From the Dispatch

New Health Insurance Plans Required to Provide Free Preventive Health Care

Enzo Pastore — Thu, 22 Jul 2010 11:09:10 -0400

New federal regulations were issued that will guarantee affordable preventive care services for millions of Americans. The new interim final regulations specify that new health insurance policies beginning on or after September 23, 2010, must include preventive services recommended by the U.S. Preventive Services Task Force, as well as preventive services recommended by the Advisory Committee on Immunization Practices in their coverage plans. In addition, health plans will be prohibited from charging co-payments, co-insurance or deductibles for these services when they are delivered by network providers.

These new rules supplement other provisions in the Affordable Care Act that support prevention, such as the creation of a National Prevention and Health Promotion Strategy and a Prevention and Public Health Fund to invest in prevention initiatives. Another policy in the federal law will increase the number of primary care professionals in order to increase access to preventive services. The elimination of cost-sharing for preventive care will make it easier and more affordable for Medicare and Medicaid enrollees to access critical preventive screenings and services.

Plans covered by these rules must offer coverage of a comprehensive range of preventive services that are recommended by physicians and other experts. The covered services will include: mammograms, colonoscopies, immunizations as well as screenings for diabetes, high cholesterol, high blood pressure, breast cancer, depression, HIV and obesity. Children would qualify for more than two dozen services, including vaccinations for influenza, diphtheria and tetanus and screenings for autism, hearing and vision impairments. A full list of the covered services is available at HealthCare.gov.

It is estimated that by next year, 41 million people in employer and individual plans will benefit from the new prevention provisions under the Affordable Care Act. By 2013, the total number of Americans who will benefit from the improved prevention coverage will increase to 88 million.

These rules will not apply to grandfathered health plans, which are group or individual plans that existed at the time the federal law was enacted and are therefore not subject to a large majority of the new insurance reforms. However, HHS officials expect the number of grandfathered plans to decrease over time.

Resources:
HealthCare.gov - Background: The Affordable Care Act's New Rules on Preventive Care
HealthCare.gov - Implementation Center
HHS.gov - Press Release - Administration Announces Regulations Requiring New Health Insurance Plans to Provide Free Preventive Care
LA Times - New Healthcare Rules Issued for Preventive Services

Project to Get Veterans VA Benefits Expands Access, Saves Millions of State Medicaid Dollars

Enzo Pastore — Thu, 08 Jul 2010 12:51:19 -0400

Based on an innovative model from Washington state, states have the opportunity to help veterans improve their benefits and save millions of dollars for their own budgets.

Using a US Department of Health and Human Services national database called PARIS, Washington’s Department of Social and Health Services has launched a program that identifies veterans on Medicaid. If those veterans are found eligible for health coverage, long-term care benefits or pensions through the US Department of Veterans Affairs (VA) or Department of Defense, they can be taken off the state’s Medicaid rolls. Since 2003, Washington state has shaved $18 million from their Medicaid budget by qualifying over 5,600 veterans and their families for VA or Defense Department coverage. The program in Washington is designed to ensure that until clients qualify for a VA monthly cash benefit that makes them financially ineligible for state public assistance, they maintain existing state benefits.

The Public Assistance Reporting Information System (PARIS) was originally designed to weed out people who were cheating state benefit systems by receiving benefits from more than one state. But in realizing how effective the database can be in not only providing veterans with more comprehensive health and related benefits and trimming state spending in the process, no less than 20 other states have expressed interest in following Washington's example.

For example, Montana implemented the system in 2007 and has saved almost $900,000 in Medicaid costs. Since last November, Colorado has identified about 1,600 potentially eligible individuals or families that could save the state up to $8 million a year. California began a 2009 pilot program of the system in three counties. According to California’s Legislative Analyst’s Office, the state could save $25 million per year if only 10% of its veteran population switched from enrollment in Medicaid to health coverage through the VA.

The program of course doesn't reduce medical costs overall, but by shifting spending from the states to the federal government, it both eases state budget deficits and ensures that veterans, who have earned the right to access the full range of VA benefits, are informed of their eligibility so they can exercise that right.

Resources
CMS letter to State Medicaid Directors: Background of PARIS (June 21, 2010)
Washington State Department of Social & Health Services - Interface between PARIS and the Veteran Benefit Enhancement Project
Washington State Department of Social & Health Services - DSHS Veterans Project
CA Legislative Analyst Office - Analysis of Veterans’ Benefits
USA Today - States try to link up vets with federal government benefits
The Bellingham Herald - Benefits Program Helps Veterans and State Taxpayers.

Bills on Single-Payer and Health Reform Implementation Move Forward in California

Enzo Pastore — Thu, 08 Jul 2010 12:50:04 -0400

California lawmakers worked feverishly at the end of June to move forward significant health reform legislation, including implementing new Medicaid rules for the next five years, setting a framework for establishing health insurance exchanges, and moving the state towards a single-payer health care system.

The challenge of getting the bills through the Assembly Health Committee was daunting because it was deadline week in the state legislature, the final days for policy committees to act on bills. But in the end, all three bills prevailed and now move on to the Assembly Appropriations Committee. All three bills previously passed the Senate.

The three major bills approved by the Assembly Health Committee include:

Medi-Cal Waiver: As one of two vehicles for renewing and implementing a new Medicaid waiver, SB 208 sets rules for the state's Medi-Cal program for the next five years. The new waiver is presented as a bridge between the existing Medi-Cal program and the full access expansion that will happen in 2014 as a result of federal health reform.

Health Insurance Exchange: SB 900 would establish the state insurance exchange pursuant to provisions in the federal health reform law. Passage of this bill in this session will allow the state the time necessary to plan how their exchange will operate beginning in 2014. Ideally, the exchange will provide expanded access for health consumers by eliminating adverse selection, creating a seamless process for enrollment and subsidies and providing an array of standardized plans and products for informed decision making. This bill also moves on to the Appropriations Committee. Its Assembly companion bill, AB 1602, was also passed this week by the Senate Health Committee.

Single-Payer Health Reform: SB 810 would create a single-payer health care system that would cover all California residents. The legislation is a policy bill that would allow a single-payer system to be established. It does not address how the system would be financed.

Resources
Health Access - Health Reform 3 Month Status Report: Californians Begin to See the Benefits; Much More to Do to Fulfill Its Promise

Preventing Loss of Medicaid Drug Rebate Funds for States

Enzo Pastore — Thu, 01 Jul 2010 11:31:24 -0400

While the new Affordable Health Care law provides a variety of funding opportunities for states, one provision in the health law that could shift billions of dollars from cash-strapped states to the federal government. Under the National Medicaid Drug Rebate Program created by the Omnibus Budget Reconciliation Act of 1990, drug manufacturers are required to enter into agreements that provide rebates for Medicaid purchased drugs, establishing a 15% minimum level of rebates. Up until now, the rebates were divided between the states and the federal government. But under the new health reform law, a significant portion of the rebates will go solely to Washington beginning this year.

Changes in Federal and State Rebate Share: On the positive side, the Affordable Care Act now requires greater discounts in Medicaid rebates by increasing the minimum rebate level from 15% to 23.1% for most brand name medications. This increase, which also applies to manufacturers of generics, is projected to raise $36 billion over 10 years. Under the old policy, states sent Washington a proportion equal to the share of Medicaid funding the federal government paid. But now, the new federal reform law allows the federal government to keep 100 percent of the rebate that falls within the 15.1 to 23.1 percent range. Any rebates above 23.1 percent will continue to be shared. According to the office of Senate Majority Leader Harry Reid the change was necessary to help pay for a $434 billion 10-year increase in federal Medicaid funding.

Some States Stand To Lose Millions: Based on 2009 Medicaid data, states received average rebates of 38.5 percent a year ago, well above the previously required 15 percent, so the change will cost them dearly. California, for instance, could lose as much as $50 million next year alone because of the changes. Indiana predicts losses of $400 million over the next 10 years. And because the new policy is retroactive to 2010, Vermont stands to lose $2.3 million in fiscal year 2010 and $4.2 million in FY 2012.

What States Can Do: If states move quickly, they can secure both federal best price rebates and state supplemental rebates that can realize Medicaid rebates as high as 40-50%- increasing the rebate portion states hold onto and offsetting losses.

One key step is to secure clear state data on base prices from which rebates are calculated. Currently, the federal government is barred by a court order from sharing data on the Average Manufacturer Price (AMP) and federal Best Price with the states, so since states don’t get this price data reported to them, state laws need to be in place to require drug companies to report AMP and best price directly to them.

Only Maine and Vermont have apparently passed such reporting laws. To respond to this emergency, Maine Rep. Sharon Treat, who also serves as Executive Director of the National Legislative Association on Prescription Drug Prices (NLARx), recommends that State Medicaid directors and State Legislatures need to immediately review their preferred drug lists. They need to make changes from a clinical perspective to reflect retroactive changes in rebate policies that will affect their budgets this year. States also need to pass a state drug price reporting law.

See also model AMP/best price legislation to address this data reporting issue.

Medicaid Rebates Now Available for Medicaid Managed Care Plans: One more twist on the changes affecting Medicaid rebates is that another provision of the federal law will help to offset the loss of rebate dollars in some of the states. For the first time, drug rebates will be allowed for drugs sold to State Medicaid managed care plans. Forty-one states use managed care plans and in total this accounts for about 70 percent of Medicaid enrollees across the country. However, only 16 of them depend on the managed care programs to administer drug benefits, while others have opted to pay for many drugs directly to get rebates. Clearly the new managed care policy strongly favors those 16 states. The provision will encourage more states to use managed care plans for drug coverage, which could lead to a reduction in drug spending. Arizona is one of the states that will see a major benefit. Its entire Medicaid program is run through managed care plans, so the state did not benefit in the past from the federally required rebates.

Resources
CMS - National Drug Rebate Agreement
Kaiser Health News - States' Medicaid Funds Tapped For Federal Health Overhaul
National Legislative Association on Prescription Drug Prices - Special Report: States Must Act Now to Preserve Medicaid Drug Rebates!
National Legislative Association on Prescription Drug Prices - Model Law: Manufacturer Drug Price Reporting
Inside Health Reform - States Upset With Guidance On Medicaid Dug Rebates, Still Have Questions
Inside Health Reform - Reid Bill Would 'Recapture' $20 Billion In Medicaid Rebates From States

New Health Insurance Rules Hailed as Patient's Bill of Rights

Enzo Pastore — Thu, 24 Jun 2010 13:33:49 -0400

Marking the 90 day anniversary of the signing of the Affordable Care Act, President Obama used the occasion to announce the implementation of a Patient’s Bill of Rights. After meeting privately with health insurance CEOs and state insurance commissioners, the White House sent a signal to insurers and to the public that the President intends to monitor how the insurance industry responds to the law’s implementation. In warning industry executives to refrain from using the law as an opportunity to boost unjustifiable rate increases, the Administration unveiled new regulations that will govern how new consumer protection provisions are implemented.

The Patient’s Bill of Rights rules are designed to clamp down on some of the most notorious practices of the insurance industry. After September 23rd,

Insurers are prohibited from denying coverage to kids with pre-existing conditions.
Certain annual and all lifetime limits on benefits would be prohibited.
Insurers would no longer be allowed to drop coverage when policy holders get sick.

The rules also ensure the ability choose a primary care doctor or pediatrician, lift the requirement of needing a referral to see an OB-GYN and dismiss the need for prior approval if out of network emergency care is needed.

While the new law does not grant the federal government authority to regulate premiums, Obama pointed to states such as Maine, Pennsylvania and New York that are investigating sudden spikes in health insurance rates. Pennsylvania is investigating the state's nine largest health insurers over rate increases that Governor Ed Rendellcalls exorbitant. California officials have investigated WellPoint's proposed 39% increases that the insurer later called a mistake.

The 196 pages of new regulations were simultaneously released by the Departments of Labor, Treasury and Health and Human Services and come on the heels of findings from a Kaiser Foundation survey that premiums for the policies most recently bought by individuals have increased by an average of 20 percent.

Resources
Health Care for America Now (HCAN) - Insurance Industry Inflates Rates While Falsely Blaming New Health Care Law
The White House - Background and Fact Sheet on the New Patient's Bill of Rights
Kaiser Family Foundation - Survey of People Who Purchase Their Own Insurance
New York Times - Obama Says Health Law Shouldn't Be Excuse to Raise Rates
Reuters - Obama warns health insurers not to hike rates
Federal Register - Interim Final Rules - Patient Protection and Affordable Care Act: Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, and Patient Protections

Up and Running: States Implementing Federal Health Reforms

Enzo Pastore — Thu, 17 Jun 2010 12:04:55 -0400

The federal health reform law is only the starting point for achieving health care access for all Americans. Many states are already moving forward, not only on implementing the basic provisions of the Affordable Care Act in their states, but are also planning how to build on its framework to further expand coverage and rein in costs for their residents. The following are a few models of implementation and comprehensive reform underway.

Connecticut is one of the leaders in moving toward comprehensive universal health care coverage. Their bold and innovative enactment of Sustinet in 2009 (HB 6600) created multiple self-insured coverage pools, providing businesses and individuals with new insurance options. This included a new public option whereby coverage pools will provide the leverage necessary to implement system innovations to drive down cost and improve quality on a large scale.

SustiNet will be rolled out over the next 4 - 6 years. By 2014, it is estimated that 98 percent of residents will be insured with a comprehensive benefits package. Sustinet will give every patient a medical home, ratings will not be based on age, gender or health status, and coverage will be guaranteed for chronic or pre-existing conditions. 2010 is a crucial year for its initial phase. The 11-member SustiNet Health Partnership Board has the responsibility for implementing SustiNet with the support of five committees and three task forces, a diverse group of more than 160 Connecticut experts volunteering their time and skills. By January 1, 2011 the Board must present a final report to the state Legislature with specific recommendations for implementation. State lawmakers will need to pass legislation in 2011 to allow the SustiNet Health Plan to be offered in 2012.

Oregon was in the forefront of laying the groundwork to implement federal reform with the 2009 passage of HB 2009, which created the Oregon Health Authority (OHA) and its oversight and policy making body, the Oregon Health Policy Board (OHPB). Now in the planning stages, the goal in Oregon is to realign most health-related programs in the state by joining them together under one administrative and operational umbrella by July 2011. In addition to developing a plan to provide every Oregonian with affordable, quality health care, addressing health care workforce issues and overseeing the interaction between state and federal health reform, OHA will also create the Oregon Health Insurance Exchange, a one-stop shop to compare and purchase health insurance plans.

Included in the creation of OHA and OHPB was a transition project to provide oversight and guidance in the transition from the current Department of Human Services to OHA. The Transition Project will help identify barriers to a smooth transition of business processes, provide a forum for exchanging ideas and serve to establish open lines for two-way communication. Members of its Executive Steering Committee include provider, consumer, advocate, county, employee union, tribe and other representatives.

Vermont is taking a unique approach in addressing comprehensive health care reform. SB 88, an Act Relating to Financing and Universal Access to Health Care in Vermont has as its goal the design of a single comprehensive health care system. What is particularly intriguing about the legislation is that it instructs the state’s Joint Legislative Commission on Health Care Reform to prepare at least three comprehensive health care system design options including plans for implementation by February of 2011. From there, it will be up to the Legislature to choose and enact one of these systems with an implementation goal of July 2012. SB 88 established a requirement to look at three options – a single payer system, a public option and continuation of the current system. The study will update past studies and provide comprehensive data on the financing mechanisms, costs and details associated with all three options.

Should the Legislature decide to implement the single payer option, it would need a waiver from the federal government to move forward. As the timeline in the Affordable Care Act sets 2017 as the first opportunity for states to apply for such a waiver, it could create some momentum in Congress to amend the timeline to an earlier date.

Thanks to the sponsorship of Maine Rep. Sharon Treat, HP1262 established the Joint Select Committee on Health Care Reform Opportunities and Implementation. It is a 17 member committee of Senators and Representatives created to study federal health care reform legislation, determine the State's opportunities for health care reform and the state's role in implementation of the federal legislation. The Committee’s first meeting on May 20th included a discussion of goals and priorities, an overview of the Affordable Care Act, the state’s role in implementation and an overview of current Maine coverage laws. In subsequent meetings, the committee will examine how the state will oversee its health insurance exchange, opportunities to conduct pilot projects on cost containment, payment reform, and the impact of the federal law on the State’s MaineCare program. By no later than November 3, 2010, the Committee will submit a report of its findings and recommendations that should include suggestions for legislation in its 2011 session.

Most other states have created commissions or task forces to move forward on implementing federal reforms. See listings of these state efforts at PSN’s website section on: State Models for Implementation

Resources
Universal Health Care Foundation of Connecticut
The Vermont Legislature Commission on Health Care Reform
Oregon Health Policy Board
Maine Joint Select Committee on Health Care Reform Opportunities
Progressive States Network: Failure of Right Wing Obstruction in the States

Table of Contents:
- Health Care Nullification Bills Strike Out in Twenty-Five States… And Counting
- Resources for Implementing Health Care Reform

Health Care Nullification Bills Strike Out in Twenty-Five States… And Counting

Even as most states are moving forward with implementation of federal health reform, right-wing efforts to undermine the law at the state level through bills supposedly opting out of parts of the federal law have failed across the nation.

Early this year, the health insurance industry-funded American Legislative Exchange Council (ALEC) claimed that over 40 individual state legislatures have "defend[ed] health care choice" by being witness to the proposed or actual introduction of their model legislation intending to attempt to nullify the recently passed federal reforms in the Patient Protection and Affordable Care Act.

Well, the results are largely in and, as we document at www.alecfail.com, state legislatures across the nation have overwhelmingly rejected ALEC’s bills:

ALEC style bills or proposed constitutional amendments have failed in Alabama, Alaska, Arkansas, Colorado, Delaware, Illinois, Indiana, Iowa, Kansas, Kentucky, Maryland, Michigan, Minnesota, Mississippi, Oklahoma, Nebraska, New Hampshire, New Mexico, North Dakota, South Dakota, Tennessee, West Virginia, Washington, Wisconsin, and Wyoming (highlighted in red with a FAIL stamp).

In other states where ALEC has claimed success, such as Montana, Rhode Island, and Texas, health care nullification bills have yet to even be introduced.

Resources
www.alecfail.com

Resources for Implementing Health Care Reform

As efforts to implement national health reform move forward across the country, Progressive States Network is highlighting resources from many of our national and state partners at our website page: State Implementation of Federal Reform: Resources

How Health Reform Will Benefit the American People: Given the misinformation about the federal health reform law promoted by the rightwing, many of the resources help highlight the gains to American health consumers and the overall economy from passage of the law:

The Impact of Health Reform on Health System Spending (Commonwealth Fund)- Coauthored by Center for American Progress Senior Fellow and Harvard economist David Cutler, this study estimates that the net combination of provisions in the new law will reduce health care spending by $590 billion over 2010–2019 and lower premiums by nearly $2,000 per family.
What Will the New Health Reform Law Do in the First Year (April 2010) (Families USA)- discusses how health reform will help people with pre-existing conditions, young adults, people on Medicare, small businesses, community health centers, and others in its first year.
How Will Health Reform Impact Young Adults? (Kaiser Family Foundation's Commission on Medicaid and the Uninsured) - explains the key ways in which the new law will affect adults ages 19 to 29, an age group that includes 13.7 million uninsured people who comprise nearly a third of the overall uninsured populations.
Medicaid Coverage and Spending in Health Reform: National and State-By-State Results for Adults at or Below 133% FPL (Kaiser Family Foundation) - this analysis and video presentation details how the expansion of Medicaid under the health reform law will significantly increase the number of people covered and reduce the uninsured in states across the country, with the federal government picking up the vast majority of the cost.
The Check Is in the Mail for Some Medicare Part D Enrollees - (Commonwealth Fund) The Department of Health and Human Services announced that $250 checks will be automatically distributed beginning June 1 to seniors who have fallen into the "doughnut hole" of their Medicare Part D prescription drug plans. HHS Secretray Sebelius said that about 80,000 seniors initially will receive their checks. Some 4 million seniors should qualify by year’s end.

Resources for Implementing Reform: Other resources included on the site highlight tools and resources for implementing reform:

High-Risk Pool Programs Take a Step Forward (Department of Health and Human Services) - details the 43 states that as of April 30, 2010 had told the Department of Health and Human Services how they plan to participate in high-risk pool programs: 28 indicating they would run a state-based high risk pool program, and 15 saying they would let HHS administer the high-risk program for their state's residents.
Fact Sheet: Keeping the Health Plan You Have: The Affordable Care Act and “Grandfathered” Health Plans (HealthReform.gov) - details of the implications of the rules for grandfathering regulation of employer health care plans. While health plans that existed on March 23, 2010 allows insurers and employers to make routine changes without losing their grandfather status, plans will lose that status if they choose to significantly cut benefits or increase out-of-pocket spending for consumers – and as a result consumers in plans that make such changes will gain new consumer protections.
Questions About Health Insurance Exchanges (Kaiser Family Foundation) - Explains how exchanges will initially serve primarily individuals purchasing insurance on their own and smaller employers, but states will have the option of opening Exchanges to larger employers a few years after implementation. This summary provides responses to questions about the purpose and function of Exchanges and how they relate to regulation of the insurance market.
Key Health Insurance Market Reforms Not Achievable without an Individual Mandate (April 7, 2010) (Center on Budget and Policy Priorities) – Details how insurance reforms without a mandate would encourage some people to wait until they are sick to buy coverage, raising premiums for everyone else. The individual mandate will help keep premiums at a more reasonable level.
Early Medicaid Expansions under Health Reform (Families USA) -This report discusses how states can expand their Medicaid programs earlier than federal reform requires them to do so (2014), and why they should. Starting in April 2010, states will be able to phase in Medicaid expansion through a state amendment process.

Resources
Progressive States Network - State Implementation of Federal Reform: Resources

STEPS FORWARD:

ME: State Predicts Cost Savings With New Health Reform Law

LA: Bills to Crack Down on Fraud by Contractors Head to Jindal

STEPS BACK:

MN: Corporate Cash Ready to Roll into Minnesota Elections

US: Lawmakers Fiddle While the Unemployed Get Burned

NE: Kansas’s Kobach in Middle of Another Illegal Immigration Showdown

Federal Health Reform Benefits for Early Retirees Begins on June 1st

Enzo Pastore — Thu, 27 May 2010 11:24:21 -0400

One of the immediate benefits of the Affordable Care Act is the Early Retiree Reinsurance Program. Beginning June 1, 2010, this new reinsurance reimbursement program is available to group health plan sponsors who provide medical coverage to early retirees and their spouses, surviving spouses and dependents.

Program Goal: Many Americans who retire without employer-sponsored insurance and before they become Medicare eligible are faced with the possibility of seeing their retirement savings disappear because of unaffordable, exorbitant rates in the individual insurance market. The goal of this temporary program is to provide financial assistance to employers to help them maintain the coverage they offer for their early retirees. Early retirees are individuals age 55 and older who are not yet eligible for Medicare and who are enrolled in health benefits under the employer-sponsored plan.

Employers will be reimbursed for the cost of providing certain health benefits, including medical, surgical, hospital, and prescription drug benefits. This will encourage employers to continue to provide health coverage to early retirees until the state health exchanges and federal subsidies for health coverage are implemented in January 1, 2014.

State Governments Are Eligible: Entities who are eligible to participate in the reinsurance program can be private employers, state or local governments, employee organizations, voluntary beneficiary associations or a multi-employer plan that already offers health benefits to their retirees. Both self-funded and insured plans are permitted to apply.

To receive assistance, plans must have their applications approved and certified by HHS. A number of requirements must be met in order to participate in the reinsurance program. One such requirement is that the plan sponsor must have in place programs and procedures that have or have the potential to generate cost savings for participants with chronic and high-cost conditions. Chronic and high cost conditions are defined as a condition for which $15,000 or more in applicable claims are likely to be incurred during a plan year by one participant.

Reimbursement: Plan sponsors must first submit an application to the Department of Health and Human Services (HHS) in order to become certified to participate in the reimbursement program. Once a sponsor is certified to participate in the program, the claims submitted for reimbursement must be between $15,000 and $90,000 per year (determined on a per-participant basis). The partial reimbursements are limited to 80 percent of the costs attributable to claims that exceed $15,000.

Maintenance of Effort: While employers can use the savings to either reduce their own health care costs, provide premium relief to their workers and families or a combination of both, one important caveat of the program is a maintenance of effort requirement. This means participating sponsors must agree to maintain funding levels to support their applicable plan or plans. The federal statute requires that funds dispersed under the reinsurance program cannot be used as general revenue. The sponsors will need to indicate how the funds they receive will be applied to maintain their level of effort in supporting the plan.

With a total allocation of $5 billion, the program will end January 1, 2014, when early retirees become eligible to choose their insurance coverage through state health insurance exchanges.

Resources:
The White House - Fact Sheet: Early Benefits from the Affordable Care Act of 2010: Reinsurance Program for Early Retirees
HealthReform.gov - Fact Sheet: The Affordable Care Act’s Early Retiree Reinsurance Program
Federal Register, Vol. 75, No. 86: 45 - Interim Final Rule for Early Retiree Reinsurance Program (May 5, 2010)
NCSL Fact Sheets on Health Reform - Early Retiree Reinsurance Program
HealthCare POV blog - Health Care Reform - Early Retiree Reinsurance Program
McDermott, Will and Emery Newsletter - Health Care Reform - Early Retiree Reinsurance Program

States Decide on High Risk Pools

Enzo Pastore — Thu, 06 May 2010 12:18:57 -0400

The choice of whether or not to establish high-risk insurance pools represents the first major decision that states are facing with the March 2010 passage of the Patient Protection and Affordable Care Act (PPACA). While twenty-nine governors -- 22 Democrats and 7 Republicans -- decided to create the pools themselves, most conservative governors failed to take advantage of the option to shape health care for their constituents and instead just kicked the issue back to the federal government, which will establish its own high-risk insurance pool in states that fail to take action.

While temporary in nature, lasting only until 2014, these high risk pools are designed to help people with pre-existing and chronic health conditions who cannot find affordable health insurance. But the decisions the governors are reaching are revealing with respect to whether or not states intend to foster a collaborative relationship with the federal government in implementing the vast array of PPACA provisions.

How the States Responded: The federal law allocated $5 billion to the high risk pool programs which are scheduled to begin July 1 of this year and last until through January 1, 2014, when the state insurance exchanges begin to operate. With last Friday as the deadline for states to respond to HHS, 29 states plus the District of Columbia said they would operate the pools themselves (not all of the rest have made a final decision). Of those twenty-nine, only seven are led by Republican governors in Alaska, California, Connecticut, New Jersey, Rhode Island, South Dakota and Vermont.

While it was conservative governors in the eighteen states who turned down the opportunity to administer the pools, the irony is that expansion of high risk pools was one of the major proposals promoted by conservative Members of Congress. Some state leaders raised the concern that the $5 billion set aside for the pools would be insufficient to assist the potential number of beneficiaries, but the continued pattern of non-cooperation highlights the suspicion that conservatives leaders have just made saying no an ongoing obstructionist tactic.

HHS told state officials in a recent conference call that states will not be asked or expected to contribute any state dollars, since there is absolutely no provision in the PPACA that even hints at such a possibility. But it's critical to remember that the most important feature of the temporary risk pools is that uninsured people around the country, who have been denied coverage for years, will soon have access to an affordable coverage option.

State Allocations: Each state’s allocation is based on population and need, not on whether it’s a state or federally operated program. California would receive the largest allocation of money, $761 million, while North Dakota, Vermont and Wyoming receive the smallest, each getting $8 million. An HHS website details the amounts of each state’s allocation for funding the high risk pools. Examples of Implementation include:

Iowa: Governor Chet Culver decided to accept the federal funds. Iowa already was one of 35 states with high risk pools prior to enactment of the PPACA with about 3,000 members, most of whom have serious medical conditions, such as kidney disease, cancer or hemophilia. HIP Iowa is currently financed by members’ premiums, plus payments from every company that sells health insurance in the state. By state law, HIP Iowa premiums may not be more than 150 percent of standard insurance rates for an Iowan of the same age and gender as an applicant, although the rules for the federal pool may require new standards for additional folks covered by the federal funds.
Ohio: While it's too soon for patients to know what Ohio's new program will look like, Gov. Strickland says he would like to build on an existing private-sector program, with the potential for up to $152 million in help from Washington. Seeking guidance from HHS before deciding on specifics, Ohio Department of Insurance Director Mary Jo Hudson presented several potential ways in which Ohio might design its own program. One would be to expand Ohio's "open-enrollment" program, which kicked in this year as an alternative to high-risk pools. The program requires private carriers who sell insurance on the open market to also sell to people who don't have other available coverage -- these are people who don't qualify for low-income, government programs -- and to limit their premiums, although they still can be 150 percent above others' premiums. To pay for the program, other clients who buy insurance on the open market are charged with a small rate hike.

Resources:
US Department of Health and Human Services - Fact Sheet on Temporary High Risk Pool Program
Kaiser Health News - Some Republican States Opting Out Of High Risk Health Insurance Pools
Kaiser Health News - States Decide On Risk Pools As First Major Health Law Decision
Washington Post - 18 states refuse to run insurance pools for those with preexisting conditions
Politico - Party Line Split on High Risk Pools
NCSL - Coverage of High-Risk Individuals: State and Federal High-Risk Pools
The Hill - GOP governors opting out of health reform pool for high-risk uninsured

Health Care Lawsuits Politicized by Right-Wing, Losing Steam in the States

Charles Monaco — Thu, 06 May 2010 12:14:41 -0400

In the weeks following the signing of the Patient Protection and Affordable Care Act, lawsuits challenging the constitutionality of health care reform were joined by multiple, conservative Attorneys General from states across the nation, despite widespread condemnation that such challenges were frivolous, wasteful, and almost certain to fail in the courts. In early April, Secretary of Health and Human Services Kathleen Sebelius commented that she believed the lawsuits had "more to do with politics than policy."

Now, new reports seem to confirm both partisan political motivation and coordination on the part of those using Attorney General offices to try to obstruct reform.

In Wisconsin, e-mail evidence uncovered by One Wisconsin Now appears to show clear political motivation behind the decision made by Wisconsin Attorney General J.B. Van Hollen to join the multi-state lawsuit challenging health care reform. Correspondence obtained by the organization shows communication between Wisconsin's Deputy Attorney General and the political director of the national Republican State Leadership Committee -- a 527 organization that has been funded in part by the health insurance industry -- in the days before Van Hollen joined the suit. One Wisconsin Now Executive Director Scot Ross claimed that “Van Hollen owes his election in 2006 to unprecedented special interest spending by big insurance and big business and now he’s paying them back."

The political maneuvering involved was further highlighted by the Milwaukee Journal Sentinel, which unearthed e-mail evidence showing that the Wisconsin AG's campaign manager and an outside political consultant in Texas were both consulted about whether to file the lawsuit. Meanwhile, in South Carolina, Attorney General and gubernatorial candidate Henry McMaster has released not one, but two campaign ads touting his involvement in the lawsuit.

Lawsuits Backfiring in a Number of States: While the anti-reform lawsuits are politically motivated, they may well fail in their ultimate goal of rallying voters. In Florida, Attorney General Bill McCollum, also running for governor, has been losing support in recent polling, a development which the Associated Press explained by noting that his decision to join the lawsuit "isn't sitting well with independent voters." Similar sentiment can be found in North Carolina, where a new poll shows North Carolinians squarely opposed to joining the lawsuit. In Connecticut, Governor Jodi Rell just this week decided not to join the lawsuit, despite having sharply criticized federal health care reform immediately after it was signed into law. And in New Mexico, the office of Attorney General Gary King has reportedly seen "a sharp decline in public support" for the anti-reform lawsuit in recent weeks, according to a study by the New Mexico Independent.

Similarly, legislative efforts by the health insurance industry and their allies at the American Legislative Exchange Council (ALEC) to obstruct reform in the states continue to falter, having already failed in over twenty-two states where ALEC has tried to pass health care nullification bills, while positive steps towards implementation continue to move forward in state after state.

Resources:
Progressive States Network - State Implementation of Federal Reform: Resources
Progressive States Network - Right-Wing Obstruction of Health Care in the States
Slate - Lawsuit Abuse, GOP Style
One Wisconsin Now - Van Hollen Documents Show DOJ-GOP Coordination on Health Reform Lawsuit
Blogging Blue - More on J.B. Van Hollen’s GOP health care connection
Center for American Progress - South Carolina AG Touts His Push For Health Care Repeal In Campaign For Governor
Kaiser Health News - GOP's 'Repeal Health Law' Strategy May Backfire In General Election
Center for American Progress - Unraveling Health Care Reform Would Leave Millions with Less Affordable Care

Health Care Nullification Bills Fail Across Country: Implementation Moving

Enzo Pastore — Thu, 15 Apr 2010 12:48:22 -0400

Progressive States Network has a new analysis of the progress of state health care legislation which indicates the failure of conservative attempts to obstruct reform at the state level. This resource, located at http://ALECFail.com, will be updated as more sessions end. Many more nullification bills are expected to fail this session, as state leaders and legislators across the country defeat the right-wing agenda attacking health care reform.

The key results so far:

40 - Number of states claimed by the American Legislative Exchange Council (ALEC) to have "defended health care choice" through the actual or proposed introduction of health care nullification bills intended to "oppose Obamacare"
4 - Number of states where health care nullification bills have actually passed
14 and counting... - Number of states where health care nullification bills or constitutional amendments have failed

In recent months, the health insurance industry-funded ALEC has claimed that over 40 individual state legislatures have "defend[ed] health care choice" by being witnesses to the proposed or actual introduction of their model legislation in an attempt to nullify the recently passed federal reforms in the Patient Protection and Affordable Care Act.

Despite their model legislation's patent unconstitutionality, ALEC has persisted in pushing nullification bills in state capitals across the nation, promising those who want to obstruct reform that they will "protect citizens from ObamaCare" and "stop ObamaCare at the state line."

In fact, nullification bills have already been rejected or failed to pass in at least fourteen states where ALEC claimed legislators would defy federal law. ALEC style bills or proposed constitutional amendments have failed in Arkansas, Colorado, Delaware, Indiana, Iowa, Kansas, Maryland, Michigan, Mississippi, New Hampshire, New Mexico, North Dakota, South Dakota, West Virginia and Wyoming.

In other states where ALEC has claimed success, such as Montana, Rhode Island, and Texas, health care nullification bills have yet to even be introduced. Nullification proposals have met significant opposition in states around the country; a few examples among these states:

In Iowa, the 2010 session ended with the House minority leader conceding the failure of conservative efforts to nullify federal health care reform.
In Arkansas, the 2010 session ended without action on a non-binding bill intended to "prevent involuntary enrollments in health care insurance programs."
In Delaware, legislative leaders directed a nullification effort to a committee described in a recent news report as a "favored burial ground for bills."
In North Dakota, a proposed constitutional amendment failed in 2009.
In Maryland and Michigan, attempts at nullification through constitutional amendments failed in committee.

Notably, in Maine, where a nullification bill was not introduced, legislative leaders defeated a resolution promoted by conservatives calling on the Attorney General to join a lawsuit seeking to block the implementation of federal reform.

States Moving Forward on Implementation: While the right wing is focused on grandstanding and political gamesmanship, legislators and officials in all 50 states are moving forward with the hard work of planning the effective implementation of the Patient Protection and Affordable Care Act at the state level. Many of these efforts began well before the passing and signing of federal reform, and will accelerate in the coming weeks and months as responsible leaders in the states focus on delivering quality, affordable healthcare to their constituents.

Here are just a few of the efforts publicly announced, although others are moving forward in states across the country (updated 4/13/10). For more details on implementation, see http://ALECFail.com.

See our extended resources below, as well as resources opposing health care nullification efforts and supporting implementation in the states.

Resources:
Opposing Health Care Nullification Efforts:

Constitutional Accountability Center - The States, Health Care Reform, and the Constitution
Center on Budget and Policy Priorities - Efforts to Nullify Health Reform Likely to Fail, But Could Interfere With Law’s Implementation
American Constitution Society for Law and Policy - Mandatory Health Insurance - Is It Constitutional?
New England Journal of Medicine - Can the States Nullify Health Care Reform?
New England Journal of Medicine - The Constitutionality of the Individual Mandate for Health Insurance
Center for American Progress - State Efforts To Repeal Health Care Reform
Center for American Progress - Unraveling Health Care Reform Would Leave Millions with Less Affordable Care

Health Care Implementation in the States:

Center on Budget and Policy Priorities - Key Health Insurance Market Reforms Not Achievable Without an Individual Mandate
Kaiser Family Foundation - Pulling It Together: Implementation Is Forever
Kaiser Family Foundation - Health Reform Implementation Timeline
U.S. Department of Health and Human Services - Sebelius Remarks: Health Reform and You: How the New Law Will Increase Your Health Security
U.S. Department of Health and Human Services - HHS Letter to Governors on High Risk Pools
U.S. Department of Health and Human Services - HHS Letter to NAIC requesting data and input on Medical Loss Ratios
Center for American Progress - Interactive Health Care Calculator for Small Businesses: Small Businesses Will Gain Under New Health Reform Bill
Center for American Progress - Interactive Map: States Lose When They Push Aside Health Reform
The National Association of Insurance Commissioners - Health Insurance Implementation Guide
AARP Advocacy Brief - Assuring the Promise of Federal Health Care Reform in 2010: State High Risk Pools
Families USA - Health Reform Central: Includes information states will need to prepare for implementation and roadblocks to implementation.