By Sue Pondrom
There are three key aspects for journalists to watch as the Affordable Care Act moves into its second year: Congress, the courts and the states, according to panelists speaking about “Health Reform: Repeal, replace of implement?”
Officials, health system administrator discuss challenges, implementation of the Affordable Care Act, Feb. 24, 2011 (audio available)
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Noam Levy, health policy reporter for the Los Angeles Times, suggested that reporters be aware of several Republican proposals. These include medical malpractice, high risk pools, interstate sale of insurance, association health plans, variable health premiums and individual/employer mandates. Additionally, watch the Obama administration for its implementation on initiatives that don’t require legislative action. These include regulations for Accountable Care Organizations (ACOs), medical loss ratios (MLRs), food labeling, and patients’ Bill of Rights. Also grants (such as for the exchanges that will be set up by states, and premium review), small business tax breaks, donut hold relief, dependent and preventive health coverage, quality/efficiency measures such as the innovation center, and health information technology.
“The exchanges won’t start until 2014, so you’ll probably see more focus on speeding implementation of ACOs” and similar areas implemented this past year, he said.
“The big issues in the next year will be Republicans proposing block grants, with a lot of discussion expected on how states can save money with Medicaid,” he said. Additional areas are maintenance of effort, dual eligibles and managed care. For Medicare, issues include cost sharing (such as whether seniors should pay more) and vouchers.
Going forward, Levy suggested coverage of delivery system reform, whether doctors and hospitals are forming ACOs, where providers are participating in ACOs, medical homes and hospital quality. Some questions he suggested pursuing:
- Is your state seeking a waiver from HHS?
- How extensively does your state us managed care and how it working?
- What has been the effect of previous cutbacks?
- Are small businesses taking advantage of tax breaks?
- Is your state going to restrict abortion?
Covering the Court action of health reform, Ken Jost, Supreme Court editor for CQ Press and associate editor of CQ Researcher, said an appellate court case to watch this spring includes Virginia ex rel. Cuccinelli v. Sebelius, Secretary of the Department of Health and Human Services (in which Judge Henry Hudson ruled the health reform law unconstitutional).
In June, appellate courts should rule on Tomas More Law Center v. Obama (in which Judge George Steeh ruled the law constitutional) and Florida ex rel. Bondi v. U.S. Department of Health and Human Services (where Judge Roger Vinson ruled the law unconstitutional. Additional lawsuits to watch include Liberty University v. Geithner, Secretary of Treasury (where Judge Normal Moon ruled the law constitutional), and Mead v. Holder, where Judge Gladys Kessler ruled the law constitutional).
“The three judges ruling the law constitutional were Democrats; the two ruling unconstitutional were Republicans,” he said. “But there is no way to make a reliable prediction about how the appellate courts will rule.”
He noted that the state of Virginia has said it will ask the Supreme Court to immediately take on the law. But, the Supreme Court “rarely does this,” Jost said.
Sarah Kliff, health care reporter for Politico, discussed the states, noting that the biggest issue is development of the health exchanges. She said states should be on track in 2013 for a 2014 implementation. If they aren’t, then the federal government will develop the exchange. She noted that seven states have been given innovator grants to help them in development: Wisconsin, Kansas, Oregon, Maryland, Massachusetts, New York and Oklahoma. But, Oklahoma just sent back its money, “under pressure from Republicans,” she said.
Story ideas around the exchanges could include the governor’s office and whether he/she supports running an exchange or leaving the task to the HHS, a profile of legislators who are pushing exchange bills or those who are obstructing, and an explanation of what the exchange will look like in your state.
Additional topics include insurance rate hikes (how are insurers reacting to the new scrutiny, and how have the 45 states who got ‘rate review’ been using it?). Also medical loss ratio waivers is a possible topic. Thus far, nine states have gotten MLR waivers: Maine, New Hampshire, Nevada, Kentucky, Florida, Georgia, North Dakota, Iowa and Louisiana.
“Ask if your state is applying for a waiver,” she suggested. “Reach out to your state commissioner to find out their current position.”
Sue Pondrom is an independent journalist based in San Diego.