Affordable Care Act State Action Newsletter 32

Patient Protection and Affordable Care Act: State Action Newsletter

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May 4, 2012

HHS Announces $728 million in PPACA grants to Community Health Centers

More than 170 community health centers across the nation got word on Tuesday that their capital investment projects will move forward. New grants totaling $728 million, authorized by the Patient Protection and Affordable Care Act, will help health centers finance renovation and construction projects. According to HHS, community health centers serve 3 million more patients today than they did in 2009, and officials expect patient rolls to increase another 1.3 million in the next two years. These grants will allow health centers to expand their brick and mortar facilities to accommodate additional patients, buy new equipment, and make other, long-term investments. With these grants, community health centers will embark on about 400 new renovation and construction projects.    

Community health centers primarily serve people who do not have any other way to get health care, including the uninsured, and people in rural or medically underserved areas. While services vary from center to center, the fundamental mission is to offer the community primary and preventative health care services.

According to the Health Resources and Services Administration’s Uniform Data System Report, in 2010:

  • More than 19 million people received health care in community health centers; 62.3 percent were members of racial and ethnic minority groups, 38 percent had no health insurance; and 43 percent were children.
  • Community health centers are an integral source of local employment and economic growth in many underserved and low-income communities. Health centers employed approximately 131,000 staff in many of the nation’s most economically distressed communities.

For more information: NCSL’s Community Health Center Overview and Primer for State Legislators

For a list of grantees, click here.

$1.3 Billion in Medical Loss Ratio Rebates

The medical loss ratio provision of PPACA requires insurance companies that issue individual and small employer policies to spend at least 80 percent of the money they collect from premiums on medical care and quality improvement. For large employer policies, the requirement is 85 percent. Insurance companies that failed to meet this standard last year are required to provide a rebate to their customers by this August.

Analysis in a new report by the Kaiser Family Foundation estimates the first rebates from insurers will total $1.3 billion for 2012—approximately $426 million for consumers in the individual market, $377 million for employers in the small group market and $541 million for employers in the large group market. 

When averaged by state, the largest per-person rebates for consumers in the individual market are in Alaska ($305), Maryland ($294) and Pennsylvania ($243). In the small group market, when averaged by state, the largest per enrollee rebates are in Alaska ($517), Alabama ($203) and Oregon ($172). The largest per enrollee rebates in the large group market are in Vermont ($386), Nebraska ($248) and Minnesota ($146).

For more background information read the NCSL report, Health Insurance Medical Loss Ratios.

Inside This Issue


Covering Children in Nontraditional Families

Millions of children and their families are expected to gain health insurance coverage under the Patient Protection and Affordable Care Act. There’s been little discussion related to the federal law, however, on the group of vulnerable children who face barriers to coverage because of complex family situations. Nearly 20 million children live in nontraditional families in which parents either live apart—or are homeless, or the children live with guardians or grandparents or in institutions. A new report from the Urban Institute, “Addressing Coverage Challenges for Children Under the Affordable Care Act,” summarizes the obstacles many of these children face in getting coverage.

As rules and regulations are formed related to PPACA, special attention related to premium subsidies, cost sharing, eligibility, and exchange rules may be required to ensure that all eligible children get covered. These vulnerable families may especially benefit from outreach and enrollment strategies that provide information about coverage options for children.

Child-only health plans offered in the exchanges may be a vehicle for covering these children. Yet, even though the PPACA requires these plans to be offered, in some cases the subsidy determination process for these policies remains unclear. For more information, see the Grantmakers in Health bulletin, “Covering Children Under the Affordable Care Act: Minding the Gaps.”


Louisiana makes first “meaningful use” incentive payment

On April 9, Louisiana became the first state to make an incentive payment to a provider for achieving "meaningful use"

Under the Louisiana Medicaid EHR Incentive Program, which began in the state on Jan. 3, 2011, eligible providers can receive an initial payment for adopting electronic health records, and can receive continued payments for five more years if they demonstrate meaningful use of certified EHR technology in ways that can be measured in both quality and quantity. Winn Community Health Center has become the first provider in the nation to demonstrate that it has met the requirements of meaningful use.

For more information visit the CMS homepage and the CMS overview. To learn more about the program in your state, check out the list of State EHR Incentive Program Launch Times and HIT Websites  

Costs of Massachusetts Reform Law

Now that Massachusetts has a five-year track record for its 2006 state health reform law, two new studies provide a current look at the results. A report by the business-backed Massachusetts Taxpayers Foundation (Massachusetts Health Reform Spending, 2006-2011: An Update on the "Budget Buster" Myth) concluded that the state "achieved near universal health care coverage with only modest additional costs to state taxpayers." They calculated that direct state spending on the health care law grew from just over $1 billion in FY 2006 to more than $1.9 billion in FY 2011. After accounting for federal reimbursements from the state's Medicaid 1115 Waiver program, that translates into about $453 million in state spending—or about 1.4 percent of the entire $32 billion Massachusetts state budget for FY 2011. Links: Press Release and the Full Report.  

The BlueCross/BlueShield Foundation of Massachusetts published "Health Care Costs and Spending in Mass.: A Review of the Evidence," and concludes that "costs can be lowered without decreasing overall quality or health outcomes" and "higher costs were not caused or markedly accelerated by health reform." In May, the legislature plans to take up a new health care cost control legislation, with final drafting still underway this week.

New Hampshire Reviews Premiums

The N.H. insurance department released its first health insurance cost drivers and premium rate report in mid-April, a study mandated by legislation enacted in 2010. According to the report, for a fixed benefit package, per-person premiums grew 14 percent between 2009 and 2010. The growth was driven primarily by claims, as well as new medical technologies and an increase in outpatient surgery, outpatient laboratory, and IV infusion therapy facility costs.

Legislatures Restrict Executive Branch Action

At least five states, Missouri, Montana, New Hampshire, Utah and Wyoming have placed restrictions on the executive branch related to the implementation of the Patient Protection and Affordable Care Act. (Please note, the states below may have taken action to implement PPACA.)

Missouri HB 45, signed by the governor in July 2011, provides that "any federal mandate implemented by the state shall be subject to statutory authorization of the general assembly."

Montana SB 125 signed by the governor as Chapter 402 in May 2011 opposes certain provisions of federal health reform. A state agency "may not implement or enforce in any way the provisions" or any federal regulation or policy implementing federal health reform "that relates to the requirement for individuals to purchase health insurance and maintain minimum essential health insurance coverage."

New Hampshire HB 601, became law as Chapter 264 without the governor's signature in July 2011.  It requires the insurance commissioner to obtain approval from the legislative Health Insurance Reform Oversight Committee before enforcing the provisions of PPACA. The provision applies "to any state official or agency that seeks to enforce the insurance provisions of the Act" and includes enforcing the immediate "consumer protections and market reforms."  Effective date July 1, 2011.

Utah HB 67 signed into law by the governor in March 2010  prohibits a state agency or department from implementing any provision of federal health reform, “unless a state agency reports to the Legislature regarding costs and impact on state reform efforts.”

Wyoming SB 58 signed by the governor as Chapter 61 in March 2012 amends the duties of the Wyoming Health Insurance Exchange Steering Committee. The committee is required to produce a report with three options: an exchange based on Wyoming data without influence from the health care reform acts;  using selected parts of required federal features; and an exchange in complete compliance with PPACA. The statute limits the state's authority to operate a federally required health insurance exchange, stating that "No state agency or any person representing the state of Wyoming shall, prior to April 1, 2013, commit the state" to operating an exchange.

National Women’s Health Week

Mark your calendars: May 13 – 19 is National Women’s Health Week. For additional information on women’s health, visit NCSL’s Women’s Health Across the Lifespan Overview webpage. Also, for some insight on women’s health and the Patient Protection and Affordable Care Act, read NCSL’s issue brief, Improving Women’s Health: Opportunities and Challenges in Health Reform, published February 2012.

Upcoming Health Webinar on Oral Health—Friday, May 18, 2012

The “Cost-Effective Investments in Children's Oral Health” Webinar will be held on Friday, May 18, at 2 p.m. ET, and will feature presentations about investments in children’s oral health and areas for significant cost savings. Register now.



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