A project of the George Washington University's Hirsh Health Law and Policy Program and the Robert Wood Johnson Foundation

Archive: January 2012

HHS releases document listing largest three small group products by state

Posted on January 30, 2012

The Department of Health and Human Services (HHS) released a document which provides illustrative information to complement the bulletin on essential health benefits (EHB) under the Affordable Care Act released on December 16, 2011. While the document included names of plans, it did not indicate what benefits are covered by those plans or what benefits it would like to see in future plans. The HHS document provides a list of the products with the three largest enrollments in the small group market in each State using data from HealthCare.gov. It provides the names of the three largest products in each State ranked by enrollment. In addition, it provides a list of the top three nationally available Federal Employee Health Benefit Program (FEHBP) plans based on enrollment. The purpose of the list, according to HHS, is to facilitate a better understanding of the intended approach to EHBs.

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GAO report suggests HHS address contractor performance and plan for needed measures

Posted on January 30, 2012

The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) directed the Department of Health and Human Services (HHS) to enter into a 4-year contract with an entity to perform various activities related to health care quality measurement. In January 2009, HHS awarded a contract to the National Quality Forum (NQF), a nonprofit organization that endorses health care quality measures—that is, recognizes certain ones as national standards. In 2010, the Affordable Care Act (ACA) established additional duties for NQF. This is the second of two reports MIPPA required GAO to submit on NQF’s contract with HHS. In this report—which covers NQF’s performance under the contract from January 14, 2010, through August 31, 2011—GAO examines (1) the status of projects under NQF’s required contract activities and (2) the extent to which HHS used or planned to use the measures it has received from NQF under the contract to meet its quality measurement needs, as of August 2011. GAO interviewed NQF and HHS officials, reviewed relevant laws, and reviewed HHS and NQF documents.

GAO recommends HHS: (1) use all monitoring tools required under the contract to help address NQF’s performance, (2) complete testing of retooled measures, and (3) comprehensively plan for its quality measurement needs. HHS neither agreed nor disagreed with these recommendations. NQF concurred with many of the findings in the report and provided additional context.

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The Center for Medicare and Medicaid Innovation: A Year’s Progress

Posted on January 26, 2012

Improving the quality of care delivery and reducing explosive growth in healthcare costs is a cornerstone of The Patient Protection and Affordable Care Act (ACA). It reflects the shared understanding that the current silo-based approaches to care delivery that focus on settings of care (e.g., physician office, hospital) rather than care delivery across multiple providers and setting (e.g., episodic) are not working. Costs are increasing at an unsustainable pace, and evidence from leading researchers collectively points to serious deficiencies in health care quality and the disconnect between high spending and health care quality.

To foster the development of more collaborative and…

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EBRI releases issue brief showing that high-deductible health insurance is more common

Posted on January 25, 2012

An issue brief released by the Employee Benefit Research Institute presents findings from the 2011 EBRI/MGA Consumer Engagement in Health Care Survey. This study is based on an online survey of 4,703 privately insured adults ages 21–64 to provide nationally representative data regarding the growth of consumer-driven health plans (CDHPs) and high-deductible health plans (HDHPs), and the impact of these plans and consumer engagement more generally on the behavior and attitudes of adults with private health insurance coverage.

The 2011 EBRI/MGA Consumer Engagement in Health Care Survey found…

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PCORI releases report proposing national priorities for patient-centered clinical effectiveness

Posted on January 24, 2012

The Patient-Centered Outcomes Research Institute (PCORI) proposed national priorities for patient-centered comparative clinical effectiveness in their first version of PCORI’s Research Agenda. PCORI expects to learn and update this as
we move forward. We are not specifying or prioritizing any particular condition or disease for
research, although we may do so in the future. Consistent with the criteria outlined in the Affordable Care Act (ACA), PCORI’s first research agenda looks at:

-Comparisons of Prevention, Diagnosis, and Treatment Options

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Sebelius announces additional time for religious employers to comply with contraception coverage requirement

Posted on January 20, 2012

US Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced today that religious non-profit employers who do not currently offer contraceptive coverage to their employees will have an additional year to comply with the preventive services requirement set forth in an earlier Interim Final Rule (IFR). The earlier rule requires, that as of August 1, 2012, all employers except for churches must include contraception among the free preventive services covered in the insurance plans they offer to employees. The new announcement allows those employers who have religious objections an additional year to comply with the requirement.

For more information on preventive services, click here.

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Update to Consumer Operated and Oriented Plan (CO-OP) Program: Final Rule

Posted on January 18, 2012

The Centers for Medicare and Medicaid Services (CMS) issued its final rule implementing the Consumer Operated and Oriented Plan (CO-OP) Program on December 13, 2011. This rule finalizes the notice of proposed rulemaking (NPRM) issued by CMS on July 20, 2011, and takes into consideration the numerous comments received during the public notice and comment period ending September 16, 2011. Established by §1322 of the Affordable Care Act (ACA), the CO-OP program develops and creates new private, non-profit health insurance issuers to offer qualified health plans (QHPs) through state Exchanges as an alternative for consumers to traditional, for-profit plans. CO-OP plans are consumer-run, and accountable to their individual membership in a way that most traditional for-profit health plans typically are not. The ACA requires HHS to award funds for start-up loans and solvency grants to eligible CO-OP applicants in order to enable each state to have at least one CO-OP. In making these awards, HHS must take into account recommendations from the Advisory Board created by ACA §1322(b)(2). Two previous Implementation Briefs provided an overview of the CO-OP program and set forth the key provisions of the proposed rule; this update describes significant changes to the proposed rule as codified in the final rule.

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Independent Payment Advisory Board (IPAB)

Posted on January 13, 2012

Section 3403 of the Affordable Care Act (ACA) established the Independent Payment Advisory Board (IPAB), a 15-member panel of appointed experts that will recommend cost-saving measures for Medicare. In the face of controversy about its structure and powers, legislation has been introduced in the 112th Congress to repeal its establishment.

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HHS deems premium spikes unreasonable

Posted on January 12, 2012

Today, the U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced that HHS has deemed insurance premium increases in five states as “unreasonable.” HHS determined that Trustmark Life Insurance Company has proposed unreasonable health insurance premium increases in five states—Alabama, Arizona, Pennsylvania, Virginia, and Wyoming. The excessive rate hikes would affect nearly 10,000 residents across these five states. To make these determinations, HHS used its “rate review” authority from the Affordable Care Act (ACA) to determine whether premium increases of over 10 percent are reasonable. In these five states, Trustmark has raised rates by 13 percent. HHS determined that the rate increases were unreasonable because the insurer would be spending a low percent of premium dollars on actual medical care and quality improvements, and because the justifications were based on unreasonable assumptions.

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RWJF report assesses the individual mandate in a new report

Posted on January 12, 2012

Today the Robert Wood Johnson Foundation (RWJF) released a report authored by researchers from the Urban Institute called “Eliminating the Individual Mandate: Effects on Premiums, Coverage, and Uncompensated Care: Timely Analysis of Immediate Health Policy Issues.” The report examines the effect that eliminating the individual mandate—the requirement for most Americans to have health insurance or face a penalty—would have on health insurance coverage, spending, premiums and uncompensated care. Using the Urban Institute’s Health Insurance Policy Simulation Model, the researchers simulated the Affordable Care Act as enacted, as well as several alternative scenarios of health reform without the mandate.

The authors find that without the mandate:
1) Between 40 and 42 million would remain uninsured as opposed to 26 million with the mandate;
2) Private coverage would fall 11 million, covering 4 million fewer people than it would have without reform;
3) Uncompensated care spending would be much higher due to the increased number of uninsured; and
4) Individual premiums in the health benefit exchanges would increase by 10 percent in a scenario assuming high exchange participation, and by 25 percent with a low participation scenario.

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