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Affordable Care Act State Action Newsletter 28

Affordable Care Act: State Action Newsletter

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March 9, 2012

Connecticut Considers an All-Payer Claims Database

The Connecticut health insurance exchange board recently approved the use of exchange grant funds to build an all-payer claims database (APCD). These databases compile health insurance claims from health care payers into a statewide information repository that serves as a tool to help contain health costs and improve quality. In recent years, nine state legislatures have enacted laws to establish these databases: Kansas, Maryland, Massachusetts, Maine, Minnesota, New Hampshire, Tennessee, Utah, and Vermont. Colorado, Oregon, Rhode Island and West Virginia have also passed legislation but have not yet fully established the database systems, according to the All-Payer Claims Database Council. Virginia lawmakers are also considering legislation this year to establish such a system.

 “The APCD will provide needed information to the new Health Insurance Exchange that will begin operations in January 2014,” says Jeanette DeJesus, Special Advisor to the Connecticut governor for the Office of Health Reform and Innovation. “The data could also be used by payers, including Medicaid, to help design better products and benefits as well as provide incentives that promote a higher level of coordination of care resulting in better health outcomes,” she says. DeJesus also points out that the new database will be helpful to policymakers, state agencies and the private industries, who are making decisions to improve access and affordability and reduce health disparities. 

Last year, Connecticut’s Office of Health Reform and Innovation convened a working group to develop a plan for a multi-payer data initiative as required by Public Act 11-58. A proposed bill, HB 5038, would implement the governor’s budget recommendation to build an APCD and require the health reform office to oversee the planning and implementation in consultation with an advisory group.


Health Benefit Exchange Update

Oklahoma’s Joint Committee on the Federal Health Care Law, which met from September to November last year, recently submitted a final report with recommendations for Oklahoma’s health insurance exchange. The committee stated that it is “adamantly opposed to a federal health insurance exchange” and recommended instead that the Legislature develop a state-based health insurance exchange. Although a bill has not yet been introduced, the Legislature has until May 25, 2012, to consider legislation to establish an exchange.

Idaho lawmakers will not take action on a bill to establish a health insurance exchange during the 2012 session, according to House Speaker Lawerence Denney and Senate President Pro Tem Brent Hill as reported by the Idaho Statesman. According to the federal timetable for health reform implementation, states must have a federally approved exchange plan in place by January 2013, or the feds will run it instead.

The Minnesota Legislature has a number of pending bills addressing health insurance exchanges, including two that offer an “alternative” to health insurance exchanges. Representative Steve Gottwalt and Senator David Hann’s bills (HB 2683 and SB 2313) would develop health premium accounts, which would allow people to use several sources to pay for health insurance premiums. In a press release, Representative Gottwalt said that the legislation would insure a free market in Minnesota. Meanwhile, Democrats in both chambers have introduced bills to establish health insurance exchanges that comply with federal requirements of the health reform law. It remains unclear what path the state will take before the session ends on May 21, 2012.

Inside This Issue

 

Supreme Court to Hear Challenge and Defense Arguments March 26-28

With the U.S. Supreme Court preparing for three consecutive days of oral argument on the legal challenges to PPACA, plaintiffs and defendants have filed numerous briefs and related court documents. 

The Court has provided online links to key documents in the cases, provided below.

The main challenge cases begin with Department of Health and Human Services, et al., Petitioners v. Florida ,et. al (11-398). On March 26 and 27, the legal questions presented are the constitutionality of the individual mandate and whether the suit brought by respondents to challenge the minimum coverage provisions of the PPACA is barred by the Anti-Injunction Act. On March 28, the action continues with National Federation of Independent Business, et al., Petitioners v. Sebelius (11-393) (legal questions presented) and Florida v. HHS (11-400) (legal questions presented) covering severability and the Medicaid expansion. The deadline for court filings is March 13. 

       

Prevention and Public Health Fund Update

Primary prevention—avoiding health problems before a visit to the doctor is necessary—is an overarching goal of the Affordable Care Act. The federal law, created a Prevention and Public Health Fund to support prevention efforts and to refocus the U.S. health system from treatment to wellness to help reduce the high costs of preventable chronic diseases. The Obama administration, however, proposed a FY 2013 budget last month that cuts the fund by 33 percent—$5 billion over 10 years—to continue payroll tax cuts and provide Medicare with enough funding to avoid payment cuts to physicians.

A policy brief from Health Affairs and the Robert Wood Johnson Foundation discusses advocate concerns about proposed reductions to the fund and argues that any cuts would reduce an already inadequate federal investment in basic public health services and prevention. Others, believe the fund duplicates existing federal efforts and is unnecessary.

As enacted, the federal health reform law allocated about 2 percent ($15 billion) of its total funding for the decade to prevention, the most substantial effort in years to fund public health infrastructure and support community-based prevention work. Funds were meant to add to, not replace, existing federal funding for public health and prevention. In its first year, however, much of the prevention fund was used to restore previously cut public health programs; $250 million went toward primary care workforce training. Second-year funding ($750 million) included $280 million for state and local community-based efforts to reduce tobacco use, improve nutrition and increase physical activity. Third-year prevention funds ($1 billion in FY 2012) are supporting activities to prevent chronic diseases and to help state and local health departments respond to public health threats and outbreaks.

The final 2012 fund allocations were split between the Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA). The CDC received $825 million for “Community Transformation” grants to help prevent diabetes and tobacco use, to increase immunization and worksite wellness programs, and to track environmental health issues. HRSA received $25 million to support public health workforce development programs. The president’s budget did propose prevention funds for FY 2013; however, the House and Senate will likely develop recommendations about how to allocate the funding. 

Lifetime Limits on Insurance: An Update

An estimated 105 million Americans no longer have lifetime dollar limits on their health benefits due to the Affordable Care Act, according to a new report by the Department of Health and Human Services released on March 5, 2012. Of these, 70 million are enrolled in large employer plans, 25 million are in small employer plans and 10 million have purchased individual health insurance. The ACA prohibits lifetime limits in all health plans that renew after Sept. 23, 2010.

About 41 percent of commercial health plans already had no limits on lifetime benefits before passage of the ACA. However, 59 percent of workers covered by their employer’s health plan, and 89 percent of people with individually purchased coverage had some lifetime limit, according to the Kaiser Family Foundation’s Employer Health Benefits Survey.

The ACA also restricts annual dollar limits on benefit coverage. For plan years that started after Sept. 23, 2011, most annual limits cannot be less than $1.25 million; for plan years starting between Sept. 23, 2012 and Jan. 1, 2014, the lower limit goes up to $2 million; and for plans issued or renewed beginning Jan. 1, 2014, all annual dollar limits on coverage of essential health benefits are prohibited.

Number of Americans Estimated to No Longer have a Lifetime Limit on Health Insurance Benefits, by State

State

Total

State

Total

Alabama

1,566,000

Montana

319,000

Alaska

237,000

Nebraska

701,000

Arizona

2,091,000

Nevada

937,000

Arkansas

313,000

New Hampshire

545,000

California

12,092,000

New Jersey

3,274,000

Colorado

1,902,000

New Mexico

555,000

Connecticut

1,386,000

New York

6,432,000

Delaware

320,000

North Carolina

13,091,000

District of Columbia

208,000

North Dakota

253,000

Florida

5,587,000

Ohio

4,154,000

Georgia

3,317,000

Oklahoma

1,197,000

Hawaii

462,000

Oregon

1,356,000

Idaho

566,000

Pennsylvania

4,582,000

Illinois

4,670,000

Rhode Island

374,000

Indiana

2,259,000

South Carolina

1,458,000

Iowa

1,187,000

South Dakota

295,000

Kansas

1,021,000

Tennessee

2,042,000

Kentucky

1,414,000

Texas

7,536,000

Louisiana

1,411,000

Utah

1,183,000

Maine

431,000

Vermont

215,000

Maryland

2,251,000

Virginia

2,974,000

Massachusetts

2,520,000

Washington

2,427,000

Michigan

3,547,000

West Virginia

581,000

Minnesota

2,043,000

Wisconsin

2,142,000

Mississippi

844,000

Wyoming

196,000

Missouri

2,148,000

TOTAL

105,164,000

Source: HHS ,Office of the Assistant Secretary for Planning and Evaluation, ASPE Issue Brief, March 2012


Containing Medicaid Costs: State Strategies to Fight Medicaid Fraud and Abuse—Webinar—March 19, Monday, 2 p.m. ET

Across the nation, state lawmakers are searching for ways to contain the rising cost of Medicaid. State programs that fight fraud and abuse—designed to prevent, identify and prosecute improper payments and unlawful behavior that increase health care costs—offer an approach most everyone supports. Hear Patricia MacTaggart, lead research scientist at the George Washington University, talk about new opportunities under the Affordable Care Act to fight fraud. Learn what New York is doing to prevent Medicaid fraud and abuse from Mark Hennessey, assistant Medicaid inspector general for Legislative & Intergovernmental Affairs. Jack Stick, Deputy Inspector General of Enforcement, will share Texas’ strategies to improve the integrity of the Medicaid program. Click here to learn more and register.   


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