Health Law and Policy Update
Headlines of the week
Governors urge Congress to approve FMAP extension
Colorado Gov. Bill Ritter was among a bipartisan group of 10 governors nationwide who called on Congress Wednesday to extend emergency Medicaid funding to the states.
The extension of Medicaid funding, also known as the enhanced FMAP, failed in the Senate last Thursday, and its future remains in doubt.
If Congress fails to pass the extension, Colorado will have to cut its budget by an additional $212 million, which would be on top of the $3.5 billion in cuts to state services over the past two years, Ritter noted in Wednesday's video conference call with reporters.
The emergency Medicaid funding is set to expire at the end of December 2010, which is mid-way through Colorado's fiscal year. Colorado, like 27 other states and the District of Columbia passed fiscal year 2010-11 budgets assuming emergency Medicaid funding would be extended for six months, through June 2011.
Patient's Bill of Rights implemented last week
Federal agencies last week issued regulations to implement a new Patient's Bill of Rights as part of the national health reform measure the President signed in March. According to a fact sheet prepared by the Department of Health and Human Services, the Patient's Bill of Rights will "help children (and eventually all Americans) with pre-existing conditions gain coverage and keep it, protect all Americans' choice of doctors and end lifetime limits on the care consumers may receive.
Help for employers through the Early Retiree Reinsurance Program begins this week
A program to help maintain coverage for early retirees began accepting applications Tuesday. The Early Retiree Reinsurance Program was created by the Affordable Care Act and provides $5 billion in financial assistance to employers, unions and state and local governments to help them maintain coverage for early retirees age 55 and older who are not yet eligible for Medicare and their spouses, surviving spouses, and dependents.
Reimbursements will be available for 80 percent of medical claims costs for health benefits between $15,000 and $90,000. Program participants will be able to submit claims for medical care going back to June 1, 2010.
Yondorf and Pramenko appointed to CO-OPs advisory board
Denver-based health policy consultant Barbara Yondorf and Dr. Michael Pramanko of Grand Junction, incoming chairman of the Colorado Medical Society, were appointed last week to the national Consumer Operated and Oriented Plan Advisory Board. The panel's purpose is to make recommendations to the Department of Health and Human Services on $6 billion in grants and loans to establish nonprofit, member-run health insurers serving the individual and small-group markets (CO-OP plans). For details, check the announcement of the board in the Federal Register, the board's charter and a list of its members.
High-risk pools go on line in 20 states, Colorado not far behind
The new high-risk pools established by the Affordable Care Act are going on line in 20 states today. Those states deferred responsibility for establishing the pools to the federal government. The high-risk pools, also known as Pre-existing Condition Insurance Plans, are plans for people who have been denied coverage in the individual market due to pre-existing conditions, and who have been uninsured for six months. Colorado Gov. Bill Ritter is expected to make an announcement about Colorado's high-risk pool on Tuesday, July 6.
Colorado exchange meetings to begin in July
The Governor's Office of Health Reform will begin meetings this month to discuss the establishment of the Health Insurance Exchange in Colorado. The first meeting will be July 23 from 9 to 11 a.m. at National Jewish Hospital. Check the Office of Health Reform's Web site for details and announcements of future meetings.
Advancing the debate
What is a CO-OP?
The Affordable Care Act establishes a structure for the establishment of Consumer Oriented and Operated Plans, or CO-OPs. This is a remnant of Sen. Kent Conrad's proposal during the health reform debate to promote or require the establishment of CO-OPs instead of a public option. While there is no absolute requirement that states establish a CO-OP, there is strong incentive and encouragement to do so.
The purpose is to "foster the creation of qualified nonprofit health insurance issuers to offer qualified health plans in the individual and small-group markets in the states in which the issuers are licensed to offer such plans."
The act goes on to say loans will be made available for start-up costs, and grants are available to assist in meeting any state solvency requirements for the establishment of a CO-OP. Proposals that will offer qualified health plans on a statewide basis, use integrated care models and have significant private support are prioritized for funding. Any profits realized by a CO-OP must be used to lower premiums, improve benefits or improve the quality of health care delivered to its members. CO-OPs must be run with a strong consumer focus, and governance must be subject to a majority vote of CO-OP members.
The secretary of the Department of Health and Human Services is directed to ensure there is sufficient funding to establish at least one CO-OP in each state. Loans and grants are to be awarded no later than July 1, 2013. If there is sufficient funding, more than one may be established per state. If states do not establish CO-OPs, the secretary is empowered to designate funds to encourage applicants.
Health insurers in existence on July 16, 2009, and any state or local government or subdivision are not eligible to operate a CO-OP plan.
Six billion dollars are available for CO-OP plans nationwide.
What you can do
Schedule a presentation on health reform
Health reform can be confusing. The health staff at the Colorado Center on Law and Policy is ready to help community groups, medical professionals, lawmakers and others understand the complexities of health reform and how it will roll out during the next few years. Please contact us to schedule a presentation.
Health Care Director
Health Care Attorney
Released July 1, 2010