employer penalties (if any) will be assessed, and transitional relief for certain businesses. The employer responsibility provisions take effect in January 2014.
New ACA Provisions Take Effect
Provisions of the ACA that took effect January 1, 2013, include two aimed at expanding access to preventive care. Specifically, the federal government will provide new funding for states that cover preventive services in Medicaid at little or no cost to patients and will increase payments to primary care physicians who treat Medicaid patients. A provision calling for a pilot program encouraging hospitals, doctors, and other providers to better coordinate and improve patient care also took effect January 1. The pilot calls for bundling service fees together and paying all providers involved in a patient's care a flat rate as opposed to the fragmented claims and billing systems typically used now.
HHS FAQ
HHS issued a Frequently Asked Questions document in late December to clarify issues raised by state leaders about the implementation of state health exchanges, insurance market reforms, and Medicaid provisions. The FAQ also clarifies that the ACA does not allow states to implement a partial Medicaid expansion.
State Update
HHS announced last month that 10 states (Colorado, Connecticut, Kentucky, Maryland, Massachusetts, Minnesota, New York, Oregon, Rhode Island, and Washington) and the District of Columbia received conditional approval to operate state-based health insurance exchanges. In addition, Delaware became the first state to be conditionally approved for a state-federal partnership exchange. To date, 24 states have submitted applications or letters of intent to run either a state-based or state-federal exchange. The remaining states will have federally operated exchanges.
New Study on Coverage for Young Adults
The ACA provision allowing children up to age 26 to remain on their parents' health insurance has helped more than 3 million young adults gain health coverage, according to a study published in the January edition of Health Affairs. Coverage gains were felt across all racial and ethnic groups as well as marital and employment status. The report also attributes broader coverage to a significant decline in the number of young adults who postponed health care or declined to seek it because of the cost.
As always, thank you for all you do every day to support laws and policies that help cancer patients and their families.
Chris Hansen | President
ACS Cancer Action Network | American Cancer Society Cancer Action Network, Inc.