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Health Law and Policy Update

Headlines of the week

Decision striking health reform's individual mandate is contrary to precedent and will not be the last word
A judge's decision this week striking down the Affordable Care Act's mandate to buy health insurance should be viewed in context with other court decisions, the full implications for federal health reform and the near certainty of further judicial review. The decision came from a federal district court judge in the Eastern District of Virginia.

The Colorado Center on Law and Policy today released an issue brief detailing what observers should know about the ruling:

  • Other courts have upheld the individual mandate.
  • The core issue is whether refusing to buy insurance is economic activity.
  • The decision found all other provisions of health reform lawful.
  • The U.S. Supreme Court will likely have the final word.
  • The decision was a predicted and predictable outcome from a conservative court.

Coaching saves money, improves outcomes for Medicare patients
Elderly hospital patients have a better chance of avoiding a costly return trip to the hospital if they work with a coach to coordinate drugs, doctor follow-ups and home health care aids, according to findings of a demonstration program developed at the University of Colorado.

The program is under way at 14 pilot sites nationwide and has already saved an estimated $100 million in Medicare spending, The Denver Post reports.

"Multiplied by the 620,000 Colorado Medicare patients and 46 million nationwide, expanding the program could save much more in one of the largest and fastest-growing portions of the federal budget," the Post said.

Congress approves Medicare 'doc fix'
Congress has approved a one-year extension of Medicare physician payment rates, averting a 25 percent cut in rates scheduled to take effect Jan. 1. The measure, known as the "doc fix" is intended to stabilize Medicare by maintaining an incentive for physicians to participate in the program. Lawmakers of both parties praised the measure but also emphasized a one-year fix is not a substitute for a permanent reforms. President Obama has said he will sign the measure.

Although the "doc fix" was essential -- it's critical that doctors serving Medicare patients are not hit with a significant rate reduction -- it is problematic to pay for the fix by rolling back supports for people who participate in health insurance exchanges in 2014 and beyond. Much of the funding for the "doc fix" came from increased penalties for people who receive tax credits for the purchase of health insurance through an exchange when their income has increased over the course of a year. The maximum penalty for increased income increased from $250 for an individual or $400 for a family to $1,500 for an individual and $3,000 per family. There is real concern that signals a dangerous willingness to undo some of the consumer protections in the Affordable Care Act and may discourage people from seeking tax credits through the exchange for fear they will be penalized if they get a raise or a better job. For more, see analysis in a blog post from Communmity Catalyst.

Colorado falls in public health rankings
Fewer child immunizations, gaps in rural health care and rising rates of alcohol abuse have led to a worsening public health picture for Colorado, according to a new study.

The study by the American Public Health Association, reported Dec. 8 in The Denver Post, ranked Colorado 13th in the nation on a range of public health factors and outcomes. The ranking was down from 8th in the nation last year.

Advancing the debate

New report on dual eligibles
Community Catalyst recently released a report that talks about people who are dually eligible for Medicaid and Medicare. Among the sickest, poorest and most expensive patients this report describes dual eligibles and describes new opportunities in the Affordable Care Act to help improve their health outcomes and reduce costs.

Report: Boomers benefiting from reform
A report recently issued by The Commonwealth Fund describes how the 8.9 million adults in the U.S. ages 50-64 benefit from health reform now and how they will benefit from health reform in 2014.

How health reform is helping Californians
Participants in a California retirement system are getting better health care for less money thanks to reforms in the Affordable Care Act. The California Public Employees' Retirement System (CalPERS) detailed the cost savings and improved care in a Dec. 10 letter to the Department of Health and Human Services (HHS). The letter noted CalPERS' participation in the Early Retiree Reinsurance Program, extended dependent coverage for young adults and the removal of lifetime limits on coverage.

"The efforts by CalPERS to act on the important programs and provisions of the Affordable Care Act shows that this new law is bringing real benefits to consumers," said HHS Secretary Kathleen Sebelius. "More Californians now have the security of health insurance - and lower health care costs for better benefits."

What's next

Free dental care available Dec. 24
Free dental care will be available to anyone Dec. 24 at Comfort Dental locations throughout Colorado. The offices will be open 7:30 to 11:30 a.m. The annual event, called Care Day, has been offered at Comfort Dental locations since 1984. Details are on the Comfort Dental website.

Important health reforms take effect Jan. 1
A range of policies to enhance health care and contain costs go into effect Jan. 1 as part of the Affordable Care Act. Among the most important is a requirement for health plans to report the share of premium dollars they spend on health care and quality improvement, and to provide rebates to consumers if the share is less than 85 percent in the large-group market or 80 percent in the small-group market.

Other provisions triggered on New Year's Day include a requirement for drug companies to provide a 50 percent discount on brand-name prescriptions filled in the Medicare Part D coverage gap and phased-in federal subsidies for generic prescriptions filled in the Part D coverage gap. Read details of numerous other provisions that kick in Jan. 1 on the website of the Kaiser Family Foundation.

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 Dec. 17, 2010