Patient Protection and Affordable Care Act: State Action Newsletter

July 13, 2012

Secretary Sebelius Sends Letter to States

On July 10, 2012 Secretary Kathleen Sebelius issued a letter to governors addressing the Supreme Court opinion, the exchanges, the Medicaid expansion and the upcoming federal regional implementation forums.

More specifically, the letter reminded governors that funding to help establish exchanges is available, setting 10 deadlines for submitting exchange establishment grants between August 2012 through October 2014. It notes that at any point a state may seek federal funds to assist with the initial costs of an exchange, regardless of where the state may be in the process or who is administering it, i.e., the state, the federal government or a hybrid of both.

It also addresses the Court’s decision on the Medicaid expansion, stating that the ruling does not remove any provisions that allow an enhanced match for expansion populations, if a state chooses to expand eligibility. From 2014 through 2016, the federal government pays for 100 percent of the newly eligibles’ coverage, 95 percent in 2017, 94 percent in 2018, 93 percent in 2019, and 90 percent federal financing for 2020 and subsequent years.

Last, the letter provides locations for “Affordable Care Act Regional Implementation Forums,” which are intended for stakeholders and policymakers to ask questions and learn more about the law. These forums will be held in four cities: Washington D.C., Chicago, Denver and Atlanta during the first weeks in August.

With a Supreme Court decision behind us, some states are determining what their next step is after the ruling, while others are holding to their previously held positions on establishing—or not—component of the federal health law in their state. Stay tuned as the specifics become known from states and the federal Department of Health and Human Services.

Ballot Language Showdown in the Show-Me-State

In November, Missourians will vote on a ballot initiative to bar state officials from creating a health insurance exchange without legislative or voter approval. It would also prohibit state departments from taking federal money to prepare for the health insurance exchange required by PPACA. The measure was approved by the legislature during the 2012 session.

The ballot language released by Missouri Secretary of State Robin Carnahan on July 3 has incited a lawsuit from several legislative leaders.

Lieutenant Governor Peter Kinder, Senate President Pro Tem Rob Mayer, Senate Majority Leader Tom Dempsey, House Speaker Steven Tilley and House Majority Leader Tim Jones filed suit in Cole County Circuit Court this week arguing that the ballot language is misleading.

The language released was as follows:

“Shall Missouri law be amended to deny individuals, families, and small businesses the ability to access affordable health care plans through a state-based health benefit exchange unless authorized by statute, initiative or referendum or through an exchange operated by the federal government as required by the federal health care act?”

The lawsuit contends that the ballot measure is about whether the state will adopt a health insurance exchange, not about denying health coverage.

This is not the first time the legislature has asked citizens to vote on issues related to the Affordable Care Act. In August 2010, Missouri voters overwhelmingly passed Proposition C, The Missouri Health Care Freedom Act, which amended Missouri law to “deny the government authority to penalize citizens for refusing to purchase private health insurance or infringe upon the right to offer or accept direct payment for lawful healthcare services.”

Upcoming Webinar—Social Determinants of Health: Reforming the Health System to Work Smarter, Not Harder, to Eliminate Health Disparities

Thursday, July 19, 2012                       
 2 p.m. ET/ 1 p.m. CT/ Noon MT/ 11 a.m. PT                                 

America spends $2.6 trillion on health care annually and everyone—from the capitol corridors to Main Street—is feeling the pinch. State lawmakers face tough choices as health costs eat up a quarter or more of their total yearly budgets. And although everyone contributes to the health care “pot,” health and wellness indicators across certain populations and zip codes are not the same.  Research has uncovered an uncomfortable reality: racial minorities are less healthy over their lifetimes and die sooner than whites. Disparities exist even when researchers control for income and health insurance coverage. The question is, why? Why are racial minorities more likely to live shorter, less healthy lives?  The answer is not simple, but a complex web of factors.  This webinar will look at some of these factors, called the social determinants of health, and examine ways policymakers can address systemic inefficiencies which lead to inequality, while containing costs and improving quality for all.

Speakers: Assemblyman Richard Pan, CA and Representative Jeffery Sanchez, MA

Register here

A Safety-Net Concern

Nationally, hospitals provided about $39.3 billion in uncompensated care during 2010; that’s 15 percent higher than three years earlier, according to the American Hospital Association. A portion of this was funded through Disproportionate Share (DSH) Payments—which totaled $11.3 billion in 2011. Medicaid DSH dollars provide federal financial assistance to hospitals serving a significant number of Medicaid beneficiaries and the uninsured. DSH is designed to offset the costs of uncompensated hospital care. The PPACA phases down the DSH funding by 2020. The PPACA includes many provisions to increase the number of Americans with health insurance, one of which was to expand Medicaid to people with incomes up to 133 percent of poverty level. These provisions are projected to lower the number of uninsured people and reduce the need for taxpayers to pick up the tab of unpaid hospital bills. The recent Supreme Court ruling makes the Medicaid expansion optional for states. If states choose not to expand Medicaid and there is no other mechanism in place to fund health care for low-income people or finance uncompensated care and the federal law’s timetable to phase out DSH does not change, hospitals could face significantly higher uncompensated care costs.