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PAHUs Letter to Congress on Health Reform
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The Health Insurance Underwriter!
If someone goes for a routine colonoscopy for a wellness check and polyps are found and removed, can the facility now bill this visit as an outpatient surgery which is subject to the deductible, or is it still treated as wellness and covered in full free of charge?
PAHU Testifies on Navigators
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Want to find an agent who is certified to market the federally-facilitated marketplaces (exchanges)? Click here
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CORBETT MAKES MEDICAID EXPANSION PROPOSAL TO FEDS
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PA ENACTS PAHU-SUPPORTED BILL ON INSURANCE DEDICATED FUNDING (SB 914)
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HOUSE COMMITTEE ADVANCES PAHU NAVIGATOR BILL (HB 1522)
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NAHU PROVIDES LINKS TO AGENT EXCHANGE TRAINING
To provide agents and brokers with information on the registration process, including training requirements, prior to assisting consumers in the Federally-facilitated Individual and SHOP Marketplaces.
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Webinar Information Table (xlsx)
LETTER FROM NEW PRESIDENT STEVE FISHER
Consedine Addresses HHS Exchange Implementation Shortfalls
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PAHU Testifies on Exchanges before House Democratic Policy Committee in Erie August 27
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HIGH COURT UPHOLDS PPACA
To access the decision, use the following link to the US Supreme Court decision in National Federation of Independent Businesses v. Sibelius
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Here is a detailed analysis of the Supreme Court ruling, courtesy of our retained counsel, Ernst & Young
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HHS Issues Final Rule On Exchanges
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PAHU Testifies Against PA OCA
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PPACA Benefits Summary Regulations Issued
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HHS Releases Essential Benefits Proposal
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PPACA Information <<< Click Here >>>
Exchanges <<< Click Here >>>
"PAHU Positions at a Glance" <<<
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PAHU’S PATH TO CONSTRUCTIVE HEALTH
|Customized Briefing for Vince Phillips
|| August 8, 2013
Leading the News
OPM Clarifies ACA Provision That Congress, Staff Enroll On Exchanges.
Several outlets report that on Wednesday, the Obama Administration released regulations which, as expected, allow members of Congress and their staff to continue receiving Federal contributions for their health insurance despite an ACA provision requiring them to purchase coverage on the law’s exchanges. Many of the sources note that the decision came after much debate and remains controversial, with many calling the exemption unfair.
Reuters (8/8, Lawder) reports the Office of Personnel Management has determined that members of Congress and their staffs will continue to receive a Federal contribution toward their purchase of healthcare insurance under exchanges created by the Affordable Care Act. The article explains the debate over the exemption, noting that many lawmakers feared a “brain drain” if their staffers lost the Federal Employees Health Benefits Program contribution
that currently covers about 75% of costs. Despite some critics’ accusations, the article notes that Congress is still subject to the ACA provision which requires them to enter the law’s exchanges.
The New York Times (8/8, Pear, Subscription Publication) sums up the “new official interpreation” of the ACA the OPM offered Wednesday: the Federal government will “continue contributing to the cost of health benefits for lawmakers and thousands of Congressional employees,” but they will “have to buy coverage as individuals through new state-based markets known as insurance exchanges.” According to the article, this means that
“older members of Congress and those who smoke” might face “much higher health insurance premiums.”
The Washington Post (8/8, Yoder) “Federal Eye” blog reports that OPM director of planning and policy Jon Foley said in a statement, “These proposed regulations implement the administrative aspects of switching Members of Congress and congressional staff to their new insurance plans – the same plans available to millions of Americans through the new Exchanges.”
The AP (8/8, Alonso-Zaldivar) reports that the regulations “resolv[e] one of the biggest unknowns” about Senator Chuck Grassley’s amendement to the Affordable Care Act: whether the Federal government would “continue to pay its standard share of premiums.” However, “questions remain,” including about “retiree coverage and definitions of residency.”
Roll Call (8/8, Dumain, Lesniewski, Subscription Publication) reports Republicans have been relatively quiet, as they “are in a tough spot – few on Capitol Hill want to take health benefits away from themselves or their staffs, but the Republican base is dead set against anything Obamacare related, as well as anything that smacks of a special carve out for lawmakers.”
The Washington Times (8/8, Howell) notes that the rule states “individuals members and staff should buy coverage through the exchange in their state,” meaning that staff will likely be “enrolling through the District, Maryland or Virginia.”
To this point, CQ (8/8, Reichard, Subscription Publication) reports that as Congressional staff prepare to enter the Affordable Care Act’s exchanges, the head of D.C.’s marketplace “says she’ll do her best to make them feel welcome.” Mila Kofman, the executive director of DC Health Link, said in an interview “that insurers participating in the new marketplace include such FEHB mainstays as Blue Cross-Blue Shield’s CareFirst plan,
Kaiser Permanente and Aetna.” She added that “just as the insurers will be familiar, so too will be the network of providers.”
Also reporting on the regulations are Bloomberg News (8/8, Rowley), the NPR (8/8, Rovner) “Shots” blog, Politico (8/8, Haberkorn, Millman), The Hill (8/8, Hattem) “Regwatch” blog, Daily Caller (8/8, Levinson), Alabama Live (8/8, Gore), and the Deseret (UT) News (8/8, Hicken).
Opinion Pieces Criticize OPM Decision.
Several opinion pieces weigh in on the regulations issued by OPM Wednesday, which allow the Federal government to continue paying most of the premiums of lawmakers and their staff. All are highly critical of the decision. First, in an editorial, the Wall Street Journal (8/8, Subscription Publication) criticizes the regulations. The paper argues they create a special standard for those with political office and their taxpayer-funded employees.
The Las Vegas Review-Journal (8/8) echoes this sentiment in an editorial, citing the news as another example of why the Affordable Care Act should be repealed.
Peter Roff criticizes the regulation in a post for the US News & World Report (8/8) blog, writing that they “confirm the worst fears of many Americans; that the government, ultimately, is only out for itself.”
Finally, Sarah Hurtbise points out in a post for the Daily Caller (8/8) that the Obama Administration was quick to offer the “flexibility” to Congress that it “denied cancer clinics under sequestration earlier this year.”
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Legislation and Policy
Some Questioning Legality Of Administration’s “Tweaks” To ACA.
The Washington Post (8/8, Kliff) “Wonkblog” reports that recent “tweaks” to the Affordable Care Act by the Obama Administration have “raised questions” about whether “the White House has overstepped its executive authority.” The tweaks in question are the employer mandate delay and the Federal government continuing to pay for Congress’ health benefits. The article acknowledges that while “the White House
can’t simply decide not to set up a law,” they are granted “some flexibility in determining what it means to ‘faithfully’ execute a law.”
Push To Defund ACA Continues To Split GOP.
Coverage, though lighter, continues to highlight the growing divide among Republicans over a bold anti-ACA strategy. First, the Washington Times (8/8, Howell) reports Grover Norquist “and a coalition of advocacy groups” calling itself the Obamacare Repeal Coalition is calling on House Speaker Boehner and Senate Minority Leader McConnell to join in the effort to defund the Affordable Care Act “through the massive spending bill, known as a ‘continuing
resolution,’ that is needed to fund the government this fall and beyond.”
Politico (8/8, Edwards) reports that the Obamacare Repeal Coalition has asked Congressional Republicans “to demand a one-year delay on all 2014 provisions of the Affordable Care Act, as a bare minimum to a final deal.” The letter read, in part, “With the clock ticking to open enrollment on October 1, it is abundantly clear to members of the Repeal Coalition that the structure at the heart of PPACA is simply not ready.”
The Hill (8/8, Viebeck) “Healthwatch” blog reports that the letter, sent to House Speaker John Boehner (R-OH) and Senate Minority Leader Mitch McConnell (R-KY), was signed by “Norquist and 18 other conservatives.”
However, the Huffington Post (8/8, McAuliff) reports that “tea party-powered” GOP Sens. Ted Cruz, Mike Lee, and Marco Rubio have been arguing that Republicans “should refuse to pass a bill to fund the government in September unless” it excludes “all funding for the implementation of the” Affordable Care Act. However, “more senior” GOP senators, including Richard Burr, Tom Coburn, and John McCain, oppose the plan, arguing “that
most of the nation” would disapprove of shutting down “the government just to hamstring Obamacare,” and warn that doing so could hurt “the GOP’s electoral chances in 2014.”
Many outlets, including the Washington Times (8/8, McLaughlin), provide continuing coverage of Mitt Romney’s opposition to the efforts of some Republicans to defund the Affordable Care Act, saying Tuesday at a New Hampshire event that it would force a government shutdown. He said, “I’m afraid that in the final analysis, Obamacare would get its funding, our party would suffer in the next elections, and the people of the nation would not be happy. I think there are better ways to
remove Obamacare.” Still, Romney believes there are “better options” to remove the law for good.
Also reporting on Romney’s opposition to the GOP plan are the Christian Science Monitor (8/8, Grier), NBC News (8/8, O'Brien), and MSNBC (8/8, Timm).
Responding, the Deseret (UT) News (8/8, Roche) reports that Utah Senator Mike Lee “dismisse[d]” Romney’s criticism, and the US News & World Report (8/8, Metzler) reports that Ted Cruz’s Office “brush[ed]” his “warnings” off.
In related news, The Hill (8/8, Viebeck) “Healthwatch” blog reports that a survey conducted for the Services Employees International Union found that “the GOP’s push to repeal ObamaCare will hurt the party in the midterm elections,” because voters are looking for “candidates that want to improve the law.” Among undecided voters, respondents “preferred an anti-repeal Democrat over a pro-repeal Republican by 10 points.”
Also reporting on various aspects of the GOP shutdown threat over the Affordable Care Act are the Huffington Post (8/8, MacNeal), The Hill (8/8, Cox) “Floor Action” blog, The
Hill (8/8, Hooper) “Healthwatch” blog, another piece on The Hill (8/8, Viebeck) “Healthwatch” blog, and Politico (8/8, Edwards).
Commentators Criticize Republicans For Continuing To Fight ACA.
Several opinion pieces weigh in Thursday on Republicans’ continued fight to repeal the Affordable Care Act, all notably critical of the push.
Greg Sargent, in his Washington Post (8/8) “Plum Line” blog suggests that Republicans, “in their drive to repeal and even defund Obamacare,” appear to be “making the same mistake they made in 2012 about the economy.” He calls their view that “the law is such an obvious catastrophe that of course voters will support whatever means are necessary to destroy it” a dangerous “miscalculation.”
Separately, Sargent, also in his Washington Post (8/8) “Plum Line” blog writes that the “pressure” is “intensif[ying]” for Republicans “to declare their undying commitment to...doing whatever it takes to bring about the total destruction of Obamacare, including threatening a government shutdown.”
Greg Sargent, again in his Washington Post (8/8) “Plum Line” blog, writes that Democrats can “win” the debate over the Affordable Care Act by “calling out Republicans for refusing to offer any solutions of their own.”
Henry J. Aaron, the Bruce and Virginia MacLaury Senior Fellow in Economic Studies at The Brookings Institution, lays out what Americans should expect from the Affordable Care Act on October 1, in a piece for the Huffington Post (8/8) blog. He predicts both success and failure, but acknowledges that the law will work better in states that have cooperated with the Federal government. He concludes by criticizing the “uncooperative and obstructionist efforts” of many Republicans “who have refused to
recognize that the Affordable Care Act is the law of the land.”
In a piece titled “The Never-ending War On Obamacare,” author Nicholas Wapshott offers a similar opinion in Reuters (8/8), noting that as people get used to the ACA, it will reflect poorly on those Republicans who keep insisting on trying to get rid of it.
Political columnist Barry Rascovar echoes this point in the Carroll County (MD) Times (8/8), noting that “hardline conservatives continue their efforts to convince Americans the president’s health reforms will send insurance rates soaring and turn into a debacle.” He continues, however, “it doesn’t look that way.”
Sebelius Heads To Texas To Discuss ACA.
A handful of regional outlets report ahead of HHS Secretary Kathleen Sebelius’ trip to Texas Thursday and Friday to discuss the ACA. The Houston Chronicle (8/8, Smith) “Texas on the Potomac” blog reports that HHS Secretary Kathleen Sebelius is stopping in Texas this week to “spread the word about Obamacare.” Sebelius will be in Austin and San Antonio Thursday to “discuss the Affordable Care Act with city officials, health care partners and community stake holders.”
Explaining the reason for Sebelius’ visit, HHS spokeswoman Joanne Peters said, “We have a robust plan to get the job done. We know it can’t be done by government alone, and it can’t be done only in Washington. That’s why we’re going straight to the communities where the need is the greatest, to work with our partners on the ground, to reach people right where they are.”
The AP (8/8, Tomlinson) notes that while Texas Governor Rick Perry “opposes the federal law and has promised to do nothing to help implement it,” Sebelius “will meet with Austin Mayor Lee Leffingwell and San Antonio Mayor Julian Castro who support it.”
The Texas Public Radio (8/8, Pace) reports that on Thursday evening, Secretary Sebelius will speak at Trinity University in San Antonio, at a public event offering “information about the new health care act.”
The San Antonio Business Journal (8/8, Bailey, Subscription Publication) “Alamo City Beat” blog reports on Sebelius’ upcoming visit to San Antonio, noting that “over the next several months,” her “presence will be in big demand.”
Three Texas television stations reported on her upcoming visits. First, in its 7:00 p.m. broadcast Wednesday night, KXAN-TV reported that HHS Secretary Kathleen Sebelius “visits Austin tomorrow,” to “talk about Obamacare with local hospitals.” The piece noted that HHS just unveiled a new website, healthcare.gov, on which you can make a personal count to sign up for coverage under the law.
KVUE-TV Austin, TX (8/8) reported that ahead of the meeting Thursday, Austin Mayor Lee Leffingwell said, “As we approach this fast-approaching enrollment date, it is vital that we engage our local community leaders to take part in discussions at the highest level about the expanded coverage. We need to work collaboratively to ensure that our residents, especially those currently without insurance, know about the Health Insurance Marketplace and that they
will soon be able to sign up for coverage.”
KHOU-TV Houston (8/8) reported that her Austin visit, “part of a multi-city tour” to discuss the ACA, “will not be open to the public.”
HHS Launches Healthcare.gov Information Site To Address ACA Confusion.
USA Today (8/8, Kennedy) reports HHS launched healthcare.gov this week, offering resources “to help Americans better understand the health insurance exchanges that will launch Oct. 1.” Announcing the website, HHS Secretary Kathleen Sebelius said, “Everywhere I go, I meet people who are excited about the marketplaces and hungry for information.” The launch comes as a “new survey showed only 14% of adults polled by Carnegie Mellon
University of Pittsburgh understood four questions about basic insurance terms.”
Security Questions Threaten Exchange Launch Date.
McClatchy (8/8, Pugh) reports that the October launch of the Affordable Care Act’s exchanges “is in jeopardy,” due to “looming questions about information security.” The article references the recent OIG audit which revealed “tight deadlines that must be met to ensure the security” of the law’s data services hub. According to the report, CMS’ chief information officer Tony Trenkle was supposed to decide by
September 4 “whether information routed through the hub was secure from hackers and identity thieves,” but now his decision is expected September 30, just “a day before open enrollment on the marketplaces is scheduled to begin.”
Wednesday night, CNBC The Kudlow Report ran a seven-minute report on the data hub’s security delay, calling it “another sign the President’s signature achievement is in trouble.”
Also reporting on the data hub security delay are The Hill (8/8, Viebeck) “Healthwatch” blog and Fox Business (8/7, Rodgers).
Given this delay, syndicated columnist Mona Charen writes in the Atlanta Journal-Constitution (8/8) that the ACA amounts to an “outright encouragement of fraud.”
Texas Declines To Enforce Any ACA Regulations.
The Texas Tribune (8/8, Luthra) reports that Texas has announced that it will not “enforce provisions and regulations” of the Affordable Care Act, becoming one of six states for which CMS must “step in to do it.” According to the article, this decision “could lead to confusion over who’s responsible for protecting Texas insurance consumers.”
The Houston Business Journal (8/8, Raji, Subscription Publication) reports that along with Texas, Alabama, Arizona, Missouri, Oklahoma and Wyoming “have all made the decision not to enforce the law.”
Public Health and Private Healthcare Systems
Hospitals Face Penalties Over Medicare Readmissions.
Media outlets across the country are reporting on the fines imposed by Medicare on hospitals that readmit patients covered by the program within 30 days after discharge. According to a report by Kaiser Health News, Medicare has levied $227 million in fines against nearly two-thirds of the country’s qualified hospitals, or 2,225 facilities, across the country, which come in the form of reduced payments for the fiscal year commencing Oct. 1.
The Middlesex County (NJ) Home News Tribune (8/7, Bichao) reports that 23 New Jersey hospitals “will pay larger penalties” next year and 36 other facilities across the state “will continue paying penalties in the second year of the program, although at lower rates than last year.” The Home News Tribune also says that “just five hospitals were not penalized this year.”
The Asbury Park (NJ) Press (8/7, Diamond) says that among those New Jersey hospitals being penalized are Community Medical Center and Kimball Medical Center following the readmission of more patients within 30 days after discharge than either hospital had anticipated. The article says that both facilities struggle with readmissions as Community caters primarily to the elderly and Kimball to “lower-income residents,” both of which are groups that are “more likely
to go to the hospital for care.” The hospitals’ owner, Barnabas Health, said it’s “working closely with doctors and insurers in a move that should help them keep closer tabs on patients who might be at risk of returning to the hospital.”
The Waterbury (CT) Republican-American (8/7, Chedekel) reports that “24 of Connecticut’s 31 hospitals will face Medicare penalties.” The article says that although none of those hospitals “will lose the maximum” two percent per Medicare payment penalty, three of them “will lose more than one percent.” The article adds that 14 hospitals “will face lower penalties than they did in the last year.” Nevertheless, the Republican-American says
that the hospitals will be assessed an average penalty of 0.43 percent of Medicare payments, which is “higher than the national average.”
The Meriden (CT) Record-Journal (8/7, Buchanan) reports that among those Connecticut hospitals facing penalties are Masonic Home and Hospital, which will be assessed a 1.14 percent loss of Medicare reimbursements, and MidState Medical Center, which was assessed a .78 percent fine. The article says that the penalties mark the second year in a row that the two hospitals are facing fines.
The Bangor (ME) Daily News (8/7, Farwell) reports that 12 Maine hospitals are facing fines but that relative to other states, “Maine’s hospitals ranked near the top, at seventh nationally by the amount of the average penalty.” The article says that none of the state’s hospitals “will face the maximum penalty of two percent” and that the state’s average fine is 0.10 percent of payments, which is “significantly less than the national
average of 0.38 percent.”
The Central Penn Business Journal (8/7, Stauffer) reports that most Central Pennsylvania “general acute care hospitals will see a decrease of no change in their assessments.”
Washington State Exchange Will Be Missing Key Components October 1.
The Puget Sound (WA) Business Journal (8/8, Bauman, Subscription Publication) “Health Care Inc.” blog reports that when Washington state’s new exchange launches on October 1, it will be missing a few components. For example, according to exchange spokesman Michael Marchand, at first “visitors to the Healthplanfinder site won’t be able to chat online with navigators when they have questions about the process.” Some fear that “the first version of the
exchange won’t make it easy for users to get help,” but officials say “the version that is available on Oct. 1 is not the final product.”
Orszag Warns Medicare Not To Adjust Payments Geographically.
Although “costs vary wildly” within the US healthcare system, the “variation doesn’t appear to be reliably correlated with differences in quality,” Peter R Orszag, vice chairman of corporate and investment banking and chairman of the financial strategy and solutions group at Citigroup Inc. and former director of the Office of Management and Budget in the Obama Administration, writes for Bloomberg
News (8/7). He points out that according to a Institute of Medicine panel, it would
be “unwise” for Medicare to “pay more in high-value areas of the country than in low-value ones.” Instead, the panel suggested that CMS “should reward value provided by individual doctors and hospitals.” Although some health economists and experts “strongly” support a “paying for value” system, the shift “loads more risk onto doctors and hospitals.”
Also in the News
Smokers Said To Cost Employers An Extra $5,816 Per Year.
The New York Times (8/7) reports on its “Well” blog that researchers at The Ohio State University have analyzed data from earlier studies on the costs of smoking and concluded that a smoker “costs a private employer in the United States an extra $5,816 per year compared with a nonsmoker.” The researchers “estimated that the largest cost, at $3,077 annually, came from taking smoking breaks” as smokers took, “on average, about five
breaks a day, compared with the three breaks typically sanctioned for most workers.” At $2,056, the second largest cost “was related to excess health care expenses,” as smokers “typically have more health problems than nonsmokers, including heart and lung disease and various cancers.” Additional costs were dues to “increased absenteeism.”
Wednesday's Lead Stories
NAHU Newswire is a digest of the most important news selected from thousands of sources by the editors of BulletinHealthcare. The National Association of Health Underwriters does not receive any revenue from the advertising herein. The presence of such advertising does not endorse, or imply endorsement of, any products or services by the National Association of Health Underwriters.
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