Health Law and Policy Update
Headlines of the week
U.S. House Appropriations committee proposes devastating cuts
On Wednesday, House Appropriations Committee Chairman Hal Rogers released a list of $100 billion in proposed cuts to the 2011 federal budget. The list shows significant and devastating cuts to health care, environmental protection, public health, law enforcement, and legal services for the poor. The Legal Services Corporation released a statement Thursday addressing the $75 million in proposed cuts to its funding.
The Colorado Center on Law and Policy strongly supports access to justice through legal aid programs that provide civil legal services to low-income Coloradans. Colorado Legal Services (CLS), Colorado's legal aid program is already grossly underfunded. CCLP works closely with CLS and was designed in part to undertake work CLS may not because of restrictions on its federal funding.
The deal is far from done, but Rogers' move is a troubling indicator of the fight over domestic discretionary funding for programs that serve the majority of Americans.
Some states say Affordable Care Act no longer in effect, undermining patient protections
Health reform opponents in some states have yanked away consumer protections included in the Affordable Care Act, asserting a federal judge's ruling that the law is unconstitutional means it's no longer in effect.
The political wrangling is likely to be resolved by a ruling from the U.S. Supreme Court, but that decision could take a couple of years to arrive. In the meantime, some health care consumers are at risk of the same insurance industry abuses and rapidly rising costs that the health reform law was intended to address.
Colorado officials are continuing to implement the Affordable Care Act and a bill to establish Colorado's Health Insurance Exchange is anticipated in the next couple of weeks. In Florida, though, some state officials say they will not enforce consumer protections such as a rule that insurance companies must spend 80 to 85 percent of premium dollars on health care services, the Palm Beach Post reports.
Officials in Indiana, Alabama and Arizona are also challenging implementation of the law, arguing it infringes on states' rights, the newspaper reported.
Wisconsin Attorney General J. B. Van Hollen claims the Florida ruling means states no longer have to comply. "Effectively, Wisconsin was relieved of any obligations or duties that were created under terms of the federal health care law," he said, according to a report by McClatchy Newspapers.
Other states including California are moving quickly to implement the law, and consumers are benefitting.
Simon Lazarus authored a particularly thorough issue brief for the American Constitution Society for Law and Policy published this week examining constitutional law and the Affordable Care Act.
Lazarus discusses the "inherently radical character of the case against the ACA," and lays out the new constitutional landscape that would result if the ACA's individual mandate provision is struck down by the U.S. Supreme Court. Such a decision, he writes, would reflect an historic constitutional change and have significant implications for the federal government's ability to tackle national problems and build a stable national economy. Today, the democratic branches of government, not the courts, have the power to shape national economic policy. The Supreme Court, he argues cannot overturn the individual mandate without violating that basic understanding. That would put the courts into the role of micro-managing national economic policy and call into question the basis for Medicare, Social Security, Medicaid, civil rights laws enforced by regulating places of public accommodations, and much more.
Health insurers adjusting to MLR changes
Health insurers are adjusting to "a once scary reform rule," governing the share of premium dollars that must be spent on health care, according to an article in The Washington Post this week. The piece discusses profits and losses, and customer rebates anticipated by carriers as a result of medical loss ratio (MLR) limits, which went into effect this year.
Hearing on repeal of Hospital Provider Fee canceled
A hearing on a measure to eliminate Colorado's Hospital Provider Fee was canceled this week. Watch Health Law and Policy Update for updates on House Bill 11-1025, sponsored by Rep. Janak Joshi. The Colorado Hospital Association prepared a fact sheet explaining background and the reasons to oppose the bill.
The Colorado Center on Law and Policy is among the many groups opposed to repeal of the fee. Money generated by the fee will fund public health insurance coverage for more than 100,000 low-income, uninsured Colorado children, adults and parents, and provide the opportunity for people with disabilities to work without losing Medicaid coverage.
What's new
The Affordable Care Act and students
Proposed rules released this week clarify that the approximately 3 million students insured through colleges and universities will be protected by key provisions of the Affordable Care Act. The protections would include the elimination of lifetime limits, a prohibition on rescissions and guaranteed access to insurance with no pre-existing condition exclusions for students younger than 19. The Department of Health and Human Services is requesting comments on how other Affordable Care Act protections apply to student health plans, including the choice of medical provider and application of the new medical loss ratio rules. In addition, the proposed rules would require insurance companies to tell students enrolled in student health plans whether their plan meets the new requirements laid out under the Affordable Care Act.
Advancing the debate
Insurance expansion to parents likely to benefit children
The number of children with health insurance coverage is likely to increase as the Affordable Care Act is implemented, in part because of the act's expansion of health coverage to adults, the Government Accountability Office (GAO) finds in a Feb. 4 report.
The GAO analyzed survey data showing a strong correlation between a parents' and children's health insurance status. Reviewing data from the Medical Expenditure Panel Survey, the GAO found 84 percent of children had the same health insurance status as their parents. The survey categorized respondents as publicly insured, privately insured or uninsured.
"(T)he association between parents' and children's health insurance status could result in newly eligible parents enrolling their children in Medicaid. Similar expansions of parental coverage through the exchanges could also increase the number of insured children," the report said.
The Affordable Care Act requires states to extend Medicaid eligibility to all adults younger than 65 with incomes up to 133 percent of the federal poverty level by 2014. Guidance from the Centers for Medicare and Medicaid Services "will be critical to facilitate states' efforts to comply with these requirements," the report said.
State ranks a little above the middle in health system's performance for children
Colorado ranks slightly better than most states by a range of measurements of how the health care system serves children, according to a new study from The Commonwealth Fund. The study examines 20 indicators of children's health care access, affordability of care, prevention and treatment, the potential to lead healthy lives and health system equity. It ranked Colorado No. 20 among the states.
While the study praised recent federal and state efforts to expand health insurance to children, it also noted big geographic disparities in the performance of the health care system for children. Iowa ranked No. 1, while Nevada ranked last.
Among the indicators for Colorado, the study notes about three quarters of Colorado children with health insurance have coverage that's adequate to their needs. That's roughly the same as the median for all states. Colorado ranked lower than the national median, though, by other measurements. Only 69.2 percent of Colorado children aged 19 to 35 months had received all recommended doses of six key vaccines, while the national median was 74.4 percent.
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 Feb. 11, 2011