Wednesday, March 23, 2011

Health care reform law turns one year old

Guess what today is? Go ahead – check your calendar (I’ll wait). That’s right! It’s March 23, 2011. I know what you must be thinking: “So what?” But after I remind you that today the Patient Protection and Affordable Care Act (ACA) turns one year old, you might be thinking, “Wow, that was a year ago?”

Yes, one year ago on this date, President Obama signed into law a historic piece of legislation aimed at expanding health care access and coverage. Since then, there’s been a plethora of health reform-related activities. Let’s take a look:

Lawsuits. One of the first activities was challenging the ACA in court. At least four cases (Florida v. HHS, Virginia v. Sebelius, Liberty University, Inc. v. Geithner, and Thomas More Center v. Obama) were filed on March 23, 2010. Numerous cases have been filed since then. The Independent Women's Forum, which has been tracking the cases since day one, indicates there are more than 20 active cases challenging the law.

In the Florida and Virginia cases, the courts ruled that the ACA is unconstitutional, and in the Liberty and Thomas More Center cases, the courts ruled the ACA is constitutional. The Eleventh Circuit Court of Appeals has agreed to an accelerated briefing schedule in the Florida case and has required all briefings to be filed by May 25. The Justice Department has asked the Supreme Court to deny Virginia’s request to review its case and allow it to be heard first by the Fourth Circuit Court of Appeals.

More than a dozen cases have been dismissed for lack of standing.

Regulations. The three agencies responsible for implementing the ACA (DOL, IRS, HHS) have issued at least 15 sets of regulations. The provisions covered include:

  • consumer support and information
  • external appeals
  • content requirements for
  • Pre-Existing Condition Insurance Plan
  • Early Retiree Reinsurance Program
  • state innovations
  • Consumer Operated and Oriented Plans Program
  • health market reforms
  • coverage for young adults
  • grandfathered plan
  • medical loss ratio
  • Patient’s Bill of Rights
  • prevention
  • review of insurance rates
  • student health plans
Guidance, other than in the form of regulations, has been issued on some of these and other provisions, including Health Insurance Exchanges and annual limit waivers.

Notices. The agencies also have issued about 10 model notices, including the (pick your favorite adjective) well-known, much maligned, complex Grandfathered Plans Model Notice.

State activity. “Every state has done something to move ahead on the new federal requirements and has accepted federal planning funds. By the end of 2010, at least 33 states had formed a task force, commission or other special group to study and guide its implementation of health care reform. At least 12 states already had issued a preliminary report,” according to Martha P. King, author of States have moved ahead despite uncertainty, risk and opposition.

King also notes that “Eight states enacted laws or passed initiatives in 2010 opposing certain requirements or refusing to enforce certain provisions. Five other states adopted resolutions to protest federal provisions.”

At least one state seemed to embrace the requirement regarding health insurance exchanges. California enacted legislation (AB 1602 and SB 900) on September 30, 2010, that established the California Health Benefit Exchange. (As you may recall, prior to the ACA, in 2006, Massachusetts had set up an exchange called the Health Connector.)

On February 16, 2011, HHS awarded seven grants to help a group of “Early Innovator” states design and implement the information technology (IT) infrastructure needed to operate exchanges. Kansas, Maryland, New York, Oklahoma, Oregon, Wisconsin, and a consortium of New England states will receive a total of approximately $241 million.

Early Retiree Reinsurance Program (ERRP). In the first nine months after enactment of the ACA, the ERRP issued $535 million in reimbursements to 253 approved retiree plans, according to the first annual ERRP report from HHS. The report notes that as of December 31, 2010, more than 5,000 plan sponsors were approved for participation in ERRP. The number of approved sponsors varied significantly by state; in several states, more than 100 sponsors were approved.

Legislation. On March 30, 2010, just one week after the President signed the ACA into law, he signed a second health reform bill – The Health Care and Education Reconciliation Act of 2010. That law made a number of health-related financing and revenue changes to the ACA and modified higher education assistance provisions.

(By the way, I just have to mention that Wolters Kluwer was one of the first publishers to provide a version of the ACA integrated with the amendments made by the Reconciliation Act. If you’d like to get your very own copy of it, please click here.)

On December 15, 2010, President Obama signed the Medicare and Medicaid Extenders Act of 2010 (P.L. 111-309), which in part extends current Medicare payment rates through Dec. 31, 2011, and avoids a scheduled 25% reduction in those rates. The law also increases the existing reimbursement limits under the ACA for amounts that individuals who, based on income, have been overpaid for the advanced refundable income tax credit for health insurance purchases in state exchanges.

In January, the “Repealing the Job-Killing Health Care Law Bill” (H.R. 2) passed the House by a vote of 245-to-189. The president has said that he would veto any repeal bill.

On March 3, 2011, the House voted, 314-112, to repeal the Form 1099 reporting requirements (H.R. 4), which the Senate had already voted to repeal (in an unrelated air transportation bill passed on February 17). The repeal would increase the federal deficit, and the House and the Senate have proposed different methods of offsetting that increase. The 1099 repeal will be stalled until Congress resolves the difference. President Barack Obama also favors the 1099 repeal but has not proposed a funding method.

Waivers. As of March 10, 2011, HHS has provided annual limit waivers to more than 1,000 organizations covering more than 2.6 million employees under Sec. 2711 of the Public Health Service Act (PHSA). The waivers include 423 self-insured employers.

Hearings, webcasts, teleconferences, comments, swear words. I don’t think it’s possible to count all these, so let’s just leave it at . . . A LOT.

What have I missed? It’s inevitable this list is incomplete. Let me know the ACA-related activity that you hold near and dear to your heart (or not) that I’ve missed.


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