Top Headlines on PPACA this Week

Sorting through news about the Patient Protection and Affordable Care Act (PPACA aka Obamacare)? Here are some good insights into the Supreme Court’s decision, implementation in the states and projected changes in consumer behavior.

Broad Discussion

HHS Issues Funding Opportunities, Implementation Guidance (Health Affairs Blog >>)

On June 29, the day following the Supreme Court’s decision, the Department of Health and Human Services (HHS)  announced the availability of ten new scheduled opportunities, lasting though October 15, 2014, for states to apply for funding to establish state-based exchanges, state partnership exchanges, or state capacity to cooperate with federally facilitated exchanges.   HHS effectively announced that, now that the Supreme Court had upheld the law, it was time for the states to move forward, and it was prepared to offer the states the funds needed to proceed.  HHS has already distributed $850 million to 34 states and the District of Columbia for exchange establishment grants, and this announcement offers additional funding.  The ACA itself appropriates funds for establishing state exchanges in the amount determined by HHS to be necessary, so no further appropriations are required to make this money available.

SCOTUS on health reform – the bloggers respond (Managed Care Matters >>)

By now all know the Court upheld the Affordable Care Act by the narrowest of margins, with Chief Justice John Roberts the swing vote and author of the majority opinion. The quick synopsis from MCM (that’s me). Everything stands except the Feds’ ability to require states to expand Medicaid coverage or lose all their Medicaid dollars.

While there will still be a significant expansion of coverage, if some states opt out the number of uninsureds will not drop below 18 million as originally forecast. I don’t see a lot of states standing on principle and rejecting the money – which covers up to 90% of the cost for the first few years, and 50% thereafter. Then again, stranger things have happened. The basis for Justice Roberts’ opinion lay not with the Commerce Clause but rather the Constitutional power of taxation. We’re going to start with the legalities.

After The Supreme Court, Higher Cost and Unrealistic Timeline Will Force Major Changes (Health Affairs Blog)

The ACA will be in the budget crosshairs.  The Congressional Budget Office (CBO) will update its estimate of the cost of the insurance expansion, and the new number will be higher.  One reason is purely optical, but that matters on Capitol Hill.  In its March 2012 update, CBO estimated that the net cost of the ACA’s coverage provisions is $1.25 trillion over the 11 years between 2012 and 2022.  Next year, CBO will add another year to the table at a cost exceeding $175 billion.  Even though that cost was there all along, the fact that the estimating window now includes it will make for some excellent political fodder.

Consumer Behavior

Urgent care visits to soar due to PPACA (benefitspro >>)

Urgent care visits will likely see a considerable boost due to the Supreme Court ruling on the Patient Protection and Affordable Care Act.

“Although urgent care isn’t specifically mentioned anywhere in the legislation, the open access that all urgent care centers have should make them a natural entry point for the newly insured—especially in areas where many primary care practices aren’t accepting new patients,” says Lou Ellen Horwitz, executive director of Urgent Care Association of America.

The law’s mandate targets the roughly 16 percent of uninsured Americans, equating to another 50 million Americans who could be seeking medical care, Horwitz says.

The Supreme Court Upholds The Individual Mandate: But Who Are We Talking About? (Health Affairs Blog >>)

While the Affordable Care Act’s individual mandate survived constitutional scrutiny in NFIB v. Sebelius, a Republican president and/or changes in the House or Senate this fall could lead to its demise.   As campaigns shift into high gear, the law’s opponents will undoubtedly draw on the strident and jointly authored dissent of Justices Scalia, Kennedy, Thomas, and Alito. Despite the value of robust debate, relying on the dissent may be problematic due to its misperceptions about the ACA and the realities of health care. Thus, while we considered what we were waiting for in the weeks before the decision, the Court’s ruling raises a new question: “Who Are We Talking About?”

State Implementation

‘Affordable’ Care Act? Not so much for Sacramento (The Los Angeles Times)

There’s a lot of emphasis on the additional federal funds — up to $15 billion annually — expected to be spent in California because of the healthcare law.

But there will be an added state cost for the expansion of Medi-Cal, the California version of the federal Medicaid program for the poor. Finocchio estimates that up to 1.6 million more Californians will enroll in Medi-Cal. But it’s really anybody’s guess. Each person will cost the state more money.

Decision Time For States On The Affordable Care Act (Health Affairs Blog >>)

As a practical matter, states face the same choices they did a week ago, with one important addition related to Medicaid (to which I will return in a moment).  The most visible choice has been and remains whether to establish a health insurance exchange or to defer to the federal government in this task.

But successful implementation of the law has always hinged on a far broader range of activities.  Shortly after enactment, state leaders identified ten categories of work necessary for effective implementation, which the National Academy for State Health Policy has broken down into 109 milestones for states to consult as they implement the law.  For states, the most important result from the Supreme Court’s opinion is that federal health policy is essentially unchanged and that all of the planning and work states have done thus far remains valid, applicable, and in force.

About thebenefitblog

Eric is a Producer at Lockton Insurance Brokers, Inc., the world’s largest privately held commercial broker. Eric has over 23 years of experience in the insurance industry and has spent the last 11 years with Lockton. Eric specializes in Health & Welfare Benefits, Retirement Planning, and Executive Benefits. Eric's clients utilize his expertise in the areas of Plan Due Diligence, Transaction Structure, Fiduciary Oversight, Investment Design, Compliance and Vendor negotiation to improve the operational & financial outcome for each client. The Benefit Blog is a place to share that expertise and industry news.
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