Health Reform Briefs: The Minimum-Coverage Requirement And Other Issues

Timothy Jost

Posted 1/07/12 on The Health Affairs Blog

©2011 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.

As every reader knows, the Supreme Court has agreed to consider challenges that have been brought to the constitutionality of two provisions of the Affordable Care Act (ACA) by twenty-six states, the National Federation of Independent Businesses, and individual plaintiffs.  The Court has scheduled the case for five and a half hours of oral arguments in late March.  It will probably decide the case early in the summer.

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Implementing Health Reform: A Bulletin on Essential Health Benefits

Timothy Jost

Posted 12/16/11 on the Health Affairs Blog

©2011 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.

On December 16, 2011, HHS released a “bulletin” describing the approach that it intends to take to establishing the “essential health benefits” under the Affordable Care Act.  A bulletin is a form of guidance that lacks the legal stature of a rule.  HHS believed, however, that the states, insurers, consumer advocates, and the public needed some indication as to the direction HHS was intending to take in defining the EHB, and the Bulletin was intended to serve this purpose until an actual rule is issued.

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Implementing Health Care Reform: Coops, MEWAs and Medicare Data

Timothy Jost

Posted 12/12/11 on The Health Affairs Blog

Copyright ©2011 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc. 

The week of December 5 was a particularly busy week in health care reform implementation.  After a lull over the Thanksgiving holiday, new regulations, proposed regulations, guidance, and grant announcements have poured out of the agencies.  This post will briefly summarize three of these issuances: the final rule on the Establishment of Consumer Operated and Oriented (CO-OP) program; the final rule on the Availability of Medicare Data for Performance Measurement to qualified entities; and a series of proposed rules and forms issued by the Department of Labor to implement new provisions of the ACA intended to address Multiple Employer Welfare Association (MEWA) fraud and abusive practices.

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Implementing Health Care Reform: Fine Tuning the Medical Loss Ratio Rules

Timothy Jost

Posted 12/02/11 on The Health Affairs Blog

On December 2, 2011, the Department of Health and Human Services released both a final rule  and an interim final rule updating the medical loss ratio rule that it issued almost exactly a year ago.  The Department of Labor simultaneously issued a technical release giving direction to employer-sponsored health plans governed by the Employee Retirement Income Security Act (ERISA) as to how to handle rebates provided by insurers who fail to meet the targets established under the MLR rule.

The MLR rule has been one of the most controversial provisions of the Affordable Care Act (ACA).  The MLR provision of the Affordable Care Act (section 2718 of the Public Health Services Act) requires health insurers in the individual and small group market to spend 80 percent of their premiums, after subtracting taxes and regulatory fees (85 percent for large groups), on payment for medical services or on activities that improve health care quality.  Insurers must report their medical loss ratios annually and insurers that fall short of the target must rebate to their enrollees an amount equal to the product of the difference between their actual medical ratio and the statutory target multiplied by their premium revenues.  According to a recent Kaiser tracking poll, 60 percent of the public views the MLR concept favorably, although only 38 percent was aware that the provision is in the ACA.

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Implementing Reform: Funding and Flexibility for States on Exchanges

Timothy Jost

Posted 10/30/11 on The Health Affairs Blog

Copyright ©2011 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.

As 2011 comes to a close, we draw ever closer to January 1, 2014, the day when the most significant changes wrought by the Affordable Care Act will come into effect.  Indeed, we are only weeks away from the halfway point between March, 2010, when the ACA was signed into law and October, 2013, the date when the exchanges will open for enrollment.

Yet few of the states seem to be halfway there.  A few states have indicated that they will not be establishing exchanges under any circumstances, but more exchanges are simply stalled in the state legislative process, held up by stiff opposition to reform or by inertia and tight legislative calendars.  Some states are also sitting it out, hoping that the Supreme Court makes the whole statute go away (which is, in fact, almost inconceivable as a legal matter).

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High Court to Review ACA’s Minimum Coverage Requirement, Medicaid Expansion

Timothy Jost

Posted 11/14/11 on the Health Affairs Blog

Copyright ©2011 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.

Today, November 14, 2011, the Supreme Court decided to review a decision of the Eleventh Circuit Court of Appeals striking down the minimum coverage requirement of the Affordable Care Act (ACA) as unconstitutional.  The case will probably be argued before the Court in March and decided in the early summer.

Procedurally, the Court “granted certiorari.”  This means that it agreed to review certain questions raised by the certiorari petitions presented by the various parties in the Florida case, including the plaintiffs who challenged the constitutionality of the Affordable Care Act — 26 states, the National Federation of Independent Business, and two private individuals — and the federal government, which defended the Act’s constitutionality.  The Eleventh Circuit had ruled against the federal government on the question of whether the minimum coverage requirement of the ACA is constitutional, but had ruled against the plaintiffs on all other issues.

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The Affordable Care Act Supreme Court Petitions: Issues and Implications

Timothy Yost

First posted 9/29/11 on The Health Affairs Blog

Copyright ©2011 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc. 

Wednesday, September 28 was a busy day at the Supreme Court clerk’s office.

It had been widely expected that there would be a major pleading filed with the clerk in an Affordable Care Act challenge, as the response of the United States to a certiorari petition in the Sixth Circuit’s Thomas More case, which had upheld the ACA as constitutional, was due.  A cert. petition asks the Supreme Court to exercise its discretion to review the decision of a lower court, and the losing plaintiffs in Thomas More had requested the Supreme Court to reverse that decision and find that Congress had no authority under the Commerce Clause of the Constitution to adopt the ACA’s minimum coverage requirement.

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