Health Law and Policy Update: Health exchange grant application delayed
This week's updates
- Health exchange grant application delayed
- U.S. Justice Department seeks Supreme Court review in health reform case
- Attorney general holds two public hearings on HealthONE hospital transaction
- Employer costs for health insurance rise sharply
- Study details how state exchanges can influence quality
- Division of Insurance to host forums on insurance changes
Headlines of the week
Health exchange grant application delayed
House Republican members of a committee overseeing creation of Colorado's Health Benefit Exchange hit the brakes on the process this week when they said they would not support submission of a $22 million grant application to the federal government.
The delay might be significant because Colorado is working against a federal deadline to have its exchange fully operational by 2014, and the state is relying on federal money complete that process. The state's current exchange planning grant expires Dec. 31. After that, state law prohibits using General Fund money to fund the exchange.
The Colorado Health Benefit Exchange Board was trying to meet a deadline today to submit the grant to fund the exchange's operations in the coming year. According to Senate Bill 11-200 which established the exchange, a legislative implementation review committee must approve all federal grants before submission. In a statement released Wednesday, House Republican members of the committee said they could not support submission of the grant at this time pointing to issues of cost, size of staff and the federal government's oversight of exchange implementation.
Staff and members of the exchange board of directors have been working on the grant and budget for several weeks. The exchange board is now aiming for a Dec. 30 submission date. The effect of a delay remains to be seen. The exchange board, for example, is in the process of hiring an executive director.
In a memo to board members today, Chairwoman Gretchen Hammer said she is "actively working to understand concerns about the Level I grant application and develop a process to continue working on the application."
U.S. Justice Department seeks Supreme Court review in health reform case
The Justice Department passed up the opportunity this week to ask the 11th Circuit Court of Appeals (Florida v. HHS) for a review of a panel decision declaring the individual mandate unconstitutional, instead asking the U.S. Supreme Court to hear the case.
The 11th Circuit is one of two circuit courts that have decided the constitutionality of the individual mandate provision of the Patient Protection and Affordable Care Act. The 6th Circuit Court of Appeals found the individual mandate constitutional while the 11th Circuit declared it unconstitutional. Other circuit courts that have issued decisions on Affordable Care Act cases have determined they don't have jurisdiction to decide on the substantive issues and therefore have not ruled on the constitutionality of the law.
The Supreme Court could take up this case, wait for more lower court decisions or decline to hear the case altogether (an unlikely result). If the Supreme Court accepts the case, a decision is likely in June 2012. In a news release, the Justice Department said: "Throughout history, there have been similar challenges to other landmark legislation such as the Social Security Act, the Civil Rights Act, and the Voting Rights Act, and all of those challenges failed. ... We believe the challenges to the Affordable Care Act - like the one in the 11th Circuit - will also ultimately fail and that the Supreme Court will uphold the law."
Some observers claim, assuming a June decision, the request is geared toward influencing the 2012 election outcome. Find coverage in The New York Times and The Christian Science Monitor. The Washington Post reported, however, "a Justice Department official authorized to speak only on background said a consensus existed within the department that there is much to do on behalf of the federal government, states and the private sector to implement the act by 2014 and that a final decision by the court was needed."
Attorney general holds two public hearings on HealthONE hospital transaction
Colorado Attorney General John Suthers held public hearings Monday and Tuesday this week to allow the public to weigh in on whether the proposed sale of the Colorado Health Foundation's interest in the HealthONE hospital system should be approved. The proposed price is $1.45 billion.
The hearings received considerable media attention, including stories from Health Policy Solutions, Colorado Public Radio and The Denver Post. Several of the pieces included remarks from Colorado Center on Law and Policy Special Counsel Ed Kahn, who wrote an opinion piece for Health Policy Solutions outlining "Five ways the HealthONE hospital deal should be adjusted to protect the public."
Suthers is exercising his common law authority to review the transaction. CCLP has endorsed the deal, provided certain changes are made.
CCLP called for Suthers to find a premium in the price must be paid because there is a shift in control of the joint venture. At present, the foundation's directors on a joint board can block certain major decisions, such as expansions and budgets. If the transaction is approved, HealthONE would solely control those decisions, except for certain continuing commitments to community.
Suthers may receive additional written comments. No time is set by law for his decision on whether to approve the transaction, and if he approves, whether conditions will be imposed. Observers expect a decision within two weeks.
Employer costs for health insurance rise sharply
Employer spending on health insurance coverage climbed 8 percent for individuals and 9 percent for families this year, according to a new survey by the Kaiser Family Foundation and the Health Research & Educational Trust.
"Although many benefit analysts say the federal health law's requirements played only a small part in the (health premium) rise, the results could provide political fodder for both supporters and opponents of the law," Kaiser Health News reported.
An analysis by The Commonwealth Fund found 1.8 percentage points of the premium increase was attributable to the health reform law.
The survey found average family premiums have increased 113 percent over the past decade. The average annual premium for individuals in 2011 is $5,429 and families $15,073. Only 60 percent of firms offer health insurance coverage in 2011, compared to 66 percent in 1999, and 69 percent in 2010.
Regarding the effects of the Patient Protection and Affordable Care Act: 2.3 million adult children have been enrolled nationwide under the law's provision requiring firms to offer coverage to adult children (up to age 26) of enrolled employees. Twenty-three percent of workers are in a plan where cost-sharing requirements changed as a result of the law's prohibition on cost sharing for preventive services.
Advancing the debate
Study details how state exchanges can influence quality
A study released this week by researchers at Georgetown University provides analysis of the opportunities available to states in the implementation of health insurance exchanges to help improve quality and make delivery system reforms.
Division of Insurance to hold forums on insurance changes
Colorado Commissioner of Insurance, Jim Riesberg, and other Division of Insurance staff will hold forums in Denver, Greeley and Grand Junction in October to help people learn about changes to their health insurance. The meetings are designed to address the causes of premium increases, benefits guaranteed in federal health reform, what Medicare participants can do when a claim is denied and similar consumer issues. The meeting schedule:
- 6:30 p.m. Oct. 13 at Merrill Middle School in Denver, 1551 S. Monroe St.
- 6:30 p.m. Oct. 20 at Greeley Ice Haus, 900 8th Ave.
- 6:30 p.m. Oct. 25 in Grand Junction at a location to be decided.
The Division of Insurance has also scheduled webinars for Oct. 11 and 18 to help small-business owners and human-resources professionals learn about changes in insurance. Details and registration links are on the Division of Insurance website.
Health Care Director
Health Care Attorney
Released Sept. 30, 2011