Health reform poll: don't cut off funding

Conservatives sometimes argue that the best way to combat what they see as intrusive government regulation is to "starve the beast": use the Congressional power over spending to cut off funding for the government programs they find objectionable. Critics of health reform have advocated (loudly) for that strategy.

But what's America's reaction to that approach? "Not so fast," according to one poll. The majority of Americans (62%) oppose the idea of Congress using defunding efforts to slow down the implementation of the Patient Protection and Affordable Care Act (ACA), according to a new poll from the Kaiser Family Foundation and the Harvard School of Public Health.

The poll, The Public's Health Care Agenda for the 112th Congress, found that 57% of Republicans favor defunding health reform in the absence of repeal, but most independents are opposed (62%) along with the great majority of Democrats (84%). And, even among those who do not like the law and want to see it repealed, almost four in ten say they disapprove of cutting off funding.

Opinions remain divided. The poll reported that 50% of Americans hold an unfavorable opinion of the ACA, while 41% hold a favorable view. However, the public is divided on what should happen next.

Arizona's Brewer has thrown down the gauntlet - will Sebelius pick it up?

There’s apparently at least one way to circumvent some provisions of the healthcare reform act while, at the same time, making the new law seem detrimental to those seeking Medicaid coverage and putting the current administration on the spot - simply ask the government’s permission to cut Medicaid spending in your state. Instructions for doing so are built right into the ACA. Arizona is now trying to do just that, and other states may follow.

To qualify for federal reimbursement for their Medicaid programs, state Medicaid plans may not have any eligibility standards or restrictive determinations of eligibility that were not in effect on the date of enactment of the ACA. There is an exception until January 1, 2014, however, for this “maintenance of effort” standard for states with budget deficits that certify to HHS that they have a deficit for the current fiscal year or are projected to have one for the following year. For those states, the maintenance of effort requirement will not apply to determinations of eligibility for non-pregnant and/or non-disabled adults with incomes above 133% of the federal poverty level.

Now, Arizona governor Jan Brewer wants to be the first to obtain the exception.

Health care reform is subject to never-ending Congressional games

The so-called repeal of the healthcare reform act is turning into a game of chess in Congress.

To begin with, Republicans may have an even tougher time repealing the ACA than they thought they would. Democrats have made clear that there will have to be a separate vote on individual portions of the healthcare reform law each time a bill to repeal it is introduced.

Under Act for the Relief of Sick and Disabled Seaman, health care purchase has been mandated before

Much was made last week of the post by Rick Ungar over at Forbes.com, pointing out that John Adams proposed in 1798, and Congress passed, a law mandating that merchant marine sailors pay a tax to support a system of government-operated marine hospitals, which Ungar likened to the ACA’s individual mandate that everyone purchase health insurance.

Fans of the health reform act have happily pointed out that this should negate the main argument of those who are against the individual mandate – that the government does not have the right to force anyone to purchase anything. Previously, comparisons had been made by those on the left to the purchase of car insurance, which you must buy in order to be in legal compliance, but, as conservatives have argued, only if you drive. By comparison, the individual mandate of the ACA requires every citizen, merely because they are citizens, to purchase health insurance. Now, it appears that Congress, with the approval of both Thomas Jefferson and John Adams had previously passed a similar mandate, making it hard to argue that the ACA is unconstitutional. But, should liberals be rubbing their hands with glee yet?

House Repeals, But We Want Our Benefits

Well, as expected, House Republicans yesterday passed a largely symbolic bill to repeal the Patient Protection and Affordable Care Act. The “Repealing the Job-Killing Health Care Law Bill” (HR 2) passed the House by a vote of 245-to-189. The measure is not expected to pass the Senate or survive a veto by President Barack Obama.

GOP lawmakers dubbed the new law the "job-killing Obamacare" and a "government takeover of health care" that would destroy state budgets, raise premiums for small businesses and cut Medicare benefits for seniors. Republicans said that several House committees would begin drafting replacement legislation to ensure that popular patient benefits in the new law would still be available to Americans.

Senate Republicans are likely to stick to the House Republican plan to dismantle health care reform legislation piece by piece. One piece of reform that is considered likely to be repealed in the near future is the new Form 1099 reporting rules, which go into effect in 2012 and require businesses that spend more than $600 with a specific vendor to report the expenditure to the IRS. Lawmakers from both parties and the White House agree the paperwork burden is too onerous. The White House supports repealing the 1099 reporting requirement for small businesses, noted an administration source.

Past efforts to repeal the Form 1099 provision failed over disagreements on how to make up the $17 billion the measure was expected to raise to help pay for health care reform. Once both chambers reach accord on a suitable revenue offset, it is likely to pass quickly and smoothly. House Republicans have already introduced the bill repealing the tax requirement (Small Business Paperwork Mandate Elimination Bill of 2011 (HR 4)), indicating that it will be one of their first pieces of business. Sen. Mike Johanns, R-Neb., and Joe Manchin, D-W.Va., have said they would introduce 1099 repeal legislation on January 25.

I’ll Take My ACA Benefits, Thank You

Meanwhile, the Department of Health and Human Services has announced that three million Medicare beneficiaries who reached the drug coverage gap, or “donut hole”, during 2010 have received a one-time, tax-free $250 rebate check, courtesy of the ACA.

And countless young adults between ages 19 and 26 who are not currently attending school, including my son and the children of other colleagues and friends, are now covered under their parents’ work-related health insurance policies. These are healthy young people, but accidents and illness can strike at any time and they, like older adults and younger children, need the medical and financial protection, too.

Furthermore, as of the end of October 2010, nearly 3,600 employers and unions had been approved to participate in the ACA’s Early Retiree Reinsurance Program, including many states among those fighting implementation of the ACA. The program reimburses employers for a portion of the cost of health benefits for early retirees’ and their families.

In addition, states have been receiving grants from HHS to establish health insurance exchanges, which when the ACA is fully implemented in 2014, will provide individuals and small businesses with a “one-stop shop” to find and compare affordable, high-quality health insurance options.

And, how many people do we all know, including us, who have even minor preexisting medical conditions that, without the ACA, would limit or totally exclude us from individual health insurance coverage?

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

Repeal Of Health Reform Would Take Us Back

As House Republicans today push for repeal of the Patient Protection and Affordable Care Act (ACA), a new Department of Health and Human Services (HHS) study shows that without the ACA’s protections up to 129 million non-elderly Americans with pre-existing health conditions would lose their health insurance or be denied coverage altogether.

The HHS report “At Risk: Pre-Existing Conditions Could Affect 1 in 2 Americans” warns that “Repealing the law would once again leave millions of Americans worrying about whether coverage will be there when they need it.”

The HHS analysis found the following:

• Between 50 and 129 million (19% to 50%) of Americans under age 65 have some type of pre-existing condition such as heart disease, high blood pressure, arthritis, asthma, and cancer. The highest rates of those with preexisting conditions, ranging from 21% to 54%, are among those with employer-sponsored insurance. However, 32 to 82 million people with both health problems and job-based coverage would be vulnerable without the ACA, which lifts limits on annual and lifetime benefits.
• Older Americans between the ages of 55 and 64 are at particular risk of preexisting conditions; 48% to 86% of people in that age bracket have a pre-existing condition.
• 15% to 30% of people under age 65 currently in good health, reporting very good or excellent health with no chronic conditions, are likely to develop a pre-existing condition over the next eight years.
• Up to one in five Americans under age 65 with a pre-existing condition – 25 million individuals – is uninsured.

Prior to the ACA, in the vast majority of states, insurance companies in the individual market could deny coverage, charge higher premiums, and/or limit benefits based on pre-existing conditions. Surveys have found that, due to preexisting conditions, 36% of Americans who tried to purchase health insurance directly from an insurance company in the individual insurance market encountered challenges purchasing health insurance.

A number of ACA protections already are in place. For example, insurers can no longer limit lifetime coverage to a fixed dollar amount or take away coverage because of a mistake on an application. Young adults have the option of staying on their parents’ coverage up to the age of 26 if they lack access to job-based insurance of their own, and insurers cannot deny coverage to children because of a pre-existing condition.

Many uninsured Americans with pre-existing conditions have already enrolled in the temporary high-risk pool program called the Pre-existing Condition Insurance Plan (PCIP), which provides private insurance to those previously excluded from the insurance market because of a pre-existing condition. The PCIP program is an interim measure until 2014, when insurance companies can no longer deny or limit coverage or charge higher premiums because of a pre-existing condition.

In addition to the ban on discrimination against people with preexisting conditions, in 2014, individuals and small businesses will have access to new, high-quality insurance choices through health insurance exchanges.

We can only hope that those bent on "repeal" of health reform will recognize the good aspects of the law and focus instead on improving it.

More information about provisions of the Patient Protection and Affordable Care Act is available here.

States Begin Applying Health Reform Insurance Provisions

Some states have already started applying certain rights and responsibilities assigned them by the Patient Protection and Afordable Care Act (ACA). States’ focus largely has been on monitoring and restraining insurers’ premium rate increases and in establishing health insurance exchanges.

In California, the state’s insurance commissioner, has asked Blue Shield of California to delay by 60 days a rate increase for nearly 200,000 policyholders. For some, the rate increase could be as high as 59%. It would be the third hike since last fall. Currently, the state does not have the authority to stop health insurers from increasing premiums, but a bill in the state legislature would require health insurers to receive approval from the state before raising premiums.

The Connecticut department of insurance rejected as “excessive” a 20% rate increase requested by Anthem Blue Cross and Blue Shield, the state’s largest health insurer. The premium increase would have affected 48,000 consumers. This is the first time that the state has flatly rejected a rate increase.

The Iowa Health Care Coverage Commission has voted 10-1 in favor of having the state form a health insurance exchange. The initial version of Iowa’s insurance exchange will offer basic information about prices and coverage of health insurance policies to help individuals and small businesses purchase insurance. Under the ACA, if states decline to set up their own exchanges, the federal government will do it for them.

The Health Reform Coordinating Council in Maryland, created through an executive order, issued a report recommending the creation of a Governor’s Office of Health Reform to guide the state’s implementation of the ACA and oversee the state’s new health insurance exchange. The Council also recommended that the health insurance exchange be established as an independent public entity, rather than as a private nonprofit entity.

South Dakota residents have access to a state-developed website with information about the ACA. The site is a resource for consumers, employers, and stakeholders in health care and outlines the initial steps the state government is taking to implement the federal law.

The Washington state insurance commissioner plans to ask state legislators to preserve the commissioner’s authority to approve health insurance rates, boost transparency, and to allow the insurance department to consider some insurers’ surpluses when reviewing rates. Currently, the state insurance department is not allowed to consider an insurer’s surplus, including investment income, when reviewing a rate request. The surplus proposal would apply only to nonprofit insurers, which account for most of the health insurance market in Washington. Specifically, the commissioner proposes denying rate hikes when a company amasses a surplus equal to three months of claims expenses. However, exceptions to that rule may be granted if limiting a rate increase threatens an insurer’s financial health. The state insurance department also would like to add more transparency to the rate-review process, insurers’ finances, and medical trends.

Wyoming has begun working on a plan to provide health insurance to the 86,000 uninsured individuals in the state. A 17-member task force has started work on the job of recommending a plan for the state’s health insurance exchange, which will go into effect in 2014 as a part of the ACA. Health insurance exchanges will lead to lower costs and increased competition, according to supporters.

More information about provisions of the Patient Protection and Affordable Care Act is available here.

Biggest health reform fears of employees, employers revealed

What part of 2010’s health reform legislation worries you the most? According to a recent survey by HighRoads, a benefits consulting/compliance firm, the answer depends on whether you’re an employee or an employer.

Employees worry most about rising costs, cancelled coverage or new taxes on medical benefits, the survey found, while employers are most concerned about the lack of federal guidance on what requirements must be communicated to employees.

Baby Boomers most likely to benefit from health reform provisions, survey finds

Effective 2014, when most of the provisions of the Patient Protection and Affordable Care Act (ACA) take effect, nearly one-fifth of the uninsured gaining health coverage will be adults between the ages 50 and 64, according to a new analysis from the Commonwealth Fund, Realizing Health Reform's Potential: Adults Ages 50-64 and the Affordable Care Act of 2010.

Up to 6.8 million of the 8.6 million adults in the age group of 50 to 64 were uninsured in 2009, and they may gain subsidized insurance through Medicaid (3.3 million in families earning less than 133% of the federal poverty level (FPL)) and through the new health insurance exchanges (3.5 million earning less than 400% of FPL). An additional 1.4 million individuals with higher incomes will have access to comprehensive health plans with new consumer protections. Another estimated 9.7 million adults in this age group with health insurance having such high out-of-pocket costs that they are considered underinsured would have access to more comprehensive benefit packages and more cost protection, the Commonwealth Fund noted.



Sixteen states with uninsured rates higher than the national average of 14.2% for adults in the studied age group in 2008 and 2009 will see particularly large gains in insured rates. The states are: Florida, New Mexico, and Texas, where at least one-fifth of the population in this age group were uninsured; Alaska, Arizona, California, Georgia, Nevada, and Wyoming, where 16.5% to 18.2% were uninsured; Louisiana, Mississippi, Montana, Oklahoma, and Tennessee, where approximately 15% were uninsured; and North Carolina and South Carolina where approximately 14% were uninsured.

The age 50 through 64 year group, which is more prone to chronic health conditions (64% were reported to have at least one chronic condition in 2007), is most vulnerable to unemployment and to lack of employment-related health insurance in the current economic climate. The Commonwealth Fund Biennial Health Insurance Survey found that of the adults ages 50 to 64 who purchased or tried to buy a health plan on the individual insurance market, 45% and 61%, respectively, found it difficult or impossible to find a plan that met their needs or that they could afford, and 39% were declined, charged a higher premium, or had a preexisting condition exclusion. Nearly 70% of older adults never bought a plan, the Commonwealth Fund reported. These uninsured older adults will avoid or delay getting needed health care (75% reported this in the Commonwealth Fund survey) and preventive screenings (46%).

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

IRS clarifies use of FSA debit cards on OTC drugs

The IRS has issued new guidance allowing the continued use of health flexible spending arrangement (FSA) and health reimbursement arrangement (HRA) debit cards for the purchase of prescribed over-the-counter medicines and drugs.

The new guidance, IRS Notice 2011-5, modifies previous guidance to permit taxpayers to continue using FSA and HRA debit cards to purchase over-the-counter medications for which the taxpayer has a prescription. Effective after January 15, 2011, in accordance with the new guidance, this use of debit cards must comply with procedures reflecting those that pharmacies currently follow when selling prescribed medicines or drugs.

Health Reform Repeal, Defund Efforts Begin; CBO Says Repeal Will Increase Deficit By $145 Billion

On Jan. 5, the first day of the 112^th Congress, Representatives introduced ten bills to repeal or defund the Patient Protection and Affordable Care Act (ACA). The House is expected to vote on one of the repeal bills next week week, H.R. 2, Repealing the Job-Killing Health Care Law Act, sponsored by Rep. Eric Cantor (Va.).

Senate Majority Leader Harry Reid (Nev.) already has noted that the health reform law will not be repealed, given the Democratic majority in the Senate.

Nonetheless, the philosophical battle regarding health reform has begun.  As noted in the title of H.R. 2, Republicans are attacking the potential job losses among small employers once the individual mandate takes effect in 2014. The Democrats are likely to use, at least in part, the argument that repeal would increase the deficit and do nothing to reduce the uninsured.

In 2011, Implementation And Repeal Will Battle For The Fate Of Health Care Reform

Polar opposites, the effective implementation of health care reform and its wholesale repeal or funding blockade, will dominate the landscape of the Patient Protection and Affordable Care Act in 2011.

In other words, health reform will continue to expand its reach even as the courts and Congress debate the validity of the law.