HealthCheck September 30, 2011


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September 30, 2011

Academy Activities

In an Aug. 31 letter to the newly created Joint Select Committee on Deficit Reduction, the Academy's Medicare Steering Committee urged the 12-member bipartisan panel, which was formed to recommend at least $1.2 trillion in savings over the next 10 years, to consider options that would improve the long-term solvency and sustainability of the Medicare program. The letter stressed the need to evaluate the effect that any potential Medicare reforms—made in the context of deficit reduction—would have on the viability of the program. The letter also asked the committee to be mindful of how the reforms could affect the cost, access to, and quality of care. It further warned against simply shifting costs from one payer to another.

Legislative and Regulatory Updates

check markNew rules stipulated in the Affordable Care Act (ACA) that require insurers to publicly disclose and provide a justification for proposed health insurance rate increases of 10 percent or more went into effect Sept. 1.

check markThe Centers for Medicare & Medicaid Services (CMS) on Sept. 6 issued a final rule that amends the rule issued in May on rate increase disclosure and review. The final rule clarifies that, for rate review purposes only, the definitions of "individual market" and "small group market" under state rate-filing laws would govern even if they differed from the definitions under the Public Health Service Act. The rule also clarifies that coverage sold to individuals and small groups through associations is subject to rate review on or after Nov. 1.

check markThe CMS on Sept. 14 issued a request for comments on Section 1331 of the ACA, which gives states the option to establish basic health programs that would provide at least the essential health benefits to be established under the ACA. The comment deadline is Oct. 31.

check markPresident Obama on Sept. 28 asked the Supreme Court to rule on the constitutionality of the individual mandate in the ACA. The president requested that the justices review the Aug. 12 decision by the U.S. Court of Appeals for the 11th Circuit. In a split opinion, the three-judge panel based in Atlanta said that Congress and the president overstepped their authority by requiring all Americans to obtain health insurance. The Supreme Court term begins on Oct. 3. If the court decides to hear the case, a decision could be delivered sometime next year.

check markIn another ACA-related decision, the U.S. Court of Appeals for the 4th Circuit on Sept. 8 ruled that Liberty University and Virginia Attorney General Ken Cuccinelli lacked standing to challenge the individual mandate under the ACA. After the ACA was passed, Virginia passed a law barring the individual mandate and then filed the suit based on the conflict between state and federal law. The strategy of using state laws to challenge a federal law had no merit, the Richmond, Va., panel argued in its decision to dismiss the case.

check markThe Center for Consumer Information and Insurance Oversight has issued a white paper on risk-adjustment implementation. The paper focuses more on risk-adjustment methodology than on the proposed rule for the three risk-sharing mechanisms under the ACA.

check markThe CMS has extended to Oct. 31 the deadline for comments on two proposed rules. One proposed rule relates to the establishment of exchanges and qualified health plans under the ACA. The other proposed rule sets the standards for reinsurance, risk corridors, and risk adjustment. Comments on both proposed rules, which were published in the July 15 Federal Register, originally were due on Sept. 28.


In The News/Media Activities

Academy Senior Health Fellow Cori Uccello was quoted in a Sept. 6 Kaiser Health News article about the individual health mandate. Uccello provided a list of policy options to strengthen the effectiveness of the individual health insurance coverage mandate contained within the ACA. She said these options also can serve as alternatives if the mandate is removed from the law, but that a strong and enforceable individual mandate is probably the most effective method to limit adverse selection stemming from ACA provisions that restrict rating and eliminate exclusions for pre-existing conditions.

The Academy Medicare Steering Committee's letter to the Joint Select Committee on Deficit Reduction was the subject of articles by Kaiser Health News and National Underwriter Life & Health on Sept. 12. The letter urged the committee to address Medicare's solvency and sustainability by developing proposals to slow health care spending growth. Academy Senior Health Fellow Cori Uccello discussed the letter and options for addressing Medicare's financial issues as outlined in an Academy issue brief in a Sept. 14 HealthLeaders Media article.

Allen Schmitz's testimony on behalf of the Academy during a congressional hearing on the Community Living Assistance Services and Supports (CLASS) Act was referenced and linked in a Sept. 15 Politico article.

News links are to external websites. The Academy is not responsible for the content of these websites.


Upcoming Health Care Reform Events

AHIP's Compliance Forum on State Issues

Conference: Oct. 5, Washington (fee charged)

Sponsor: America's Health Insurance Plans (AHIP)


For a complete listing of upcoming and recent health care reform events click here.