MHA Federalist

ACOs, Medical Homes, And Reform: A Crucial Consensus

With the federal government poised to propose rules governing accountable care organizations, a broad array of public and private health care stakeholders has laid out a consensus on how to use ACOs and patient-centered medical homes to move toward the “triple aim” of better health, better care, and lower costs. The report, Better to Best: Value-Driving Elements of the Patient-Centered Medical Home and Accountable Care Organizations, was released March 30 by the Patient-Centered Primary Care Collaborative in partnership with the Commonwealth Fund and the Dartmouth Institute for Health Policy and Clinical Practice.

Read more from the Health Affairs blog here.

Health Lobbyists, Advocates Brace For Much-Anticipated Accountable Care Organization Regulations

ACOs continue to hold attention, with the administration's rule expected this week. Meanwhile, other reform news includes reports about health exchanges and a medical device tax. Read more here.

Health Insurance Exchanges Already Making Waves

Kaiser Health News staff writer Julie Appleby, working in collaboration with The Washington Post, reports: "It seems like a simple idea: create new marketplaces, called 'exchanges,' where consumers can comparison shop for health insurance, sort of like shopping online for a hotel room or airline ticket. But, like almost everything else connected with the health overhaul law, state-based insurance 'exchanges' are embroiled in politics."

Read the story here.

GAO reports on alternatives to the ACA’s individual mandate

The Government Accountability Office on March 25 released a report identifying potential alternatives to the Patient Protection and Affordable Care Act’s individual mandate. Sen. Ben Nelson (D-NE) asked the GAO to investigate ways to encourage insurance enrollment without an individual mandate, given “the possibility that legislative or judicial action could result in a change to, or elimination of, the mandate.”

The report outlines nine alternatives and their potential challenges, drawn from interviews with 41 health care experts. GAO does not recommend one option over others, but ranks the alternatives by the frequency they were discussed by the experts.

The alternatives are: modify open enrollment periods and impose late enrollment penalties; expand employers’ roles in autoenrolling and facilitating employees’ health insurance enrollment; conduct a public education and outreach campaign; provide broad access to personalized assistance for health coverage enrollment; impose a tax to pay for uncompensated care; allow greater variation in premium rates based on enrollee age; condition the receipt of certain government services upon proof of health insurance coverage; use health insurance agents and brokers differently; and require or encourage credit rating agencies to use health insurance status as a factor in determining credit ratings.

[ via AHA News Now ]

Database tracks ACA-related state legislation

The National Conference of State Legislatures on March 14 launched a free database for tracking state legislative actions related to the Patient Protection and Affordable Care Act. The database currently contains about 600 bills introduced in 2011, which can be searched by state, topic, keyword, status and sponsor.

Topics include Medicaid; health insurance exchanges; health insurance reform; health information technology; prevention and wellness; providers and workforce; and challenges and alternatives. For 2010 state actions to implement ACA provisions, or challenges to certain provisions, visit www.ncsl.org.

[ via AHA News Now ]

Board issues recommendations for CO-OP health plans

A federal advisory board on March 13 urged the Department of Health and Human Services to develop flexible criteria for the consumer-governed nonprofit health plans that will be sold through state insurance exchanges. The Patient Protection and Affordable Care Act established the Consumer Operated and Oriented Plan (CO-OP) program, which will provide $6 billion in loans and grants to develop the cooperatives.

In a report summarizing its recommendations for awarding the loans and grants, the board said HHS “should develop flexible criteria that recognize the diversity of market conditions around the country and enable differing models of CO-OPs created and supported by different types of sponsors to develop.” At the same time, the report stresses consumer control and focus. In comments submitted to HHS last month, AHA urged the agency to look to successful non-profit, consumer-focused integrated delivery systems as models; provide federal funds to help with startup costs; and ensure requirements are not so prescriptive that they fail to balance the need for clarity against the need for different approaches to CO-OP formation and operation.

HHS issues proposed rule for state ACA waivers

The U.S. departments of Health and Human Services and Treasury on March 10 issued a proposed rule for states applying for "innovation waivers" under section 1332 of the Patient Protection and Affordable Care Act. Beginning in 2017, the waivers allow states to implement policies that differ from ACA requirements if they do not increase the federal deficit; provide coverage to at least as many residents as the ACA would cover; and the coverage is at least as comprehensive and affordable as the coverage offered through health insurance exchanges.

The proposed rule describes the content of the waiver application and how such proposals may be disclosed to the public, monitored and evaluated. The rule will be published in the March 14 Federal Register, with comments accepted for 60 days.

[ via AHA News Now ]

Judge says health care law can proceed, with conditions

U.S. District Judge Roger Vinson on Thursday said the 2010 health care law can be implemented even in the states challenging the law while the appeals process is ongoing, provided that the Obama administration submits its appeal within one week and requests a fast-track consideration from the Supreme Court or U.S. Court of Appeals. Vinson previously ruled that the law is unconstitutional.

Read more from The Washington Post here.

Scoreboard: Tracking Health Law Court Challenges

All over the country, lawsuits challenging the Patient Protection and Affordable Care Act are working their way through the federal courts. Kaiser Health News is tracking the status of 22 cases and will update those and other new cases on this page.

House passes bill revising ACA health insurance subsidy

The U.S. House of Representatives on March 3 voted 314-112 to approve the Small Business Paperwork Mandate Elimination Act (H.R. 4), which includes a provision that would require more Americans to repay a portion of the tax credit they receive to purchase health insurance under the Patient Protection and Affordable Care Act. The bill would repeal new 1099 tax reporting requirements for small businesses that were included in the ACA and other legislation, offsetting the estimated $21.9 billion cost of the repeal by recouping a larger share of overpayments to people who receive government subsidies to purchase health insurance under the ACA.

The Senate last month approved legislation repealing the 1099 provision, offsetting the cost with unobligated discretionary funds, as part of its reauthorization bill for the Federal Aviation Administration.

[ via AHA News Now ]