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6-30-11 Affordable Care Act Update
July 1, 2011
Litigation Update
Yesterday, the U.S. Court of Appeals for the Sixth Circuit issued the first appellate decision in litigation challenging the constitutionality of Affordable Care Act (ACA). The court upheld the law, reasoning that Congress had acted within its constitutional authority when it required individuals to purchase health insurance (the so-called "individual mandate"). One of the leading conservatives on the circuit – George W. Bush appointee Jeffrey Sutton – wrote the concurring opinion, making him the first Republican-nominated judge to rule in favor of upholding the mandate. The law’s challengers claimed that Congress had exceeded its powers in forcing people to purchase insurance, arguing the decision not to purchase insurance is "inactivity" and that the government cannot force people to purchase any good or service. Read The Los Angeles Times and Washington Post articles and listen to the NPR story.
The court's opinion showed an understanding of how the industry operates in practice, and that the individual mandate regulates "active participation in the health care market." The opinion also discussed the uniqueness of health care, and the necessity of access to it. Judge Sutton’s concurring opinion referenced cancer patients when discussing the constitutionality of the law: "Life is filled with risks, and one of them is not having the money to pay for food, shelter, transportation and health care when you need it. Unlike most of these expenses, however, the costs of health care can vary substantially from year to year. The individual can count on incurring some health costs...but cannot predict others (e.g. a cancer diagnosis, a serious accident)."
As you know, the Society and ACS CAN, along with the American Diabetes Association and the American Heart Association, filed an amicus brief with the Sixth Circuit, along with all of the other circuits hearing appeals, outlining the critical need for ACA's protections for patients with chronic illnesses, and citing studies linking cancer outcomes with insurance status. Read a joint statement from the groups in response to yesterday’s decision.
Decisions in similar cases challenging ACA are still pending in the Fourth and 11th Circuits, and are expected before Labor Day. The U.S. Supreme Court is likely to accept the appeals during its fall term of 2011, with a final decision issued in the spring of 2012.
Federal Update
Institute of Medicine Report Illustrates Barriers to Care for Patients in Pain
The Institute of Medicine (IOM) released a new report yesterday titled Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research. ACS CAN has been a long-time advocate for research to better understand the difficulty that chronically ill patients have in accessing appropriate pain relief in this country. In 2006, ACS CAN, along with the National Pain Care Forum, drafted the National Pain Care Policy Act that garnered bipartisan support in the House and the Senate. Three of the four provisions of the bill were subsequently enacted as part of the Affordable Care Act, including a provision requiring the Department of Health and Human Services to enlist IOM in examining pain as a public health problem.
The final report identifies pain as a major driver for visits to physicians and other health care providers, a major reason for taking medications, a major cause of disability, and a key factor in quality of life and productivity. A new analysis undertaken as part of the study finds that at least 611 million adult Americans experience pain, and that the medical costs of pain care and the economic costs related to disability days and lost wages and productivity amount to at least $560 billion to $635 billion annually.
Key provisions of existing federal law also call for the establishment of an Interagency Pain Research Coordinating Committee and an Education and Training Grant Program. ACS CAN will continue to work to implement these provisions that are important for cancer patients and their families. Read the ACS CAN press release.
Health Disparities
HHS announced this week new draft standards to improve the monitoring of health data by race, ethnicity, sex, primary language, and disability status. The proposed standards for collection and reporting of data in population health surveys are intended to help federal agencies refine their population health surveys so that researchers can better understand health disparities and make better decisions on potential effective strategies for eliminating them.
State Update
Ten states – California, Colorado, Hawaii, Illinois, Maryland, Nevada, Oregon, Vermont, Washington and West Virginia – have passed health insurance exchange legislation that their governor has signed into law. Two more states -- Connecticut and North Carolina --have exchange bills awaiting action by their governor. Additionally, the governors of Alabama, Georgia and Indiana have issued executive orders to create panels to study exchanges, and the governors of Mississippi, North Dakota, Virginia and Wyoming have signed bills that allow the legislative process to move forward without yet establishing an exchange.
Improvements to Pre-Existing Condition Insurance Plan
Improvements go into effect tomorrow, July 1, intended to make the Pre-Existing Condition Insurance Plan (PCIP) easier to access and more affordable for patients. Patients in states with federally-run PCIP programs, the new high-risk pool created by the ACA, will see their premiums reduced by as much as 40 percent. In addition, people applying for the program will be able to demonstrate their eligibility more easily than before by providing a letter from a health care provider dated within the past 12 months that states that they have or had a serious medical condition, disability, or illness. Until now patients have had to produce a denial letter from an insurance company to qualify for PCIP. Patients must still demonstrate that they have been uninsured for six months or more.
For more information on PCIP, visit www.pcip.gov or call 1-866-717-5826 (TTY 1-866-561-1604) toll-free. Information about the improvements to PCIP will also be available on the Health Care & You website, the collaboration that involves ACS CAN, AARP, the American Medical Association, and other national health groups that aim to educate the public about the new law.
Media/Polling
New Study Finds Few Health Care Executives are Familiar with Law
Just one in four health care executives claim to be “very familiar” with the ACA, according to a new Bacon Partners study. Beyond that, only 64 percent are “somewhat familiar” with the legislation. The survey was conducted to gauge the knowledge and planning levels around the ACA of more than 250 C-suite executives in the health care field. The majority of respondents, 48 percent, say their ACA planning process is “under development”.
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)