With a law as
complex as the Patient Protection and Affordable Care Act (PPACA),
unintended consequences are always a concern. Last week The Wall Street
Journal reported that the physician community is witnessing the
emergence of a significant unintended consequence — since tax-advantaged
flexible spending accounts can no longer be used to pay for
over-the-counter medications without a prescription, under the law, many
patients are now visiting their doctors expressly for the purpose of
getting new prescriptions for the OTC medications. The change in the law
was meant to discourage wasteful spending on some health products and
raise revenue. Instead, critics say the provision is driving up health
care costs. Unintended consequences of the health care reform
law is an area of focus for Aetna insurance, and will continue to urge
flexibility in the implementation process to help address potential
unintended consequences.
Federal
In response to various requests for clarification
(including from Aetna insurance), federal regulators last week issued a
Question & Answer document that further refines the previous
proposed rule on student health. In short, this clarification makes it
clear that nothing from PPACA applies to student health plans until
policy years beginning in 2012 or until academic year 2012-2013. The Q
& A also clarified that the proposed regulation must be finalized to
show what parts of the PPACA would apply to student health plans. This
is welcome news in the college and university community. Aetna is
communicating with its clients in a manner that is consistent with last
week's clarification, though many schools were hearing conflicting
advice from state regulators.
The House-passed continuing
resolution includes language that would "prohibit the use of funds to
pay any employee, officer, contractor, or grantee of any department or
agency to implement the provisions" of the PPACA. In a letter to Finance
Committee Chairman Max Baucus, HHS Secretary Kathleen Sebelius made
several claims that, should the de-funding provisions in the resolution
be enacted into law, seniors will lose access to Medicare Advantage
plans and other services. Senate Republicans were quick to dispute these
allegations stating, the scenarios the Secretary envisions are not
allowed under Congressional rules, are not assumed by the Congressional
Budget Office (CBO), and can be prevented by HHS. Senator Orrin Hatch
and Ways and Means Committee Chairman Dave Camp also sent Secretary
Sebelius a letter expressing their disappointment in what they called
the letter's "baseless allegations," and expressing hope that "the
urgency with which this letter was sent to Chairman Baucus is also being
applied in answering a growing backlog of serious questions." The CBO
also released a letter regarding the impact of the resolution, including
the impact of the de-funding provisions on Medicare Advantage. The
letter shows the de-funding provisions would have a minimal MA budgetary
impact of $5.7 billion over 10 years.
States
Governor
Jan Brewer's Special Advisor on Arizona health insurance Health Care
Innovations held a meeting last week with the state's major health
insurers, including Aetna insurance, to discuss identifying IT gaps the
state must address to develop the online product selection and enrollment mechanism for an insurance exchange. Social Interest Solutions, the organization that developed the enrollment
form currently used by Medicaid applicants, provided a demonstration of
that application process. Individual interviews will be conducted with
the IT staff of each company to obtain recommendations for the new
system.
The Real Estate Committee last week voted out a
substitute prior-approval rate bill that retains all the problematic
sections of the original bill. The sections of concern cover public
hearings, new subpoena powers for the Attorney General and Connecticut
health insurance Healthcare Advocate, multiple notice requirements, and
new definitions of inadequate, excessive, and unfairly discriminatory.
The only change is that the Commissioner would have to promulgate
regulations to carry out the proposed public hearing process. The full
contingent of Republicans and Rep. Linda Schofield (Dem.) voted against
the bill, with Schofield stating that she was concerned the bill gets
rid of any timeline under which the Department must act and would
require public hearings, nonsensically, for group rates. She also said
the bill would provide the Attorney General and Advocate with
extraordinary subpoena powers. The Chairs indicated that the bill is a
work in progress.
Florida health insurance Insurance Commissioner Kevin McCarty has
disclosed that he will be submitting a medical loss ration (MLR) waiver
request to HHS this week.
Georgia health insurance Insurance
Commissioner Ralph Hudgens has indicated he will be submitting an MLR
waiver request to HHS within a week. Aetna insurance continues to work
with the Chamber of Commerce and plan sponsors to help defeat
legislation that would apply prompt-pay requirements to self funded
plans, in violation of ERISA.
Oklahoma health insurance Last week
State Rep. Mike Ritze, one of two doctors serving in the Oklahoma
legislature, called on state officials to turn down $54 million that
would be used to implement the new federal health care law. Shortly
thereafter, Governor Mary Fallin joined other state leaders in
announcing that Oklahoma will accept the grant to help design and
implement the information technology infrastructure to operate an
Oklahoma health insurance exchange. Fallin listed the creation of such
an exchange as one of her top priorities in her State of the State
address earlier this month. She and others announced their support for
the grant after working with state agencies to ensure that no unworkable
federal mandates were included.
Later in the week, the
legislature continued taking steps forward to reduce the number of
uninsured Oklahomans. House Speaker Kris Steele authored a bill that
defines the membership and appointments to the Health Care for the
Uninsured Board (HUB), which is designed to establish a system of
counseling, including a website, to educate and assist consumers in
selecting an insurance policy that meets their needs. The seven-member
HUB consists of representatives from the Insurance Commissioner's
Office, the Oklahoma Healthcare Authority, insurance companies, agents
and also consumers. The purpose of HUB is to implement a market-based
insurance exchange. The bill passed the House Public Health Committee
at the end of the week and will proceed to the floor of the House.
Texas
health insurance Legislators are wrestling with to what extent they
should intervene in what residents eat, drink and breathe. In a state
with some of the nation's highest obesity and diabetes rates, supporters
of various proposals say they are trying to give Texans more ways to
combat unhealthy decisions by others, as well as make good choices for
themselves. The president of the Texas Medical Association testified
last week in favor of a bill banning the sale of unhealthful drinks
(sugary fruit juices, sodas, whole milk) to students during school
hours. Other related bills would allow the state to raise taxes on sweet
sodas and fine restaurants for not posting nutritional information.
About
30 percent of Texas schoolchildren are obese or overweight, according
to the Texas Public School Nutrition Policy. And last month, Republican
Comptroller Susan Combs released a report saying obesity cost Texas
businesses $9.5 billion in 2009 — that could rise to $32 billion by 2030
due to the cost of health care
services, absenteeism, decreased productivity and disability.
Legislators will continue debate on these bills until the session
adjourns on May 31.
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