Party Lines On Entitlement Programs Play Role In ‘Fiscal Cliff’ Negotiations


Topics: Health Costs, Medicare, Medicaid, Politics

Nov 28, 2012

Congressional leaders signal they are making progress in “fiscal cliff” talks. Rep. Tom Cole, R-Okla., urged his party to back an immediate extension of Bush-era tax cuts for households earning less than $250,000 and focus on tax breaks for higher-income people later. Meanwhile, Sen. Dick Durbin, D-Ill, said that Medicare and other federal health care programs should be part of long-term solutions, but not a short-term deal.

The New York Times: House Republican Urges Party To Yield On Tax Cuts For Most Earners
Democrats said they would not accept cuts to Medicare or Medicaid as part of the upfront “down payment” on deficit reduction that would be passed next month along with a broader framework on tax and entitlement changes to be worked over in 2013. In a speech at the liberal Center for American Progress, Mr. Durbin still expressed confidence that beneath all the public posturing, the White House and Speaker John A. Boehner, Republican of Ohio, were making progress toward averting the so-called fiscal cliff. … Mr. Durbin said that Medicare should not be tapped for that upfront down payment but that federal health care programs should be part of next year’s deliberations. And he opened the door for money-saving adjustments to Mr. Obama’s signature health care law (Weisman, 11/27).

Los Angeles Times: Senate’s No.2 Democrat Calls For Cuts To Social Safety Net
A top Democrat pressured fellow progressives Tuesday to consider long-term changes to the social safety net, even as the party digs in for a fight to save Medicare and other government programs from deep budget cuts. As closed-door talks continue with the hope of a year-end deal, President Obama will travel to a Pennsylvania toy store this week to pressure Congress to extend the expiring tax cuts for the middle class, while letting those for the wealthiest 2% of Americans expire (Mascaro and Parsons, 11/27).

USA Today: Durbin Outlines Liberal Plan To Avert ‘Fiscal Cliff’
Sen. Richard Durbin, D-Ill., is optimistic President Obama and congressional leaders will reach a deal to avert the “fiscal cliff” of tax hikes and spending cuts at the end of the year only if Republicans relent on their opposition to raising individual tax rates on the wealthy (Page, 11/27).

Bloomberg: Durbin Says Deficit-Reduction Talks Can Include Medicare
Deficit-reduction talks can include savings from Medicare without raising the eligibility age or turning it into a voucher program, said Richard Durbin, the Senate’s second-ranking Democrat. Still, proposals to address the long-term solvency of Medicare and Social Security shouldn’t be part of the current short-term negotiations to avert the year-end fiscal cliff, Durbin said in remarks prepared for his speech today in Washington. Though he didn’t deliver that portion of his prepared speech, he told reporters he stood by the full text (Rubin, 11/27).

Reuters: Senior Democrat Durbin Urges Talks On Medicare
Dick Durbin, a senior Senate Democrat and close ally of President Barack Obama, urged fellow liberals on Tuesday to consider reforming Medicare and Medicaid, the U.S. healthcare programs they have long fought to shield from spending cuts. The timing of his message – just as Democrats and Republicans struggling to avoid the “fiscal cliff,” looming early next year – and its prominence may signal that Democratic leaders and the White House will discuss social programs at the fiscal policy negotiating table (Dixon and Ferraro and Morgan, 11/27).

The Wall Street Journal: Democrats Harden Budget Positions
The White House and congressional Democrats hardened their budget positions on Tuesday and signaled they are prepared for partisan jockeying before any agreement to block impending spending cuts and tax increases can be reached with Republicans. Sen. Dick Durbin (D., Ill.), a rare liberal who has supported changes in Medicare and other entitlements as part of a broad budget deal, made clear he wouldn’t back them under a short-term agreement to avoid the fiscal cliff (Hook and Lee, 11/27).

The Associated Press/Washington Post: Senate Democrats Divided Over Cuts To Benefit Programs, Raising Roadblock To Any Fiscal Deal
Deep divisions among Senate Democrats over whether cuts to popular benefit programs like Medicare and Medicaid should be part of a plan to slow the government’s mushrooming debt pose a big obstacle to a deal for avoiding a potentially economy-crushing “fiscal cliff,” even if Republicans agree to raise taxes (11/28).

Politico: Democrats Talk Tough On Entitlements In Fiscal Cliff Debate
Congressional Democrats are starting to draw a much tougher line on entitlements in the increasingly messy fiscal cliff talks, warning Republicans to keep their hands off Social Security and Medicare benefits. Democrats also say they’ll refuse to look at GOP calls to dramatically slash Medicaid. And for them to even entertain any changes to Medicare and Medicaid, they say the price is for Republicans to agree to far higher taxes than they have flirted with so far (Raju, 11/27).

Los Angeles Times: Reid, McConnell Clash On ‘Fiscal Cliff,’ Filibuster Rules
Asked about Sen. Richard Durbin’s (D-Ill.) comments earlier in the day calling for major entitlement programs to remain open to negotiations, Reid partially agreed with his colleague. … Despite his complaints about Republican stonewalling, Reid said that he’s still optimistic that a deal can be reached before the end of the year, when automatic federal tax hikes and spending cuts would kick in (Little, 11/27).

CQ HealthBeat: Labor Lobbies Hill On Entitlements, Bush Tax Cuts
AFL-CIO leaders orchestrated a “lobby fly-in day” Tuesday on Capitol Hill, with local labor leaders and their advocates from 33 states visiting lawmakers to urge them to refuse benefit cuts to Medicare, Medicaid and Social Security and to let the 2001 and 2003 tax cuts expire for the top 2 percent of American earners. The effort coincided with a report the AFL-CIO issued that lists the number of people per state who currently get their health coverage through Medicaid. The report also highlights the amount of money Medicare, Medicaid and Social Security pump into each state’s economy and the economic costs to individuals if the Medicare eligibility age were increased (11/27).

This is part of Kaiser Health News’ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

U.S. Senator Richard Durbin, of Illinois.

U.S. Senator Richard Durbin, of Illinois. (Photo credit: Wikipedia)

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Hospitals Get New Grades On Safety


By Jordan Rau

November 28th, 2012, 5:55 AM

Updated at 9:35 a.m.

The Leapfrog Group is out with its second round of hospital safety ratings, and what a difference a few months has made.

Photo by Phil Jern via Flickr

In the results released Wednesday, 103 hospitals that Leapfrog had given a “C” or lower in its first round of ratings in June got an “A” in the updated Hospital Safety Score, based on more recent data and a slightly tweaked methodology. These included New York-Presbyterian Hospital, the Hospital of the University of Pennsylvania and Geisinger Medical Center.

Two hospitals awarded an “A” in the first round, Leonard J. Chabert Medical Center in Houma, La., and Lawrence General Hospital in Lawrence, Mass., both slipped to a “D.”

Altogether, 8 percent of the 2,619 hospitals that Leapfrog rated changed by two or more grades, like an “A” to a “C,” according to Leapfrog, a patient safety nonprofit based in Washington, D.C. Thirty-four percent changed one grade, like a “C” to a “B,” and 58 percent kept the same grade, Leapfrog said.

Leapfrog’s effort to provide a single letter grade based on 26 different measures of safety is part of a burgeoning effort to help consumers evaluate medical providers. Consumer Reports this year also started boiling down hospital metrics into its signature circular symbols, known as “Harvey Balls.”

In its first effort, Leapfrog gave a break to hospitals with poor showings, giving them a “Grade Pending.” This time, Leapfrog pulled out its red pen, giving 25 hospitals an “F,” including the Ronald Reagan UCLA Medical Center in Los Angeles. Another 122 hospitals got a “D.”  Leapfrog gave 790 hospitals an “A,” and 678  received a “B.” Leapfrog gave 1,004 hospitals a “C.”

Leapfrog calculated its grades using publicly-available data, including the frequency of blood line infections, falls in the hospital, bedsores and the consistency that hospitals follow recommended methods of care, such as discontinuing an antibiotic within 24 hours of surgery.

Leapfrog’s effort has earned grumbles from hospitals, which note that much of the data is old, with some of it dating to events from as far back as July 2009.  Hospitals also have complained Leapfrog incorporates its own survey in its evaluations, although the organization says that doesn’t disadvantage hospitals that don’t fill them out.

Dr. Shannon Phillips, patient safety officer at The Cleveland Clinic—which saw its grade slip from a “C” to a “D”—said the Clinic “has seen measurable improvement month after month,” so Leapfrog’s evaluation is now outdated.

Phillips said the grades are of no help to hospitals since they are already aware of the underlying measures, which Medicare calculates and publishes. “It’s repackaging of data the public and we already have,” she said.

Leah Binder, Leapfrog’s chief executive officer, said the ratings will help companies and other health care purchasers as they try to educate their employees to select services with the highest value. “When a person or employee looks at comparative pricing information, they assume the highest price is the highest quality,” she said. Leapfrog’s grade is “something that can be incorporated pretty easily into pricing transparency,” she said.

The individual hospital scores can be looked up on Leapfrog’s web site. A breakdown of how hospitals in each state did as tabulated by Kaiser Health News is below.  Maryland hospitals are not listed, because Medicare does not collect the same data from that state’s hospitals due to a unique arrangement with the federal government.

Number of Hospitals Receiving Each Grade for Patient Safety
State A B C D F
AK 1 2 1 2
AL 12 13 25 4 1
AR 3 5 22
AZ 11 10 14 5
CA 92 56 80 14 4
CO 13 11 15
CT 6 9 13
DC 1 4 2
DE 3 2 1
FL 61 38 49 8
GA 11 27 32 4 1
HI 1 4 4 1
IA 10 8 11 1
ID 1 2 5 1 1
IL 51 31 28 3 5
IN 15 31 16 1
KS 3 11 14 5
KY 12 20 21 1
LA 8 13 29 3 1
MA 50 4 5 1
ME 16 3 1
MI 37 25 22 1
MN 20 14 12 1
MO 18 11 30 3 1
MS 8 8 18
MT 3 4 3
NC 20 29 26 2
ND 3 1 1 1
NE 3 3 11
NH 2 5 6
NJ 23 22 24 1
NM 1 5 7 1
NV 2 5 12 1
NY 33 38 70 16
OH 35 23 45 8
OK 3 12 22 3
OR 4 10 14 2 1
PA 37 29 59 1
RI 2 4 3
SC 14 11 19 1 2
SD 2 1 5 1
TN 25 18 21 3
TX 52 44 91 16 5
UT 3 4 11 1
VA 30 16 21 2 1
VT 3 1 2
WA 13 15 14 1
WI 10 12 24
WV 2 5 17 2
WY 1 3 4
Grand Total 790 678 1004 122 25
Source: Leapfrog Group

Research centers and laboratories at the Unive...

Research centers and laboratories at the University of California, Berkeley (Photo credit: Wikipedia)

More Workers Covered By Bosses’ Self-Insured Plans


By Ankita Rao

November 28th, 2012, 5:25 PM


The number of U.S. workers covered by self-insured health plans—in which their employer assumes the financial risk for health costs rather than paying insurance companies to do that—has grown steadily in recent years. But such plans are still primarily used by large companies, not small employers, a new study finds.

As of 2011, more than half of U.S. employees were covered under these self-insured plans, compared to about 41 percent in 1998, according to a report by the Employee Benefit Research Institute. These plans can lower costs for employers by reducing administration, exempting them from state-mandated services, and allowing them to provide uniform coverage across state lines.

Sometimes workers do not even know that their employer is self-insuring because the company will hire a traditional insurance plan to administer the program.

Businesses with less than 50 employees have not followed the same trend, with only 10.8 percent of private sector enrollees in self-insured plans in 2011. The number has remained generally around 12 percent since 1998, according to EBRI.

The analysis also found that the rates varied by state — Hawaii was on the lower end with 30.5 percent of workers enrolled in self-insured plans, and Indiana and Minnesota were on the higher end with more than 70 percent enrolled. Massachusetts, the only state to have enacted universal health care coverage, saw more medium and large firms choose self-insurance.

The report’s author, Paul Fronstin, director of EBRI’s Health Research and Education Program, says the research was prompted by speculation that smaller firms increasingly may move to a self-insured model because of their concerns about rising insurance costs under the 2010 federal health law.

Employers generally, and small employers particularly, concerned about the rising cost of providing health coverage may view self-insurance as a better way to control expected cost increases,” notes Fronstin. “This new analysis provides a baseline against which to measure future trends.”

In a separate issue brief, researchers from The Urban Institute said the health law will make self-insurance plans more attractive to small employers because of less price discrimination against small groups.

But since the federal regulations don’t apply to self-insurance, authors said a small business migration to the plans could “undermine the effectiveness of the Affordable Care Act’s small-group reforms and to destabilize the market.” But the brief describes ways that federal or state regulation can help mitigate that problem.

This sign, displayed at all credit unions, inf...

This sign, displayed at all credit unions, informs members that their savings are insured by the NCUA. (Photo credit: Wikipedia)

Advocates Of Medical Marijuana Face Another Hurdle: Insurance Coverage


English: Discount Medical Marijuana cannabis s...

English: Discount Medical Marijuana cannabis shop at 970 Lincoln Street, Denver, Colorado. (Photo credit: Wikipedia)

Topics: Health Costs, Insurance, Marketplace

By Michelle Andrews

Nov 19, 2012

With the passage of a ballot initiative this month, Massachusetts became the latest state to allow the use of marijuana for medical purposesjoining 17 others and the District of Columbia.

But for patients who use marijuana to help alleviate chronic pain and nausea and stimulate appetite, legalization is only part of the battle. Health insurance rarely if ever covers its use; some patients spend hundreds of dollars a month or more on the drug. The situation may not change anytime soon, some experts say.

Medical marijuana advocates demonstrate outside in February in San Francisco (Photo by Justin Sullivan/Getty Images).

Along with heroin, LSD and some other drugs, marijuana is classified as a Schedule 1 substance under the federal Controlled Substances Act. That means the drug is considered to have no accepted medical use and a high potential for abuse.

In October, consumer advocates presented oral arguments before the U.S. Court of Appeals for the D.C. Circuit to remove marijuana from that list. Reclassification would make it easier to conduct research on therapeutic uses for marijuana, say advocates, and ultimately make the drug more accessible to patients.

Last year, the Drug Enforcement Administration denied a request to reclassify the drug, following an evaluation by the Department of Health and Human Services.

More From This Series Insuring Your Health

Proponents of medical marijuana argue that research shows marijuana to be effective or show promise in treating a variety of medical problems, from cancer pain and nausea to spasticity caused by multiple sclerosis. They point to the drug Marinol, which is approved to stimulate appetite in patients with AIDS and contains a synthetic version of tetrahydrocannabinol (THC), one of the active ingredients in marijuana. But health insurers remained unconvinced.

There are “legal issues in most states,” says Susan Pisano, a spokewoman for America’s Health Insurance Plans, a trade group, since it’s a federal crime to use marijuana, even in states that permit it for medicinal purposes. In addition, she says, employers and health plans want to see stronger scientific evidence that marijuana is as safe and effective as other drugs to treat pain or nausea, for example, before they would cover it.

In states that allow medical marijuana, laws vary widely. Some permit people to grow their own supply, others only permit marijuana to be distributed through a state regulated dispensary. Patients generally must get a recommendation from a physician and then register with the state. States restrict the amount someone can possess for his own use, permitting a specified number of ounces or a supply that lasts up to 60 days, for example.

A typical patient might purchase an eighth of an ounce — the equivalent of about three joints — from a dispensary at a cost of $20 to $60, says Kris Hermes, a spokesman for Americans for Safe Access. But patients’ needs vary widely.

“Some people only need a few hits at a time to experience a therapeutic effect,” he says. “Others need to smoke several marijuana cigarettes a day or ingest it with food, which takes considerably more.”

Meanwhile, even some patients in states that permit its use for medical purposes scramble to maintain their supply.

Steph Sherer is one of them. She lives in the District of Columbia, which passed a medical marijuana law in 2010 but hasn’t yet set up dispensaries to distribute the drug. (It selected six companies to cultivate the plants last spring.)

Sherer, 36, is the executive director of Americans for Safe Access, which promotes access to marijuana for medical use. She has torticollis, a condition that causes the muscles in her neck to spasm constantly and, if untreated, twists her head down to her left shoulder. Ibuprofen helped reduce the pain and inflammation, but after less than two years at very high doses, her kidneys started to fail in 2001.

At the time, Sherer was living in California, the first state to pass a medical marijuana law in 1996. Her doctor recommended she try marijuana to relieve her symptoms, and it worked. Sherer used a tincture of marijuana that she bought from a local dispensary and sprayed under her tongue several times a day. Her weekly cost: about $60.

When she moved to the District in 2006 to work on federal laws related to marijuana, Sherer lost access to her dispensary.

Until dispensaries are operating in the District, she will continue buying marijuana on the street and making her own tincture, at a cost of about $300 weekly.

English: The Wo/Men's Alliance for Medical Mar...

English: The Wo/Men’s Alliance for Medical Marijuana (www.wamm.org) presents Victoria, the nation’s first legal medical marijuana plant. (Photo credit: Wikipedia)

Why so expensive? For one thing, a dispensary can make it in bulk, which brings down the price, she says. For another, “I don’t always make it correctly, and sometimes the medicine isn’t strong enough,” she says.

Fiscal Cliff: Lame Duck Budget Talks Begin


Topics: Politics, Medicaid, Medicare, Health Costs

Nov 21, 2012

News sources report on the beginnings of negotiations among White House and congressional staff.

Politico: Rough Start For Fiscal Cliff Talks
The opening round of negotiations this week between White House and senior GOP congressional staffers left both sides pessimistic about their ability to reach a quick deal on averting the fiscal cliff, according to sources familiar with the talks. Hill Democrats say Republicans aren’t serious about crafting a deal that President Barack Obama can accept. … For their part, Republicans remain unconvinced that Obama and Senate Majority Leader Harry Reid (D-Nev.) will make the kind of significant concessions on entitlement programs like Medicare and Medicaid that would make them agree to tax rate hikes (Sherman, Bresnahan and Budoff Brown, 11/20).

CNN Money: Deficit Reduction? Not Without Entitlement Reform
The nation is staring into the fiscal cliff, which involves $7 trillion worth of spending increases and tax cuts over a decade. If no other action is taken, it will start to take effect in January, kicking off with $491 billion in deficit reduction in fiscal 2013, a large chunk of which will come from the expiration of the Bush tax cuts. Another $54 million in spending cuts are set to take place as a result of last year’s debt-reduction deal. Empowered by his re-election victory, Obama is centering the conversation on increasing taxes on the wealthy. House Republicans, who lost seats on November 6, have said they are willing to talk about raising revenue if it is accompanied by spending cuts and entitlement reform. House Speaker John Boehner called on Democrats Monday to come forward with proposals (Luhby, 11/21).

Meanwhile, interest groups stake out their positions and brace for cuts.

Politico: Medicare Cuts Give Health Providers Jitters
The $716 billion in Medicare “cuts” that got so much attention in the presidential election have already begun sinking their teeth into health care providers. And there are widespread jitters that any further cuts as part of a year-end deal to stave off sequestration or strike a “grand bargain” for a long-term fiscal deal would deeply gouge some providers, if not put them out of business (Norman, 11/20).

The Hill: Nursing Homes Tout Quality Improvement, Blast Sequester
The lead advocacy group for nursing homes touted high customer satisfaction in its annual survey, released Tuesday, and cautioned that automatic federal spending cuts could hamper the industry. The American Health Care Association (AHCA) found that short-stay patients’ satisfaction reached 87 percent in 2012 as staff turnover decreased and individuals received more time with nurses. The group has been pushing Congress to stop the sequester’s looming cuts to Medicare, which AHCA President Mark Parkinson said could “undo this progress” (Viebeck, 11/20).

Los Angeles Times: Union Ads Take New Tack: Praising GOP Members
Labor unions seeking a fiscal solution that protects entitlement programs and raises taxes on the rich are trying the carrot approach before taking the stick to lawmakers. A new six-figure ad campaign backed by three major unions includes radio spots praising four Republican House members as “leaders willing to put people ahead of partisan politics.” … The commercials call on the lawmakers “to stand up for us by investing in job creation, extending the middle class tax cuts, and protecting Medicare, Medicaid and education from cuts.” (Gold, 11/20).

English: President Barack Obama signs the Tax ...

English: President Barack Obama signs the Tax Relief, Unemployment Insurance Reauthorization, and Job Creation Act of 2010 at the White House. (Photo credit: Wikipedia)

This is part of Kaiser Health News‘ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

Health Law Provisions Still Unknown To Lots Of Americans


Topics: Insurance, Politics, Health Reform

Nov 21, 2012

Meanwhile, the administration continues to get ready to implement the law.

The Washington Post: Many Americans Unaware Of Health-Care Law Changes
After surviving a Supreme Court decision and a presidential election, the Obama administration‘s health-care law faces another challenge: a public largely unaware of major changes that will roll out in the coming months. States are rushing to decide whether to build their own health exchanges and the administration is readying final regulations, but a growing body of research suggests that most low-income Americans who will become eligible for subsidized insurance have no idea what is coming (Kliff, 11/20).

Politico: Next Up For Obamacare: Launching The Exchanges In 2014
[T]he Obama administration and its backers are turning their attention toward getting the law right — before the next elections come around in 2014. All eyes are on January 2014, when the health insurance exchanges — online portals where individuals and small businesses can get their health coverage — are slated to start covering millions of people. Consumers will have access to tax subsidies, if they qualify, to help them buy coverage, and almost everyone will be subject to the mandate to have insurance. Each step holds the potential to reinforce — or change — public perception (Haberkorn, 11/20).

Politico: HHS Looks To Step Up Role In Health Exchanges
The last thing the Obama administration wanted to do was come into a bunch of states and start running health insurance exchanges. But when the new insurance marketplaces open for business late next year, it’s clear that the Department of Health and Human Services will have a much bigger job than it wanted (Millman, 11/20).

Politico Pro: Schnatter On ACA: It’s The Franchisees
Papa John’s CEO John Schnatter says he had no plans to “close stores and cut jobs because of Obamacare.” In a Huffington Post op-ed Tuesday, Schnatter — who supported Republican Mitt Romney’s presidential candidacy — insisted his company actually plans to expand, regardless of any Affordable Care Act costs, and that he’s “cool” with all full-time workers getting health care coverage (Cheney, 11/20).

English: The Department of Health and Human Se...

English: The Department of Health and Human Services headquarters by the National Mall. Español: La sede del Departamento de Salud y Servicios Humanos de los Estados Unidos, cerca del National Mall (Photo credit: Wikipedia)

This is part of Kaiser Health News‘ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

New Rules For ‘Obamacare’ Scrutinized By Insurers, Employers, States, Consumers


Topics: Health Reform, Insurance, Quality, States

Nov 21, 2012

Long-awaited draft regulations offer new guidance to insurers, states and employers.

USA Today: Administration Unveils Health Care Regulations
The Obama administration released new health care regulations Tuesday that preclude insurers from adjusting premiums based on pre-existing or chronic health conditions, tell states what benefits must be included in health exchange plans, and allow employers to reward employees who work to remain healthy (Kennedy, 11/20).

The Washington Post: Obama Administration Officials Propose Altered Rules For Health Insurers
The Obama administration proposed new rules Tuesday that would loosen some of the 2010 health-care law’s mandates on insurers while tightening others. Certain health plans, for instance, would be able to charge customers higher deductibles than originally allowed under the legislation. But all plans would be required to cover a larger selection of drugs than under an earlier approach outlined by the administration (Aizenman, 11/20).

The New York Times: Administration Defines Benefits That Must Be Offered Under The Health Law
The proposed rules, issued more than two and a half years after President Obama signed the Affordable Care Act, had been delayed as the administration tried to avoid stirring criticism from lobbyists and interest groups in the final weeks of the presidential campaign (Pear, 11/20).

Los Angeles Times: Administration Affirms Key Mandates Of Healthcare Law
Consumer advocates, insurers and business groups were looking for signs the administration might try to modify some of the law’s requirements as the federal government races to implement the legislation by the end of next year. But the proposed rules issued Tuesday hew closely to the Affordable Care Act (Levey, 11/20).

Kaiser Health News: Administration Releases New Health Law Rules For Insurers, Employers
[A] quick review showed that no one group won everything it wanted. For example, insurers did not succeed in getting the government to phase-in a requirement that limits their ability to charge older applicants more than younger ones. And consumer groups, which wanted specific details on the benefits required in 10 broad categories, instead saw continued discretion given to state regulators to pick “benchmark” plans and benefits (Appleby, Hancock and Carey, 11/20).

The Wall Street Journal: States Get A Say In Health Law
The federal government also expanded requirements for prescription-drug coverage from previous proposals, but it left states with different options to choose from, as well as responsibility for enforcement. Some employer groups praised the rules for keeping new plan benefits in line with what is already offered by small businesses. But the insurance industry said the rules didn’t go far enough to keep insurance costs down, particular for younger consumers (Radnofsky, 11/20).

Modern Healthcare: HHS Releases Proposed ACA Insurance Regulations
Starting in 2014, the Patient Protection and Affordable Care Act will make it illegal for health insurance companies to discriminate against people who have pre-existing conditions, which HHS estimates affect some 129 million nonelderly Americans. In the proposed rule, health insurance issuers would generally be barred from denying coverage for such conditions, and individuals would have new special enrollment opportunities in the individual market when they have certain losses of other coverage (Zigmond, 11/20).

NPR: Administration Lays Down Rules For Future Health Insurance
[T]he administration is laying out rules to govern the use of employer-provided “wellness programs.” These popular programs encourage employees to meet certain health goals, such as losing weight, quitting smoking, or lowering cholesterol. The rules spell out that programs must not be “overly burdensome” and must provide a “reasonable alternative means of qualifying for the reward” for individuals whose medical conditions “make it unreasonably difficult, or for whom it is medically inadvisable, to meet the specified health-related standard” (Rovner, 11/20).

Kaiser Health News: Obama Administration Gives Smokers A Way Out Of Higher Insurance Premiums
[The rules] effectively nullified a provision of the federal health law that would have allowed insurers in the small group market to charge smokers up to 50 percent more than nonsmokers. Under the proposed regulation, employees who use tobacco can avoid paying those higher premiums if they participate in a program to quit (Galewitz, 11/20).

The Associated Press: HHS Details Overhaul Rules And Required Benefits
Having the federal government set minimum standards for what health insurance must cover is a departure from normal practice. Usually, insurance companies, their state regulators and employers play that role. But the Affordable Care Act requires that Washington establish a baseline for minimum coverage in areas that include inpatient and outpatient care, emergency services, maternity and childhood care, prescription drugs, preventive screenings and lab work  (Murphy, 11/20).

The Hill: HHS Releases Health Law Rules Requiring Pre-Existing Conditions Coverage
The regulations still leave key questions unanswered, including the structure of a federally run insurance exchange in the roughly 30 states that won’t set up their own. HHS officials said more information on the federal exchange will be coming soon. … While the new rules don’t answer some questions for states, they do provide much-needed specifics for insurance companies that must prepare for new mandates set to take effect in 2014 (Baker, 11/20).

Medpage Today: HHS Proposes Rules On Key Parts Of ACA
The rules also mandate that insurers maintain separate statewide risk pools for the individual and small-employer markets, unless a state wants to combine the two. Premiums and rate changes would be based on the health risk of the entire pool (Pittman, 11/20).

McClatchy: Insurers’ Duties Under Health Care Law Taking Shape
The rule’s final provision insures that young adults and people who can’t afford insurance will have access to catastrophic health coverage in the individual insurance market. Many of today’s proposed rules will help “ensure that consumers are protected from some of the worst insurance-industry practices,” [Gary Cohen, the director of the Center for Consumer Information and Insurance Oversight at the Department of Health and Human Services] said (Pugh, 11/20).

Politico Pro: Essential Benefits Rule: No Surprises, Some Gaps
The health care industry waited 11 months for the Obama administration’s follow-up act to its essential health benefits bulletin. For many, Tuesday’s EHB proposed rule felt like a repeat performance. Credit the administration’s bulletin last year for spelling out what the proposed rule itself would look like. States will get to set benefits from a choice of certain plans, insurers will have some flexibility and HHS will be there watching over it all in some capacity (Millman, 11/20).

Politico Pro: HHS To States: Costs Of New Rules ‘Minor’
In a section of its proposed rule titled “Costs to States,” HHS estimates that although states “may need additional resources” to ensure that health plans in their exchange meet minimum coverage requirements, “these costs will be relatively minor.” In the rule, HHS also notes that federal law prohibits Washington from imposing an “unfunded mandate” on states in excess of $139 million in a given year (Cheney, 11/20).

CQ HealthBeat: Lots Of Regs, But What About The Federal Exchange?
Missing from Tuesday’s massive release of hundreds of pages of proposed rules filling in the details of the sweeping redesign of the insurance market, set in motion 32 months ago by passage of the health care law, were details on an entity looming ever larger in delivering the fruits of that legislation: the federally facilitated exchange. By the end of the day, however, it appeared that officials had made considerable progress on the regulatory front, with insurers and states now having to scramble to conform to the new mandates (Reichard, 11/2).

CQ HealthBeat: Obama Administration Rolls Out Proposed Rule On Insurance Market Changes
The long-anticipated next steps in a complicated regulatory dance involving the federal government, states and health insurers were laid out by the Obama administration on Tuesday, and federal officials acknowledged that there is much more work ahead (Norman, 11/20)

CQ HealthBeat: Essential Health Benefits Proposal Gives States Flexibility, Expands Prescription Drug Requirements
The proposed rule also included standards on how the actuarial value of plans would be determined. Separately, the Centers for Medicare and Medicaid Services issued a guidance to states on the types of benefits that Medicaid programs must include if they expand coverage under the health care law. Under the essential benefits proposed rule, health plans in the individual and small-group markets — both in and outside of the new exchanges — would have to provide coverage in the 10 categories of services that the health care law requires (Adams, 11/20)

CQ HealthBeat: Proposed Rule Sets Standards For Wellness Programs
[T]he maximum permissible rewards would increase in 2014 from the current ceiling of 20 percent of the cost of health coverage to 30 percent. However, the proposed regulation says that when it comes to programs designed to prevent or decrease tobacco use, the maximum reward could be increased to as much as 50 percent (Reichard, 11/20).

Reuters: U.S. Releases New Health Insurance Reform Rules
The proposed measures were likely to come under fire from healthcare reform opponents including a growing number of Republican governors who have rejected the provisions calling on states to operate their own healthcare exchanges beginning January 1, 2014. States have until December 14, under a newly extended deadline, to tell the Department of Health and Human Services whether they intend to pursue their own healthcare exchanges (Morgan, 11/20).

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