HealthCheck August 26, 2011

Legislative and Regulatory Updates

The U.S. Court of Appeals for the 11th Circuit in Atlanta found [1] that portions of the Affordable Care Act (ACA) are unconstitutional. In a 2–1 decision, the court ruled on Aug. 12 that the individual mandate requirement was an improper exercise of federal authority. The lawsuit was brought by Florida and 25 other states that oppose the ACA. Additional legal challenges to the act currently are pending in lower federal courts.

The National Association of Insurance Commissioners (NAIC) said that state insurance rules should be the authority for the large multi-state plans that will show up on health insurance exchanges in 2014. The NAIC's comments [2] were in response to the Office of Personnel Management's (OPM) recently issued request for information [3] about multi-state plans offered through health insurance exchanges. The ACA requires the OPM to organize at least two multi-state health plans to be sold through exchanges beginning in 2014.

The Department of Health and Human Services (HHS) has issued two proposed rules relating to the development of exchanges under the ACA. The first proposed rule [4] outlines the process of enrolling eligible individuals into qualified health plans and the process for implementing premium and cost-sharing subsidies. It also establishes standards for employer participation in the Small Business Health Options Program (SHOP). The second proposed rule [5] implements sections of the ACA related to Medicaid and Children's Health Insurance Program eligibility and coordination. Comments on both proposed rules are due by Oct. 31.

The HHS also is soliciting comments on proposed rules that address the disclosure [6] of, and the instructions and templates [7] for, the summary of benefits and coverage and the uniform glossary for group health plans and health insurance coverage in the group and individual markets under the ACA. Comments are due by Oct. 21.

The Internal Revenue Service (IRS) has proposed regulations [8] that provide guidance on the manner in which an individual enrolled in qualified health exchanges may claim the premium tax credit. Comments are due by Nov. 10. The IRS will hold a public hearing on the proposed regulations on Nov. 17.

President Obama signed the Budget Control Act of 2011 [9] into law on Aug. 2. The act increases the debt ceiling, reduces the federal deficit over the next 10 years, and creates the Joint Select Committee on Deficit Reduction. The committee is charged with identifying $1.5 trillion in additional cuts, which can include changes to entitlement programs. The committee is composed of 12 members—six members from both the Senate and the House, with membership divided equally between Democrats and Republicans. The members of Congress named to the committee are: Sen. Max Baucus, D-Mont.; Sen. Patty Murray, D-Wash.; Sen. John Kerry, D-Mass; Sen. John Kyl, R-Ariz.; Sen. Rob Portman, R-Ohio; Sen. Pat Toomey, R-Pa.; Rep. David Camp, R-Mich.; Rep. Fred Upton, R-Mich.; Rep. Jeb Hensarling, R-Texas; Rep. Chris Van Hollen, D-Md.; Rep. Xavier Becerra, D-Calif.; and Rep. James Clyburn, D-S.C.

In The News/Media Activities

The Academy's Consumer-Driven Health Plans (CDHP) Work Group's analysis [10] of CDHP research studies was cited on Aug. 10 in a South Florida Sun-Sentinel [11] op-ed by Janet Trautwein, the CEO of the National Association of Health Underwriters. The Academy work group said that CDHPs can save as much as 12 to 20 percent in health care costs in the first year and 3 to 5 percent on average in subsequent years.

Academy Senior Health Fellow Cori Uccello was quoted by Congressional Quarterly's [12]HealthBeat [12] on Aug. 12. During a discussion on a U.S. Government Accountability Office report [13] that examined potential alternatives to the individual health insurance mandate contained in the Affordable Care Act, Uccello said, "Any mechanism that encourages broader participation will help limit adverse selection. These tools should be considered with or without the coverage mandate."

The Academy's concerns [14] about adverse selection and sustainability in the Community Living Assistance Services and Supports (CLASS) program were cited in an Aug. 16 Reuters Money [15] article.

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

Upcoming Health Care Reform Events

New Strategies for Engaging Consumers in Development and Use of Evidence [16]

Webinar: Sept. 14 (fee charged)

Sponsor: AcademyHealth

For a complete listing of upcoming and recent health care reform events click here [17].