Patient Protection and Affordable Care Act: State Action Newsletter
June 15, 2012
Supreme Court Ruling—Informational Conference Call for Members
NCSL will offer members the opportunity to discuss the Supreme Court ruling on federal health reform with NCSL health policy staff and other experts. The day after the decision is announced, a conference call will be held at 2 p.m. EDT. Callers will have the opportunity to ask questions and gain insight into what the ruling might mean for their states. All legislators and legislative staff have been sent an email with call-in details and mechanisms to pose questions. Reminders will be sent to all legislators and legislative staff Thursday, June 28. Need further assistance or information? Contact email@example.com
Please join us in Chicago, Ill., at the 2012 NCSL Legislative Summit, Aug. 6 – 9, 2012.
Attend Health Committee sessions, beginning Monday, Aug. 6, at 3:15 p.m., to learn about what’s happening in Washington, D.C. that may affect your state’s programs and budgets; what’s new in state Medicaid innovations; and how to prevent and manage costly chronic diseases. In addition, Health Committee members will consider and vote on state-federal policy positions that direct NCSL’s important state advocacy efforts in Washington, D.C.
NCSL’s Task Force on Federal Health Reform Implementation will meet on Monday morning, August 6 (prior to the Summit’s opening session), to discuss what the U.S. Supreme Court ruling on the Patient Protection and Affordable Care Act will mean for states.
Health-related Issue Forums will include updates about Insurance Exchange Plans and Options, Medicaid “Best Buys,” and “What’s Ahead for Pharmaceuticals?”
To view detailed information on these sessions, please see the Health Topics Agenda.
For Registration/Hotel Information. We hope to see you in Chicago!
NCSL will also be hosting the 2012 Fiscal Analysts Seminar at the state capitol in Salt Lake City, Utah, Aug. 29 – 31.
NCSL invites all legislative staff involved in fiscal research and analysis to discuss state policy, network with colleagues, and discover innovative solutions to problems facing states. The Fiscal Analysts Seminar (FAS) offers professional development opportunities for fiscal staff of all skill levels through the knowledge of national experts and the expertise of legislative staff who are policy experts in their states. The seminar will feature session tracks on Medicaid, tax & revenue, and crime & corrections.
Inside This Issue
California Selects Vendor to Build IT System for Exchange
On May 31, 2012, the California Health Benefit Exchange announced it will award $359 million to Accenture LLC, to build the exchange’s new Web and eligibility system, called CalHEERS. Accenture may use $183 million to build the system and the remainder for continued development and operation over three years. Consumers will use the Web portal to purchase health insurance coverage and obtain subsidies, if qualified. It is expected to be ready on Oct 1, 2013. The funding comes from PPACA related federal grants. Many states creating health insurance exchanges are also soliciting vendors to carry out various functions of the exchange. California has also selected vendors and consultants to provide an insurance plan analysis and assist with marketing and public relations. The state is now seeking a vendor that can run the service center to provide consumer assistance to the state exchange.
Kentucky Governor Considers Exchange Options
Kentucky Governor Steve Beshear announced that if the Supreme Court upholds the Patient Protection and Affordable Care Act, he will issue an executive order to establish a state-run health insurance exchange. Regardless of the court’s decision, the governor emphasized that “it is imperative that the state prepare for any [Supreme Court] decision.” He says Kentucky is currently taking steps to ensure that, if upheld, the state will be ready to operate its own health insurance exchange, rather than allowing the federal government to do so.
Some Insurers Plan to Keep Selected PPACA Provisions
On June 11, three major commercial health insurers announced plans to voluntarily keep several of the insurance benefits launched in 2010 as required by PPACA, even if the Supreme Court ruling invalidates parts or all of the federal law.
According to company news releases, United Healthcare (the nation’s largest with about 26 million enrollees), Aetna (the third largest) and Humana will continue to keep adult dependents on family policies until age 26; provide preventive services with no out-of-pocket co-payments; not impose lifetime dollar limits on policy benefits; not cancel or rescind policies, except for fraud; and provide a clear, timely process for appealing denied services or coverage.
United described the protections as “effective immediately, and will remain available to current and future customers” with no sunset provisions. Aetna said in a statement: “A number of provisions in the health reform law have been woven into the fabric of our healthcare system, bring value to customers and consumers, and should be maintained.” At least three other companies, WellPoint (the second largest), Cigna and Horizon Blue Cross Blue Shield of N.J. say they are awaiting the court’s ruling before addressing these issue; dozens of other regional and local insurers have not made voluntary public announcements.
Insurers did not mention other coverage provisions of the federal law such as children and adults with pre-existing conditions, guaranteed issue, premium rates or medical loss ratios in their statements
Study Shows Cost Savings in Treating Seniors at Home
A recent study published in Health Affairs found states that gradually changed, sometimes referred to as rebalanced, their long-term care services and supports under Medicaid to include more home- and community-based programs served more people and “saved money compared to the amounts that they would have spent had they done nothing to shift expenditures away from institutional services.”
According to the authors, gradually rebalancing a state’s long-term services, “by roughly two percentage points annually, can reduce spending by about 15 percent over ten years.”
Federal law, as enacted in the Americans with Disabilities Act of 1990 and interpreted by the Supreme Court in the Olmstead decision, requires that long-term care be provided in the most integrated setting appropriate to the needs of the person.
A number of lawsuits filed since the Olmstead decision prompted states to reconsider how their long-term care is delivered. The Patient Protection and Affordable Care Act contains a number of provisions that motivated states to shift resources to more home- and community-based care.
The study also states that “Medicaid-financed long-term services and supports for people with intellectual and developmental disabilities have mostly moved away from institutional and toward community-based services” over the past couple of decades. Long-term services and supports for seniors, however, have not moved away from institutions at the same rate.
For more information about the challenges states face in providing long-term care to seniors, check out a new policy brief from Health Affairs.