Hart Health Strategies provides a comprehensive policy briefing on a weekly basis. This in-depth health policy briefing is sent out at the beginning of each week. The health policy briefing recaps the previous week and previews the week ahead. It alerts clients to upcoming congressional hearings, newly introduced bills, regulatory announcements, and implementation activity related to the Patient Protection and Affordable Care Act (PPACA) and other health laws.


Medicare in Focus

Republican presidential candidate Mitt Romney picked Rep. Paul Ryan, the Chairman of the House Budget Committee and author of the House budget plan, as his vice presidential running mate. The Republicans turned table on President Obama’s criticism of the Ryan Medicare budget plan by campaigning all week on Obamacare’s $716 billion cut in Medicaid to pay for health reform. The Obama campaign fired back that Romney’s call for the repeal of Obamacare would result in moving up the date of Medicare trust fund insolvency from 2022 to 2016. The Romney camp said their revised plan for Medicare reform would not affect those 55 and older and result in transforming the program for younger beneficiaries into one that looks similar to the Medicare Part D drug program.

Health Insurance Exchange Blueprint Released

The CMS Center for Consumer Information and Insurance Oversight (CCIIO) issued a final “Blueprint for Approval of Affordable State-based and State Partnership Insurance Exchanges” which, among other things, explains:

functions to be performed by state-based exchanges;

functions performed by exchanges operated as joint federal/state partnerships; and

functions that states can perform in “federally facilitated” exchanges that HHS by default must set up in states that do not meet the state-based qualification requirements.

Applications for the first two types of exchanges are due by this November 16th and the CCIIO will approve or give additional approval to the applications by the beginning of next year.

The CCIIO is still urging states to perform various functions, such as Medicaid and SCHIP eligibility determinations, in instances in which the federal exchange is in operation. As an inducement for states to adopt their own exchanges, the CCIIO said such states will stil have the option of allowing the federal government: to conduct eligibility determinations for tax credits and cost-sharing reductions for low and moderate income exchange participants; to make determinations about exemptions from the individual mandate for hardship or other reasons; to operate risk adjustment programs; and to operate a reinsurance program for issuers of individual coverage. HHS is holding meetings in DC, Atlanta, Chicago and Denver with state officials and others to discuss the rules and urge state participation.

Will CLASS Begin?

Rep. Charles Boustany and Senator John Thune sent a letter to HHS Secretary Kathleen Sebelius raising concerns about recent HHS activities involving the potential implementation of the PPACA long-term care CLASS program. They said “We’re disappointed CLASS implementation deadlines remain part of federal law, and more troubled to learn it appears that HHS officials have resumed CLASS implementation discussions during large group meetings with stakeholders….” They asked for clarification of whether HHS thinks it has the legal authority to implement the CLASS Act even though the program has not been repealed. The House previously passed H.R. 1173, legislation that would repeal the CLASS Act

GAO Reviews Studies of Employer Reaction to PPACA

The GAO released a report, Patient Protection and Affordable Care Act: Estimates of the Effect on the Prevalence of Employer-Sponsored Health Coverage, which reviews 27 studies and various surveys estimating how many employers will drop coverage as a result of the PPACA’s employer mandate and other provisions. Of note, the CBO estimated that employer plan coverage would be reduced by about 4 million participants, or 2.5% and CMS estimated coverage would increase by about 200,000 participants. The Lewin Group projected a net decrease in coverage of 1.6%. In 19 surveys of employers, the percentage of employers stating they would drop coverage ranged from 2 to 20%.

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