American Society of Hematology

Health Reform Still in Headlines Nearly Two Years after Law's Passage

Published on: March 15, 2012

March 24 marks the two year anniversary of the enactment of the Patient Protection and Affordable Care Act (PPACA). Although Republican members of Congress continue to seek to repeal parts of the law and the U.S. Supreme Court is set to hear arguments later this month in a lawsuit challenging the health reform law's constitutionality, the past two years have seen a lot of changes to the health system and the Obama Administration continues to push forward in drafting regulations to implement the remaining provisions of the law. A number of actions related to the law that have made headlines in recent days are highlighted below.

CBO Slightly Lowers Estimate of Coverage Expansion, Cost of Health Law
The 2010 health care overhaul will cost taxpayers slightly less and insure fewer people than previously estimated, according to updated projections from the Congressional Budget Office (CBO). The law will reduce the number of non-elderly uninsured Americans by 30 million, rather than the 32 million estimated a year ago, the budget office concluded in a report issued March 13. By 2022, 93 percent of legal, non-elderly residents are expected to have insurance – up from 82 percent coverage this year.

The law's coverage provisions are estimated to cost $1.083 trillion from fiscal 2012 through 2021. That is almost $50 billion less than the $1.131 trillion cost figure offered last year. The change is attributed in part to a reduction in the estimated cost of tax credits and subsidies for individuals and small businesses, and a slower rate of health care cost growth. The CBO still projects that the law, as a whole, will reduce federal budget deficits over the 2012-2021 period.

Insurance Exchange Rule
The Department of Health and Human Services (HHS) unveiled a final rule on March 12 on the establishment of state health insurance exchanges, which will serve as marketplaces for individual and small group health insurance policies when the health reform law goes into effect in 2014. The regulation estimates that 8.9 million people will get their coverage through exchanges in 2014, 14.3 million will be covered by exchanges in 2015 and 21.7 million will use exchanges in 2016.

The rule offers specific guidance about the options on how to structure exchanges in two key areas:

  • Setting standards for establishing exchanges, setting up a Small Business Health Options Program (SHOP), performing the basic functions of an exchange, and certifying health plans for participation in the exchange;
  • Establishing a streamlined, web-based system for consumers to apply for and enroll in qualified health plans and insurance affordability programs.

Missing from the rule, however, were any details on what a federally operated exchange will look like, something officials in a number of states want to know before deciding if and when to create their own exchanges. HHS has indicated it is working on information about the federally run exchange but has not indicated when those details would be available.

Lifetime Limits Lifted for Millions of Americans
HHS Secretary Sebelius released a new report on March 5on how the health reform law has eliminated lifetime limits on coverage for more than 105 million Americans. Before health reform, many Americans with serious illnesses such as cancer risked hitting the lifetime limit on the dollar amount their insurance companies would cover for their healthcare benefits.

In the report, HHS provides data on the number of people in each state that benefit from this component of the law. While some plans provided coverage without dollar limits on lifetime benefits, 105 million Americans were previously in health plans that had lifetime limits. HHS estimates that 70 million people in large employer plans, 25 million people in small employer plans, and 10 million people with individually-purchased health insurance had lifetime limits on their health benefits prior to the passage of the Affordable Care Act. This includes 39.5 million women and 28 million children; 11.8 million Latinos and 10.4 million African Americans.

The end of lifetime limits is one of many new consumer rights and protections in the law for Americans nationwide. The Obama Administration also released updated state data on other ways the new law has impacted Americans, including the number of people with Medicare receiving new preventive benefits and the various grants awarded to states.

Bill to Abolish Medicare Payment Board to be Considered in House
Prior to adjourning for a week-long recess, two key committees in the House signed-off last week on Republican-backed legislation (H.R. 452) that would kill a significant component of the health care overhaul: an independent panel charged with curbing Medicare spending growth.

The measure would abolish the 15-member Independent Payment Advisory Board (IPAB), a panel created by the 2010 health reform law that would determine annually whether projected Medicare expenditures will exceed certain target levels and submit cost-cutting proposals to Congress and the President. The board's cost-cutting recommendations would take effect automatically unless Congress clears legislation to achieve equivalent savings.

Republicans backing repeal believe the panel will be composed of "bureaucrats" who infringe on congressional authority and have also cited the possibility of rationing, which they said would cause certain people to lose health care. Although the health care law bars the panel from submitting recommendations that would ration care, it does not define "ration." Most Democrats view the bill as part of an overall Republican effort to terminate the health care law. President Obama signaled opposition to the bill in his 2013 budget request, in which he called for strengthening the board.

With 234 cosponsors, the bill has drawn support mainly from Republicans but also from 20 Democrats. The bill is expected to be considered by the entire House as early as the week of March 19.

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