Health Law and Policy Update
Headlines of the week
FMAP extension still on hold
Despite attempts at a compromise, efforts to extend increased Medicaid funding to the states failed in the U.S. Senate for a third time this week.
If the increased Medicaid funding, known as FMAP, isn't included in H.R. 4213, Colorado will have to cut an additional $212 million from its 2010-11 state budget. Some of the cuts might come from Medicaid, but the program has already been stripped nearly bare, so it's more likely the cuts will come from other vital public services.
An extension of FMAP was removed from the bill when it passed the House of Representatives in late May. Other measures removed from the bill included an extension of unemployment insurance benefits and a subsidy to help people who have lost their jobs retain health insurance under the COBRA program.
Some members of the Senate have tried unsuccessfully to restore those provisions, a move the Colorado Center on Law and Policy strongly favors. Failing to restore the provisions would result in considerable hardship for Colorado, particulalry for people who are unemployed or have low incomes.
Senator Mark Udall posted a statement this week supporting the FMAP extension. Find more detailed coverage of the issue in previous editions of Health Law and Policy Update.
Court upholds setting of Title on Proposed Initiative 45
In a 5-2 ruling issued Monday, the Colorado Supreme Court upheld the title set for Initiative 45, sponsored by the Independence Institute's Jon Caldera and Linda Gorman.
Proponents are in the process of collecting signatures. The court rejected arguments that the title violates Colorado's single-subject requirement for ballot measures, is misleading and contains an impermissible catch phrase. The majority determined the measure pertains to the single subject of health care payment options and does not establish an overarching right to health care choice. In a dissent, Chief Justice Mary Mullarkey agreed the title contains a single subject, but she argued the phrase "right of health care choice" is an impermissible political catch phrase. She would have stricken that language and allowed the measure to proceed. Also agreeing there was a single subject, but dissenting in part, was Justice Alex Martinez. He said the title contains an impermissible political slogan "right to health care choice." Martinez said voters could be mislead by the title, too, because the measure does not actually create a broad right of health care choice.
The Colorado Center on Law and Policy opposes Initiative 45.
Connecticut is first state to expand Medicaid under health reform
This week, Connecticut became the first state to get approval to expand Medicaid to low-income adults under the new law. Health and Human Services Secretary Kathleen Sebelius said in an announcement of the approval of Connecticut's waiver: "We applaud Connecticut's speedy action to expand coverage for its lowest-income residents who will now have reliable access to affordable, quality care as a result of the incentives contained in the Affordable Care Act. ... Today's action will bring substantial new federal support to the state and help improve the health of its citizens."
The health reform law, called the Patient Protection and Affordable Care Act, permits states to receive federal funding for providing Medicaid coverage to adults with incomes up to 133 percent of the federal poverty level, $14,400 for an individual in 2010. Before passage of health care reform, states could cover childless adults only by applying for a waiver of Medicaid rules. The waivers were temporary, and states had to meet strict criteria for approval and renewal. Health care reform requires states to cover all low-income individuals in Medicaid starting in 2014, but it also allows states to get federal funding to enroll them right away.
This is an opportunity Colorado is likely to take advantage of since the state plans to expand Medicaid to childless adults with incomes of less than 100 percent of the Federal Poverty Level early in 2012. Colorado will use money from the Hospital Provider Fee to match federal dollars.
Obama warns against steep rate increases
President Barack Obama on Tuesday warned insurance companies against imposing extraordinary rate increases before regulation resulting from health reform takes effect.
What's new
Exempla trains staff on compliance with rules that could threaten patient rights
Since January, Exempla Healthcare has held meetings for medical and other staff instructing them on how to implement Ethical and Religious Directives (ERDs) promulgated by the US Conference of Catholic Bishops. Exempla operates three hospitals in the Denver metropolitan area, St. Joseph Hospital in Denver, Lutheran Medical Center in Wheat Ridge and Good Samaritan Medical Center in Lafayette.
CCLP and Colorado State Sen. Betty Boyd have pressed the Colorado Department of Public Health and Environment (CDPHE) and the Board of Health to issue a rule requiring disclosures to prospective and actual patients by all hospitals which claim to be governed by the ERDs, of what procedures are and are not available in such hospitals. Procedures that may be affected include those dealing with tubal ligation and sterilization, use of condoms and other anti-pregnancy devices, counseling regarding "safe sex," post-rape anti-pregnancy medication, patients' medical directives. Medical directives are orders by the patient such as "do not resuscitate" or no "artificial hydration." Colorado legislation enacted in 2010 requires hospitals to follow medical directives or transfer patients whose directives will not be followed to a hospital that will follow them.
Some other issues remain ambiguous in hospitals employing the ERDs, such as whether the rights of gay and lesbian couples to visitation, disposal of remains, etc. will be observed. CCLP will continue to report on developments.
CCLP will continue to monitor CDPHE to determine whether a rule is being adopted, to try to assure that such a rule will serve the public's interest. The agency issued a fact sheet in March detailing the history and considerations around implementing ERDs.
Advancing the debate
Cost of individual insurance up 20 percent on average
A new survey of people who buy their own insurance found most were self-employed or small-business owners. People spent $3,606 on average each year on health insurance premiums, and families spent $7,102.
The Kaiser Family Foundation released the survey results Monday.
Out-of-pocket expenses ran an average of $924 for individuals and $2,688 for families. Six in 10 people reported it was difficult to afford health care. Among the 77 percent who reported an increase in their premiums, the average increase was 20 percent. Most respondents chose to pay the increased premium, while others switched to less expensive plans with potentially inferior coverage.
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 Law and Policy Update is issued weekly by the health staff of the Colorado Center on Law and Policy. Subscribe by e-mail or read previous editions.
Health Care Director
Elisabeth Arenales
Health Care Attorney
Adela Flores-Brennan
Special Counsel
Ed Kahn
Communications Director
Perry Swanson
Released June 25, 2010