Mar. 16: Healthcare Reform Challenge Hinges On Arguments On Mandates

NAHU Newswire

CBO: 20 Million Could Lose Employer-Based Health Insurance As A Result Of ACA.

According to a CBO report released Thursday, as many as 20 million Americas could lose employer-based healthcare coverage as a result of President Obama’s healthcare reform law. The Hill (3/16, Pecquet) reports in its “Healthwatch” blog that the CBO says the figures represent a “worst case scenario” and the law “could just as well increase the number of people with employer-based coverage by 3 million in 2019.” The Hill notes that Republicans seized on the report because the numbers “appear to violate Obama’s pledge that people who like their health plans will be able to keep them.”

Politico  (3/16, Feder) reports, “House Budget Committee Chairman Paul Ryan said the report proves President Barack Obama has already broken his promise that health reform wouldn’t endanger the coverage people already have.” In a statement, Ryan said, “As nonpartisan analysts made clear today, millions of Americans will soon learn the hard way that Washington’s overreach into their health care decisions will result in sharp disruptions to their coverage and their care.” Meanwhile, “Sen. Orrin Hatch (R-Utah), the ranking Republican on the Senate Finance Committee, said the 20 million estimate ‘exposes more of the real costs of the president’s unconstitutional, deeply flawed health spending law.'”

However, according to CQ  (3/16, Norman, Subscription Publication), the analysis “says that a ‘sharp decline’ in employment-based insurance as a result of the law is ‘unlikely,’ and even if it occurred it ‘would not dramatically increase the cost’ to the federal budget.” Also covering the story are the Huffington Post  (3/16, Young) and Modern Healthcare  (3/16, Zigmond, Subscription Publication).

CBO Report: Decline In Employer-Sponsored Coverage Could Potentially Reduce Deficit. In Forbes  (3/16), Avik Roy writes, “One of the biggest concerns with the Affordable Care Act has been that the law will drive employers to stop sponsoring health insurance for their workers, instead dumping those workers on to the new law’s subsidized insurance exchanges.” However, “the Congressional Budget Office, in a provocative new report, believes that such behavior could, in some circumstances, actually reduce the deficit.”

        The Washington Post  (3/16, Kliff) “Wonkblog,” citing Roy’s Forbes piece, says “the government would have to spend $372 billion for workers who received their coverage through the exchanges, Medicaid and CHIP. But it would also net more in revenue, from newly-taxable income from fees imposed on employers who drop coverage,” which would lead to about “$13 billion in deficit
reduction.” The major caveat to this analysis, however, is that “it assumes that when employers drop coverage, the money previously spent on insurance will get tacked onto a worker’s paycheck.”

Healthcare Reform Challenge Hinges On Arguments On Mandates.

USA Today  (3/16, Wolf) reports that a key issue for the Supreme Court later this month when it hears arguments on the healthcare reform law challenge will be “whether requiring Americans to buy health insurance is a law with a ‘limiting principle.’ If President Obama’s health care law — his landmark legislative achievement — is to withstand legal challenge, government lawyers must convince a majority of justices that the health care marketplace is unique,” and by failing to purchase insurance, “millions of Americans transfer $43 billion in health care costs to others in the form of higher premiums.”

The Hill  (3/16, Baker) reports in its “Healthwatch” blog, “The Obama administration has shifted its legal arguments as it prepares to defend the president’s healthcare law before the Supreme Court.” In brief submitted prior to oral arguments, government attorneys, who have previously “defended the mandate as its own regulation of economic activity,” are “now stepping up a separate argument emphasizing that the mandate is part of a broader regulatory scheme.” The Hill adds, “Some legal experts say the shift could steer the case in a direction that would make Justice Antonin Scalia more likely to uphold the healthcare law’s mandate requiring individuals to purchase health insurance.”

McClatchy  (3/16, Rau) reports, “Experts consider the requirement to hold insurance, known as the individual mandate, to be the most legally vulnerable part of the 2010 law.” McClatchy adds, “There are ways that Obama – if he’s re-elected – might be able to salvage the law even if the court strikes down the individual mandate but leaves the rest intact, health policy experts say. These fixes would create financial incentives for people to not delay enrolling in insurance.” CQ  (3/16, Jenks, Subscription Publication) also reports on the Supreme Court briefs.

Chamber To Court: Either Strike Healthcare Law Or Leave It Be. Bloomberg News  (3/15, Wayne) reports that the US Chamber of Commerce is seeking an all-or-nothing court decision on the healthcare overhaul. According to Bloomberg News, “as the Supreme Court is set to begin reviewing a key provision of the law, the group’s message is different: If you can’t kill it, don’t maim it, the chamber said in a legal brief filed separately with the court.” The story notes that “the chamber is among lobby groups for large companies caught between their own distaste for the law and the self- interest of members who have won concessions since it was passed.”

Bill Would Allow Seniors To Use Federal Employee Health Plans.

The New York Times  (3/16, Weisman) “The Caucus” blog reports that “four Republican senators — Rand Paul of Kentucky, Jim DeMint of South Carolina, Lindsey Graham of South Carolina, and Mike Lee of Utah –” initiated “a conversation Thursday on changes to Medicare, releasing a proposal that would end the federal fee-for-service insurance program in 2014 and enroll all recipients into the health insurance plan now offered to federal employees.” Their plan would “give seniors and other recipients a menu of health insurance plans to choose from,” including “all of the options available to members of Congress and federal workers, but fee-for-service would end.” Their plan also involves “a sliding scale for payments.” In addition, “eligibility for the program would also slowly rise by three months a year for 20 years, going from age 65 to 70.”

The Hill  (3/16, Pecquet) “Healthwatch” blog quotes Graham, who said, “Our goal is to save Medicare from bankruptcy and ensure seniors have affordable, high-quality health care – a crisis President Obama has only made worse during his time in office. Allowing seniors access to the Federal Employee Health Benefit (FEHB) program, which members of Congress and federal employees use, will give them more choices and lower their out-of-pocket costs.”

Article Details Some Provisions In Place After ACA.

USA Today  (3/16, MacMedan) reports, “Two years after President Obama signed the Patient Protection and Affordable Care Act, some provisions have taken effect, while others still have two years to wait.” According to “a recent poll by the non-partisan Kaiser Family Foundation,” it found that “two in three Americans said they have not been affected by the law yet. Only 14% said they have benefited; 21% said they have been affected negatively.” The piece details “some provisions with the broadest potential impact.”

Two-Thirds Of Americans Say They Have Not Been Impacted By Healthcare Law.

USA Today  (3/16) reports that a recent poll by the Kaiser Family Foundation, found that “two in three Americans said they have not been affected by the law yet. Only 14% said they have benefited; 21% said they have been affected negatively.” USA also notes the provisions of the laws “with the broadest potential impact.”

New Jersey Assembly, Senate Pass Bill To Create State Health Insurance Exchange.

The Record and Herald News (NJ)  (3/16, Washburn) reports that on March 15 in New Jersey, a measure “to create a state health insurance exchange, an essential part of federal healthcare reform intended to benefit the state’s most vulnerable citizens, passed both houses of the state legislature.” The legislation “creates an independent ‘health benefit exchange’ within the state Department of Banking and Insurance to help individuals and small businesses shop for and purchase health coverage and obtain federal subsidies to do so.” However, “Governor Christie has said he wants to see how the US Supreme Court rules on a constitutional challenge to the Patient Protection and Affordable Care Act before the state uses taxpayer money to establish an exchange. Oral arguments before the Supreme Court are scheduled later this month, with a decision expected before July 1.”

Mississippi Moving Ahead On Health Insurance Exchange.

On its website, the NPR  (3/15, Hess) “Shots” blog ran a piece from the Mississippi Public Broadcasting/Kaiser Health News in which it was reported, “Mississippi, a deeply red Southern state that is part of the Supreme Court case against the health law, is moving full speed ahead with one of the key provisions of that law: an online health insurance exchange.” The piece added, “Efforts to set up an insurance exchange in Mississippi stretch back to before the Affordable Care Act passed, and an exchange had the outright support of former Mississippi Gov. Haley Barbour (who nonetheless attached the state to the case against the federal health law).” According to state Sen. Buck Clarke (R-Hollandale), “Mississippi may appear to be an anomaly in the South, but he points out that other states did not have the same legal options to avoid a political fight.”

Florida Counties Urging Veto Of Bill Regarding Unpaid Medicaid Costs.

The Lakeland (FL) Ledger  (3/16) reports, “Florida’s counties are urging the governor to veto” HB 5301, which “could cost the local governments nearly $300 million during the next five years. … In crafting the new state budget, lawmakers said the counties owe $325 million in unpaid bills for Medicaid,” but “counties bitterly complain that the billing system that was changed by” the state Agency for Health Care Administration “in 2008 is deeply flawed.” However, “vetoing the bill is not necessarily a straightforward calculation for [Gov. Rick] Scott, because the measure also contains other major Medicaid and health care provisions. For instance, it includes a six-visit emergency room limit for nonpregnant adult Medicaid patients.” In addition, it “would lift the state ban on allowing the children of state workers to receive health care benefits through the Kidcare program.”

Research Scholar Says “Healthcare Wasn’t Broken.”

In a Los Angeles Times  (3/16) op-ed, Christopher Conover, a research scholar at Duke University’s Center for Health Policy and Inequalities Research, writes that “the fierce battle over” healthcare “reform was based on the perception that Americans did not get good value for their money. Many of the global comparisons that informed this view, however, were flawed, incomplete or misleading.” He concluded, “A fairer comparison reveals that the performance of the US health system is far superior to the statistical caricature critics have presented.”

Group Identifies Reasons For Reform. The Gainesville (GA) Times  (3/16, Hale) reports, “Weeks before the Supreme Court weighs in on controversial national health care reform legislation, a panel of local medical experts weighed in on the potential impacts on the health system on Thursday night at Brenau University.” The “panel largely gave mixed reviews to changes that could be coming down the pipe – noting that the current system is unhealthy but the prescribed reform will likely be painful.” Every panel member “agreed that the reason for reform was rocketing costs without the benefit of better service.”

Survey: Employer-Sponsored Insurance Declined Between 2007 And 2010.

Modern Healthcare  (3/16, Evans, Subscription Publication) reports, “Employer-sponsored insurance declined across all income categories between 2007, the year the Great Recession began, and 2010 among nonelderly Americans, newly released survey results show.”

CQ  (3/16, Subscription Publication) reports, “The study by the Center for Studying Health System Change (HSC) for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR) found that the proportion of people younger than 65 with no workers in the family jumped 10 percentage points to 31.6 percent in 2010.” This “was the key driver of the decline in employer health coverage, accounting for about three-quarters of the drop since 2007, according to findings from HSC’s 2010 Health Tracking Household Survey, a nationally representative survey with information on 13,595 non-elderly people.” But in addition to this factor, “some workers forced to take part-time work didn’t then get access to employer-based insurance, and rising health costs have led to fewer companies offering coverage and fewer workers signing up as premiums and co-pays increased.”

MedPAC Report Suggests Reimbursement Changes.

The Hill  (3/16, Pecquet) “Healthwatch” blog reports that the Medicare Payment Advisory Board’s “March report  (pdf) to Congress reiterates calls for reimbursing doctors’ visits at the same rate whether they take place in a hospital or a physician’s office.” In addition, the report suggests “cutting payments to nursing homes, particularly those with high rehospitalization rates, while shifting payment from facilities that concentrate on intensive therapy to facilities that treat medically complex patients. Finally, MedPAC recommends tweaking the low-income subsidy for Medicare’s prescription drug program to encourage the use of generic drugs.” The blog adds, “Teaching hospitals, however, argue that they need the extra payments to train interns and care for vulnerable populations in team-based settings.”

Modern Healthcare  (3/16, Zigmond, Subscription Publication) reports, “The Medicare Payment Advisory Commission reiterated its position from last fall that federal lawmakers should repeal Medicare’s sustainable growth-rate formula and replace it with 10 years of statutory fee-schedule updates. … Other recommendations for 2013 include a payment update of 0.5% for the ambulatory surgery center and hospice segments, and no payment increases for skilled-nursing facilities, long-term-care hospitals and inpatient rehabilitation facilities. The report also said Congress should direct the HHS secretary to begin a two-year rebasing of home health rates in 2013.”

CQ  (3/16, Reichard, Subscription Publication) reports that MedPAC “also specified cuts totaling $219 billion that could be made to offset the costs of overhauling the SGR. These included not only the MedPAC recommendations, but also potential cuts identified by such entities as the Office of the Inspector General at HHS and the Congressional Budget Office. The SGR proposal by MedPAC brings down the $300 billion price tag cited by the CBO as the cost of an SGR overhaul by cutting payments to some physicians, arguably for better-paid doctors who can more easily afford them.”

CMS Will Not Enforce Move To 5010 Transaction Standards Until June 30.

Modern Healthcare  (3/16, Robeznieks, Subscription Publication) reports, “The CMS will not begin enforcing the mandated move to Version 5010 transaction standards for an additional three months, until after June 30. … The agency’s e-mailed announcement stated that the industry is making ‘steady progress’ in the conversion, and it noted that the Medicare Fee-for-Service program was successfully processing 70% of Medicare Part A claims and more than 90% of Part B claims in the 5010 format. Also, according to the announcement, commercial plans have been reporting ‘similar numbers’; state Medicaid agencies are ‘showing progress,’ and that 98% compliance is expected before the July 1 enforcement start date.”

Report Calls For Medicaid To Improve QoL Measurement Tools.

CQ  (3/16, Adams, Subscription Publication) reports, “Medicaid officials should improve tools to measure the quality of care for patients with disabilities, coordinate care for those patients, and make sure that anti-fraud practices for the program don’t burden the states, according to a new report  (pdf) by the Medicaid and CHIP Payment and Access Commission. … The group called on the Secretary of Health and Human Services to work with state officials to simplify regulatory requirements and get rid of any federal anti-fraud efforts that are redundant, outdated or not cost-effective. HHS officials also should inform states about new, effective ways to combat fraud, the panel said.”

Report Recommends Initiatives To Improve Care, Reducing Cost, Fraud. Modern Healthcare  (3/16, Daly, Subscription Publication) reports, “The second annual report from the congressionally chartered advisory group on Medicaid quantified the program’s historic size and recommended a series of initiatives to improve the quality of care it funds while reducing costs and fraud.” The Medicaid and CHIP Payment and Access Commission “reported to Congress on Thursday that the two federal-state public insurance partnership programs for the poor grew to a combined 78 million enrollees in the last fiscal year and cost $444 billion.” In addition, the commission “recommended renewed improvement efforts, including widespread use of approaches proven to improve care, control costs, and update quality measurement for the 9.1 million nonelderly enrollees whose disabilities qualify them for Medicaid.”

Cigna CEO Says Court Ruling Won’t Stop Healthcare Shift.

Bloomberg News  (3/15, Nussbaum, Wayne) reports, “A Supreme Court (1000L) ruling on whether the US health-care law is constitutional won’t stop market forces transforming how Americans get their medical care, said Cigna Corp. (CI)’s chief executive officer.” In an interview at Bloomberg’s New York headquarters, Cigna CEO David Cordani said, “Employers are increasingly pushing workers into plans where they share more of the cost and responsibility for managing their medical care.” The shift, “aimed at taming soaring health costs, has come to businesses including JPMorgan Chase & Co,” Cordani said and added, “Even if the 2010 law is overturned, ‘the problem still exists, the problem of affordability, eroding health status, an aging population. T