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Affordable Care Act: State Action Newsletter
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October 7, 2011
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Breaking News –IOM Releases Guidance on Essential Health Benefits
On October 6, the Institute of Medicine issued guidance to the U.S. Department of Health and Human Services on the "essential benefits" to be offered by qualified health plans that participate in the health insurance exchanges. The report makes recommendations about the criteria and methods for determining the essential health benefits. These benefits affect states because Section 1311(B)(ii) of the ACA requires states to assume the cost of any additional benefits not contained in the federal mandate.
Among the 50 states, more than 1,800 laws mandate health insurance coverage for specific services and select populations. More than half the states also have laws that require review and evaluation of such mandates with an emphasis on the cost of adding new benefits to coverage. Click here for more information on state insurance mandates.
The IOM also recommended that the HHS secretary grant to states that administer their own exchange the ability to request changes to the essential health-benefits package if they can produce a package that is “actuarially equivalent” to the national package. The IOM report urges HHS to announce the formal list of essential benefits by May 1, 2012.
The report, Essential Health Benefits: Balancing Coverage and Cost is available online.
Vermont Implements State Reform
Building on a universal and unified health system proposed by the governor and passed earlier this year by the legislature, Vermont is taking steps to become the first state in the nation to implement a single-payer health insurance system. “This is groundbreaking,” Governor Peter Shumlin wrote in a blog, “but our success in guaranteeing coverage depends on our ability to control health care costs, so our plan is focused squarely on that goal.”
Gov. Shumlin took the first step to address the details of the new program, including financing, by appointing the five-member Green Mountain Care Board. The board is responsible for redesigning the state’s health care delivery and payment systems, providing oversight of cost-control initiatives, and determining reimbursement rates. Pilot programs will be used to test various health care delivery models, including bundled payments and an advanced medical home system.
Critics of the single-payer system are concerned about the costs for the state, the potential for additional taxes, and that businesses may lose control over employee insurance. Others believe the fears are unfounded. For example, a report by the Commonwealth Fund estimates that after expanding health care services and providing coverage to the uninsured, the single-payer system could save Vermonters close to $200 million in the first year. These anticipated reductions would be achieved through lower administrative costs, malpractice reform, reduced rates of fraud and abuse, and a more integrated delivery system. By 2015, the report concludes that the system could create nearly 3,800 new jobs and increase Vermont’s economic output by around $100 million. Similar results were found in a recent study conducted by Harvard economist William Hsiao.
As Vermont begins considering possible options for financing, various implementation challenges remain. For example, the state’s single-payer system is contingent on receiving necessary federal waivers and legislative approval.
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Inside This Issue
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Home Visiting Grants Awarded
Forty-nine states and six jurisdictions were awarded $224 million in grants to support voluntary home visiting programs that aim to improve child development, maternal-child health, economic sufficiency, school readiness and child abuse prevention. The funds were announced in late September by the U. S. Department of Health and Human Services as part of the federal Maternal, Infant and Early Childhood Home Visiting (MIECHV) Program, which was established through the Affordable Care Act.
Grants totaling $124 million were awarded to all states, except North Dakota, to support evidence-based home visiting programs for at-risk families. In addition, nine states—Arizona, Arkansas, California, Illinois, Indiana, Louisiana, Maine, Massachusetts and Oklahoma—were awarded $66 million in four-year competitive expansion grants to increase the scale or scope of each state’s existing high-quality home visiting programs and services. An additional $34 million in two-year development grants was awarded to 13 states—Alabama, Delaware, Georgia, Hawaii, Michigan, Montana, New Hampshire, New Mexico, Oregon, Rhode Island, Texas, West Virginia and Wisconsin—to strengthen each state’s existing, modest home visiting efforts. Click here for more information on home visiting.
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Challenges to ACA Move Closer to U.S. Supreme Court
On Sept. 28, both the plaintiff states and the U.S. Justice Department in the Florida-based multi-state challenge to the Affordable Care Act (ACA) formally petitioned the U.S. Supreme Court to take up the case during the current term (October 2011 to June 2012). On Aug. 12, in State of Florida v. U.S. Dep’t. of Health & Human Services,
The Supreme Court filings requesting a review provide insight to the latest legal arguments: Florida et al. petition /United States Justice Department submitted 9/28/2011. The Court has not announced any response or action. Other pending lawsuits also may request a Supreme Court hearing. So far these interim steps do not affect the legal status of the Act itself.
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ACA Funds Support Childhood Obesity Demonstration Project
On Sept. 29, the Centers for Disease Control and Prevention (CDC) launched a four year, $25 million Childhood Obesity Demonstration Project authorized by Section 4306 of the Affordable Care Act. Building on existing community efforts, the project will identify effective health care and community efforts to support children’s healthy eating and active living.
“Over the last three decades, obesity rates among children and adolescents have nearly tripled,” said CDC Director Thomas R. Frieden, MD, MPH. “This project will help figure out ways our children can grow up to lead long, healthy and productive lives.” Since childhood obesity rates are especially high in minority and low-income communities, the project will target 2- to 12-year-olds covered by the Children’s Health Insurance Program (CHIP), which provides low-cost insurance to more than 7 million children from working families.
Innovative efforts to reach these families are aimed at facilitating complementary changes in preventive care at doctor visits and supportive changes in schools, child care centers, and community retail food stores and parks. Community health workers will be recruited to educate hard-to-reach populations, limited English speakers, and minority communities on ways to prevent diseases (including obesity), obtain health insurance, and manage chronic diseases. Three research facilities—the University of Texas Health Science Center at Houston, San Diego State University and the Massachusetts Department of Public Health—will receive approximately $6.2 million each over four years. Project findings will be disseminated nationwide in September 2015.
Announcements
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