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 Legislative and Policy Corner

Health Reform Implementation

Outreach and Enrollment
The U.S. Department of Health and Human Services (HHS) has announced that since Nov. 15, 2014 nearly 6.4 consumers "selected a plan in the Federally Facilitated Marketplace or were automatically re-enrolled, with approximately 30 percent of this total comprised of people newly signing up for Marketplace coverage."

Continue being a champion for open enrollment! Open enrollment for Obamacare runs through Feb. 15. More information can be found in the AMCHP fact sheet and find more information on the Affordable Care Act and women here.

King v. Burwell
The U.S. Supreme Court will hear the case on Mar. 4; decision is expected in June. At issue is the legality of the advance premium tax credits (the "subsides"). As written, the Affordable Care Act states that subsidies will be provided only in states that operate their own exchanges. The Obama administration argues that the law always intended to make the subsidies available to all, regardless of whether an exchange was state- or federally run. If the Supreme Court rules that subsidies are not available in the federal exchange, it could result in loss of coverage for millions of people and destabilization of the health insurance industry. The Obama administration has not indicated if contingency plans exist, should the court rule in favor of the plaintiff. The 37 states with federally facilitated marketplaces also are largely unprepared for this potential outcome.

Anti-ACA Legislation in 114th Congress

Repealing the medical device tax
The ACA includes a 2.3 percent excise tax on medical devices. The provision took effect in 2013 and is projected to raise $20 billion between FY 2013 and 2019. The tax has been politically contentious since the ACA took effect. There is now strong bipartisan support in Congress to repeal it. Sens. Amy Klobuchar (D-MN) and Orrin Hatch (R-UT) are working on legislation to repeal the tax, coupled with a fiscal offset. Other Democrats – including Sens. Elizabeth Warren (D-MA) and Al Franken (D-MN) – are supporting repeal of the tax as well.

Repealing the employer mandate
Certain members of Congress are working on legislation to repeal the employer mandate. The ACA requires that firms with 100 or more full-time equivalent employees (FTE) insure at least 70 percent of their full-time workers by 2015, and 95 percent by 2016. Small businesses with 50-99 FTE will need to start insuring full-time workers by 2016. 

Redefining F-T employment
In an effort support broader employer-based health coverage, the ACA includes a provision that classifies a full-time worker as one who works 30 hours per week. It is anticipated that members of Congress will develop legislation to redefine full time employment as 40 hours per week.

Medicaid Expansion
The ACA Medicaid expansion is gaining traction in states that have traditionally opposed the legislation. Republican governors in Wyoming, Utah, Idaho, North Carolina and Tennessee are attempting to persuade their legislators to accept federal funding, while Democratic governors in Montana and Pennsylvania will work with Republican-controlled legislatures in a similar vein.

Report: Non-medically Indicated Deliveries Paid by Medicaid
A recent study published in Health Affairs shows that "Nearly 9 percent of the births covered by Medicaid – or about 160,000 each year – were elective deliveries before 39 weeks of gestation, which lead to worse health outcomes for mothers and children and higher costs." AMCHP has an issue brief on state strategies to reduce non-medically indicated deliveries before 39 weeks.​

Medicaid payment bump
The ACA provision for a two-year Medicaid primary care payment increase expired on Dec. 31, 2014. The elimination of the payment bump comes at a time of dramatic increase in Medicaid enrollment nationally. The reduction in revenue is expected to further exacerbate the Medicaid provider shortage. Maryland, Alabama, Colorado, Iowa, Mississippi and Connecticut have opted to continue the payment increase using state funds.​