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

Archive: March 2012

Commonwealth Fund article evaluates boosting Medicare fees for primary care visits

Posted on March 30, 2012

The 2010 Affordable Care Act (ACA) boosted Medicare fees for primary care ambulatory visits by 10 percent for five years starting in 2011. Using a simulation model with real world parameters, the Commonwealth Fund evaluates the effects of a permanent 10 percent increase in these fees in their brief “Paying More for Primary Care: Can It Help Bend the Medicare Cost Curve?” The analysis shows the fee increase would increase primary care visits by 8.8 percent, and raise the overall cost of primary care visits by 17 percent. However, these increases would yield more than a sixfold annual return in lower Medicare costs for other services—mostly inpatient and postacute care—once the full effects on treatment patterns are realized. The net result would be a drop in Medicare costs of nearly 2 percent. These findings suggest that, under reasonable assumptions, promoting primary care can help bend the Medicare cost curve.

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New RWJF project examines health reform progress

Posted on March 30, 2012

A series of in-depth case studies based on site visits and reports from national data sets tracks how the Affordable Care Act (ACA) is being implemented in states and establishes a baseline for measuring progress over the coming years. The reports, prepared by researchers at the Urban Institute and Georgetown University’s Health Policy Institute, are designed to share background information, processes, and learnings that can inform the work of state government agencies, policy-makers, and others across the country as ACA implementation progresses.

In the first reports, the authors found that…

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Georgetown University Health Policy Institute releases paper on state revenues and Medicaid

Posted on March 29, 2012

The Georgetown University Health Policy Institute published a report which examines the decline in state revenues and changes in Medicaid spending during the last two recessions to look more closely at what has been driving state budget deficits. As states have faced large budget deficits, some politicians have blamed Medicaid, claiming that rising program costs are crowding out other priorities. While spending in Medicaid has grown as a result of increased enrollment due to the recession, most of this added spending has been shouldered by the federal government. Although less frequently discussed, a greater challenge to state budgets during these difficult economic times has been the steep declines in revenues.

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Editor’s Comment: Two Years and Counting

Posted on March 29, 2012

March 23, 2012, marked the two-year anniversary of the Affordable Care Act (ACA), and the Administration’s two years worth of implementation efforts that span the full scope of the law. Major areas of implementation encompass the range of reforms under the Act: improving performance in the private insurance and employer-sponsored health plan markets; strengthening Medicare, Medicaid and CHIP; improving health care access and building a stronger health workforce; improving health care quality and accountability; increasing investments in public health; strengthening health care fraud and abuse controls; and reforming federal policies applicable to tax-exempt hospitals.

Health Reform GPS reported on the first year of implementation efforts here. This updated table includes both year-one and year-two key agency implementation actions. Year-two actions appear in italics.

ACA implementation efforts in Year Three can be expected to reach more deeply into the core of the reforms. Among other topics…

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Supreme Court hears Medicaid expansion oral argument

Posted on March 28, 2012

In the afternoon on the the third and last day of oral arguments, the Supreme Court heard whether the Affordable Care Act’s (ACA’s) expansion of Medicaid is unlawful. Medicaid is a state-federal program that provides health insurance coverage to the disabled and poor, including families with dependent children. To increase participation rates in the program, the federal government allocates money to states that voluntarily create Medicaid programs that meet federal standards. The ACA expands Medicaid coverage to include single adults that fall within federal poverty standards.

Mr. Paul Clement, representing the challengers, opened the afternoon arguments. Mr. Clement’s allotted 30 minutes ran over, as Justices continued to fire questions well after the time had expired. The majority of Mr. Clement’s argument was spent on the coercion question, which suggests that because the federal government has the option of pulling all the state’s Medicaid funding if a state doesn’t want to participate in the law’s Medicaid expansion, states will thus be coerced to participate in the expansion.

Solicitor General Donald Verrilli followed, representing the Obama Administration.

To end the ACA oral arguments, Chief Justice Roberts gave Mr. Clement 5 minutes to make a final rebuttal.

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Supreme Court hears severability oral argument

Posted on March 28, 2012

On the last day of oral arguments surrounding the Affordable Care Act (ACA), the Supreme Court heard the severability issue in the morning. The severability question would only come into play if the Justices rule to strike down the minimum coverage provision (argued yesterday).

Mr. Paul Clement, representing the challengers, opened this morning’s arguments. Mr. Edwin Kneedler followed, presenting the government’s position. Mr. Kneedler argued that if the individual mandate is stricken from the ACA, two other provisions would have to fall as well. The first prohibits insurers from turning away individuals due to pre-existing conditions. The second provision limits how insurers can set rates. The government takes issue with the aforementioned provisions because if applied in the absence of the mandate, the insurance market would crater. Apart from these insurance regulations, however, the government argued that every other aspect of the law could stand in the absence of the individual mandate.

Following Mr. Kneedler’s argument was Mr. H. Bartow Farr, a court appointed lawyer, who argued that all other provisions of the law should remain in place even if the Justices strike the minimum coverage provision.

Mr. Clement returned for a four-minute rebuttal to close the morning session.

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Supreme Court hears minimum coverage provision oral argument

Posted on March 27, 2012

Today, from 10:00 am-12:02 pm, the Supreme Court heard one of the most highly anticipated oral arguments in years. The subject in question was the constitutionality of the individual mandate, a provision of the March 2010 Affordable Care Act (ACA). The 26 states, the National Federation of Independent Business (NFIB), and a few individual business owners brought the suit, contending that the law’s individual mandate is unconstitutional. The challengers argued that the minimum coverage provision regulates economic “inactivity,” and forces people to enter a market. The Obama Administration, on the other hand, contended that it is essentially impossible to avoid entry into the health care market. Health insurance is not a stand-alone product, like broccoli or a car, but rather a means of financing a market.

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RWJF and Urban issue paper on the effect of the minimum coverage provision

Posted on March 27, 2012

The minimum coverage provision, or individual mandate, is a provision under the 2010 Affordable Care Act (ACA). According to a short paper recently issued by The Robert Wood Johnson Foundation and the Urban Institute, if the ACA were in effect today, 94 percent of the total population (93% of the nonelderly population) or 250.3 million people out of 268.8 million—would not face a requirement to newly purchase insurance or pay a fine.

In this brief, the authors use the Urban Institute’s Health Insurance Policy Simulation Model (HIPSM) to estimate the number and share of Americans potentially subject to the mandate, identify their insurance status absent the ACA, and simulate eligibility for Medicaid and exchange-based premium and cost-sharing subsidies. To allow the most direct comparison of postreform coverage with coverage absent reform, their analysis treats the provisions of the ACA as if fully implemented in 2011. The results of their analysis are presented in a table format—with estimates of the population exempt from the mandate; the population potentially affected by the mandate but already covered by insurance of some type; and the remaining population required to newly purchase coverage or pay a fine.

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Challenges to the Affordable Care Act: Highlights from the Supreme Court Briefs (updated weekly)

Posted on March 27, 2012

About this special series: On November 4, 2011, the Supreme Court granted certiorari in two cases arising out of constitutional challenges to the Affordable Care Act (ACA). The Court is set to hear oral arguments in the (now consolidated) cases over three days, beginning on March 26, 2012. As part of our continuing coverage of the litigation, HealthReform GPS will post periodic updates as the parties and their amici file briefs in the coming weeks. Amicus briefs, filed by individuals and organizations with an interest in the outcome of the litigation, are also known as “friend of the court” briefs. In ACA litigation, numerous amicus briefs are expected on the four questions the Court will hear. For a detailed explanation of the cases and the four issues, click here.

The oral argument dates are shown below:

  • Monday, March 26: Department of Health and Human Services et al., v. Florida et al.–Anti-Injunction Act – 1 hour beginning at 10 a.m.
  • Tuesday, March 27: Department of Health and Human Services et al., v. Florida et al.–Minimum Coverage Provision – 2 hours beginning at 10 a.m.
  • Wednesday, March 28: National Federation of Independent Business v. Sebelius, Secretary of HHS et al. and Florida et al., v. Department of Health and Human Services et al.–Severability – 90 minutes beginning at 10 a.m. AND Florida et al., v. Department of Health and Human Services et al.–Medicaid – 1 hour beginning at 1 p.m.

For access to our entire list of Supreme Court brief summaries, please click “Continue Reading” below.

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Supreme Court hears Anti-Injunction Act oral argument

Posted on March 26, 2012

From 10:12-11:41 am on March 26, 2012, the Supreme Court Justices heard the Anti-Injunction Act oral argument in Case Number 11-398, Department of Health and Human Services v. Flordia. Robert A. Long, the court-appointed amicus curiae opened the session, followed by Donald B. Verrilli on behalf of the petitioners. Gregory G. Katsas argued on behalf of the respondents and Mr. Long closed the session with a rebuttal argument. The Anti-Injunction Act is an 1867 federal law that bars suit “for the purpose of restraining the assessment or collection of any tax.” If the Supreme Court finds that the 1867 law does apply, a decision would be deferred until 2015, when Americans will first be penalized if they do not have health insurance.

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