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With $500 million available this year in the Public Health Fund, established by the Affordable Care Act (ACA), tobacco cessation supporters are looking to develop and expand programs aimed at ending America’s tobacco addiction. Robert Gould, President and CEO of the Partnership for Prevention, in a column for Kaiser Health News argues that to obtain the biggest bang for the buck the Public Health Fund should be used for anti-tobacco initiatives at the state and community levels and to fund a nationwide public education program targeting smoking among youths and disadvantaged populations.
Small Business Majority applauds IRS guidance on the small business tax credit for small businesses that offer health insurance.
A Wall Street Journal (WSJ) op-ed argues that implementation of the Patient Protection and Affordable Care Act (ACA) will force individuals to change their health insurance plans, while the White House claims that an individual’s ability to stay with their current plan is explicitly protected by the law. Scott Gottlieb, for the WSJ, claims that the provision requiring insurers to spend at least 80-85 percent of collected insurance premium dollars on medical services (known as the Medical Loss Ratio (MLR) requirement) will force changes to insurance plans in effect violating the promise that individuals can keep their current plan. The White House fired back stating that most of the provisions in ACA only apply to new insurance plans and those that apply to all policies, such as the MLR provision, are aimed at protecting consumers and containing cost.
From the NCHC perspective, only the details of how the law is implemented and the extent to which cost containment reform provisions are applied equitably, system-wide and across the health industry within both the public and private sectors, will determine the future.
As of the April 30th deadline, 31 states have elected to run temporary high risk insurance pools to provide affordable, quality insurance coverage to those who are uninsured due to a pre-existing condition. Fifteen states have explicitly said they want the Federal government to run a program for their residents, while the remaining states have not notified HHS yet of their decision. Five billion dollars is available to support the operation of these state high risk insurance pools, which must be in place by July 1, 2010.
The Associated Press (AP) and other sources report that Congress is nearing a deal on annual tax breaks and “extenders” that likely will include an extension of COBRA subsidies and unemployment benefits, it is also rumored that the deal will include some SGR rate fix for Medicare providers (a 21% fee cut has been delayed a few times and legislation under consideration may delay fee cuts for up to five years). It is not clear from media reports whether or not the related deal making will also extend the enhanced Medicaid FMAP enacted last year to help keep state Medicaid programs solvent.
Tobacco is the “only consumer product that when used as directed kills its consumer.” The landmark “Family Smoking Prevention and Tobacco Control Act” enacted last year, granted the Food and Drug Administration (FDA) authority to regulate tobacco and tobacco products. The law tightened restrictions on the sale and advertisement of tobacco products giving the FDA discretion to regulate the production and sale of menthol flavored cigarettes, and the sale of tobacco products claiming to be healthier than other tobacco products. The law prevents the FDA from reducing the allowable level of nicotine to zero, but regulations taking effect on June 22, 2010, will dictate among other things the maximum amount of nicotine that cigarettes can contain.
To read a New England Journal of Medicine article summarizing the law and FDA authority, click here.
To see comments of the American Legacy Foundation on menthol and other issues, click here.
To read the law, summaries, and Congressional Research Service reportson the Tobacco Control Act click here.
As implementation of the Patient Protection and Affordable Care Act takes off, it is instructive to watch new implementation difficulties in the rulemaking process regarding interim final regulations for mental health parity for group health plans. The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 which strengthens mental health coverage by requiring things like cost-sharing and treatment limits to be applied equally to both physical and mental health plan benefits. (The Medicare Improvements for Patients and Providers Act of 2008 includes a mental health parity provision for Medicare, which gradually equalizes treatment for Medicare mental health cost-sharing by 2015). Interim Final Regulations for the mental health parity law were issued January 29, 2010. As discussed in an article by Robert Pear for the New York Times , some insurers and employers are challenging the regulations as being overly burdensome.
To read the NYT article, click here.
Click here to read the interim final regulations.
In a detailed letter to HHS Secretary Sebelius and National Association of Insurance Commissioners President Jane Cline, Senator John Rockefeller, Chairman of the Senate Committee on Commerce, Science, and Transportation, warned that insurers have been reported to aggregate medical loss ratio data in such a way to make it easier to meet new minimum levels and to re-classify expenses as “medical” or “quality improving”. He urges regulations that mandate insurers demonstrate that quality improving expenditures are actually benefitting consumers.
Click here for Senator Rockefeller’s letter.
Congressman Steve Kagen noted that while the Patient Protection and Affordable Care Act (PPACA) provides some consumer protections, it did not create a transparent medical marketplace to foster competition between caregivers, pharmaceutical manufacturers and health insurers. Therefore, On May 6, 2010, The House Energy and Commerce Committee held a hearing on health care pricing transparency which centered on 5 bills, some with bipartisan support, one of which was sponsored by Congressman Kagen. Terry Gardiner of Small Business Majority testified that without information on the cost of care, businesses and individuals lack the information to make informed choices about coverage and care. US PIRG expressed its support for Congressman Kagen’s proposal, HR 4700, calling it “the most comprehensive attempt to bolster transparency across the health care sector.”
The Patient Protection and Affordable Care Act (PPACA) makes it easier for employers to provide health benefits for early retirees by creating a temporary re-insurance program to fill the gap between now and 2014 when other measures take effect to make the purchase health insurance easier. In essence, the reinsurance program will reimburse employer sponsored health plans for a percentage of related costs. The program allows employers to offer competitive early retirement packages at a fraction of the pre-reform cost.
