Health Reform Talk Takes A Brief Break

With a momentous health reform year finally coming to an end, the authors of Health Reform Talk are taking a brief break after today.

Health Reform Talk will resume its regular insights into health reform on January 5.

Happy Holidays and Happy New Year.

Health Reform Will Dramatically Lower Rate Of Uninsurance, Costs Of Uncompensated Care

Under the Patient Protection and Affordable Care Act (ACA), the number of uninsured adults younger than age 65 would drop by 27.8 million (from 18.6% to 8.3% of this population), and the cost of uncompensated health care provided to the uninsured would drop by 61%, according to the Urban Institute. The report, America Under the Affordable Care Act, also found that the Medicaid expansion would enroll an additional 16.8 million people, and 43.8 million people would be covered through health insurance exchanges (both nongroup and Small Business Health Options Program (SHOP)).

Virginia Court Strikes Down Individual Mandate In Health Reform

The 2010 health reform requirement that individuals maintain essential health coverage or pay a penalty invites an “unbridled exercise of federal police power” and “exceeds the constitutional boundaries of congressional power,” according to a December 13 ruling by Judge Henry E. Hudson of the U.S. District Court for the Eastern District of Virginia.

In the ruling (Commonwealth of Virginia v. Kathleen Sebelius (Civ. Act. No. 3:10CV188-HEH)), the judge specifically declared unconstitutional Sec. 1501 of the Patient Protection and Affordable Care Act (ACA), the Requirement To Maintain Minimum Essential Coverage. The case originally was filed soon after passage of the ACA by Virginia attorney general Kenneth T. Cuccinelli II.

Guidance Issued For Mini-Med Plans

Two new sets of guidance issued by the Department of Health and Human Services (HHS) on December 9 require that health insurers offering “mini-med” plans must notify consumers in plain language that their plan offers extremely limited benefits, and restrict the sale of new mini-med plans except under very limited circumstances. Mini-med plan insurers also must direct consumers to http://www.HealthCare.gov where they can get more information about other coverage options.

Health Reform Law Is Amended (A Tiny, Tiny Bit)

It’s not much of a change, but Congress has passed its first amendment to the Patient Protection and Affordable Act (ACA) since President Barack Obama signed it in March 2010.

Forget about the calls for wholesale repeal—even provisions Republicans and Democrats agreed should be changed remain in the law (more about that later). But on December 8 and 9, the Senate and the House of Representatives passed the Medicare and Medicaid Extenders Act of 2010, which in part extends current Medicare payment rates through Dec. 31, 2011. Under the current "sustainable growth rate" (SGR) formula, Medicare physician payment rates were scheduled to be reduced by 25% on January 1, 2011.

Premium Rate Review, Or How To Know If The Pudding Is Any Good

Just as the proof of a pudding is in the eating, so the test of a law is in its implementation.  And if past practice in the states is any indication, the implementation of rate reviews of health care premium increases may require many taste tests.

How To Sort Through The Complications Of The Small Business Health Care Tax Credit

As new guidance issued by the Internal Revenue Service makes clear, the path to receiving the small employer tax credit (under the Patient protection and Affordable Care Act) is complicated. Nevertheless, the Council of Economic Advisors estimates that as many as 4 million small businesses are eligible for the credit if they provide health care to their workers.

The maximum credit is 35% of premiums paid in 2010 by eligible small business employers and 25% of premiums paid by eligible employers that are tax-exempt organizations. In 2014, this maximum credit increases to 50% of premiums paid by eligible small business employers and 35% of premiums paid by eligible employers that are tax-exempt organizations.

Virginia court dismisses health reform challenge

In the latest round in the ongoing legal debate over the constitutionality of portions of the Affordable Care Act, a district court in Virginia has dismissed a challenge to the employer and individual coverage provisions of the ACA.

Liberty University, the plaintiff in the case (Liberty University v. U.S., DC VA, No. 6:10-cv-00015-nkm), offered nine separate challenges to the health reform law. It claimed that the ACA's provisions violated numerous parts of the Constitution, including the Commerce Clause, the Guarantee Clause, and the Free Exercise and Establishment Clauses of the First Amendment.

U.S. District Court Judge Norman K. Moon dismissed all the challenges. With respect to the Commerce Clause claim, the court noted that "the employer and individual coverage provisions are a regulation of interstate commerce authorized by the Commerce Clause."

An appeal to the U.S. Court of Appeals for the Fourth Circuit is expected. In November, the Supreme Court declined to hear one challenge to the ACA. In addition, a Michigan federal court dismissed another constitutional challenge to the Act, while a Florida court has allowed two challenges to move forward.

For a comprehensive analysis of the Affordable Care Act, including the full text of the law and additional information on health reform and other developments in employee benefits, just click here.

Delivering health care: challenges remain for Integrated Delivery Systems

Integrated health care delivery systems (IDSs), in which medical care is coordinated and compensated within the system, have been shown (when compared to traditional health delivery systems) to make patient care more efficient, while at the same time improving both access to and the quality of the care received.

That said, challenges remain, especially among IDSs designed to care for underserved populations, such as Medicaid enrollees and rural populations. That's the conclusion of "Features of Integrated Systems Support Patient Care Strategies and Access to Care, but Systems Face Challenges," a recent report issued by the Government Accountability Office (GAO-11-49). For its study, the GAO analyzed a sample of 15 private and public IDSs that are clinically integrated across primary, specialty and acute care disciplines.

Challenges faced by the IDSs include the following:

• Lack of compensation from health insurance companies for the care coordination services provided to patients by the IDS;
• Securing access to specialty care, including mental health care, for underserved patients; and
• Resistance to organizational change from various stakeholders, including physicians.

The GAO report is here. For more answers about health care delivery systems, go here.