HHS is quickly moving to implement the Affordable Care
Act. Rules are out in the past two weeks that charge
insurance companies to participate in federal exchanges, prohibit
discrimination based on pre-existing conditions, detail essential
health benefit requirements, and expand employment-based wellness
programs. In addition, in response to Liberty
University's request, the Supreme Court ordered the 4th Circuit
to examine the constitutionality of ACA's employer
requirements.
AT THE AGENCIES
On Friday (11/30), HHS issued new rules that charge insurance
companies monthly fees to sell plans through federally run
insurance exchanges. These fees will be pegged to the number
of customers each insurer has in the exchange.
On Tuesday (11/20), HHS released three proposed rules implementing
the Affordable Care Act. Comments may be submitted during the
90-day comment period. One of the rules details ACA's
guaranteed issue and community rating requirements. The rule
would prohibit health insurance companies from discriminating
against individuals because of pre-existing or chronic conditions,
gender or occupation starting in 2014. Under the rule, the
only factors by which insurers can underwrite are family size,
geography and whether or not the individual smokes. In
addition, insurers may not charge seniors more than three times
what they charge young people – currently, insurers in 42
states charge seniors five or more times what they charge young
adults.
Another of the proposed rules outlines coverage of essential
health benefits, which are the minimum package of benefits the
Affordable Care Act says must be included in health insurance
plans. The categories of benefits that must be included are
inpatient and outpatient care, emergency services, maternity and
childhood care, prescription drugs, preventive screenings and lab
work, mental health and substance abuse treatment, rehabilitation
for physical and cognitive disorders, and dental and vision care
for children. Much of this information was already
known. One surprise, however, is that health insurance plans
will have to cover the same number of prescription drugs as the
benchmark plan in their states, which means there will be a greater
number of prescription drugs covered in each class of drugs.
Finally, HHS also released a proposed rule that implements and
expands employment-based wellness programs to promote health and
help control health care spending. Under the regulation,
employers may reward employees for annual exams or regular
workouts, but they may not punish people who do not engage in these
activities.
IN THE STATES
According to a
report released Monday (11/26) by the Kaiser Family Foundation,
states that expand their Medicaid rolls would see only modest cost
increases compared with the expense to the federal
government. Part of the states' concern over costs,
however, is that the federal government could increase the
percentage of the bill states have to cover in later years in
response to fiscal woes. The report also says that states
would face increased Medicaid costs even if they do not expand
their Medicaid programs.
On Friday (11/16), Georgia Gov. Nathan Deal said
Georgia would not build a state exchange because it has "no
interest in spending ... tax dollars on an exchange that is
state-based in name only."
Wisconsin Gov. Scott Walker,
Texas Gov. Rick Perry, Maine Gov.
Paul LePage and Arizona Gov. Jan Brewer also each
sent letters to HHS Sec. Sebelius saying that their states would
not set up state-based insurance exchanges. This means the
federal government will set up the exchanges in these states.
Gov. Perry also said he will not expand Medicaid.
On Friday (11/16), Michigan Gov. Rick Snyder
announced he is planning to move forward with a partnership
exchange, however, he has not foreclosed the option of a
state-based exchange if the federal deadline is again moved or the
state House votes for the bill.
Oklahoma Gov. Mary Fallin announced that Oklahoma
would not pursue the creation of a state-based exchange or expand
its Medicaid program.
On Monday (11/19), Pennsylvania Gov. Tom Corbett
said that expanding Medicaid pursuant to the Affordable Care Act
would cost the state millions of dollars that it does not
have. The state has not officially made its decision yet,
though. The state is particularly concerned about the
"woodwork effect" – even though the federal
government will cover the costs associated with newly eligible
beneficiaries, many new beneficiaries will also "come out of
the woodwork" who were previously eligible. These
individuals would have to be paid for by Pennsylvania since the
federal assistance is only for individuals who are newly
eligible. This concern is by no means unique to
Pennsylvania.
On Thursday (11/29), Missouri Gov. Jay Nixon said
that he plans to expand Medicaid in the state.
IN THE COURTS
On Monday (11/26), the Supreme Court ordered the 4th Circuit Court of Appeals to examine the constitutionality of the Affordable Care Act's employer requirements and mandatory coverage of contraceptives without a co-pay. This was in response to Liberty University's request that the Supreme Court reopen arguments against the employer mandate and contraceptive coverage mandate.
On Monday (11/19), a federal judge ruled against Oklahoma City-based Hobby Lobby in its attempt to block enforcement of contraceptive health insurance provisions of the Affordable care Act. Hobby Lobby's attorneys said they plan to appeal the ruling to a federal appeals court in Denver.
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