Health Reform Implementation
King v Burwell
AMCHP is closely monitoring the Supreme Court case, King v. Burwell. This case hinges on the legality of the advance premium tax credits (the "subsidies"). As written, the Affordable Care Act (ACA) states that subsidies will be provided only in states that operate their own exchanges. Currently 34 states are operating a federally facilitated exchange. 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, rendering coverage unaffordable and inaccessible. According to an estimate by the National Women's Law Center (NWLC), "Without this financial help, approximately 4.2 million women are at risk of losing their health insurance because they could not afford full cost of monthly health insurance premiums (NWLC, 2015)." Kaiser Family Foundation developed an interactive map that helps us understand the state by state implications for a ruling in favor of the challenger. Additionally, some lawmakers at the federal and state level are drafting alternative plans in the event of a ruling in favor of the challenger. A ruling is expected sometime in the next few weeks.
FAQs – ACA Implementation
On May 11, the Centers for Medicare and Medicaid (CMS) released the 26th set of FAQs regarding implementation of the ACA. This FAQ clarifies questions regarding the coverage of preventive services such as BRCA testing, coverage of contraceptives, well-woman preventive care for dependents, clarification on sex-specific recommended preventive services, among others. The FAQ is available here.
Medicaid Managed Care
CMS recently announced a notice of proposed rulemaking to modernize Medicaid and the Children's Health Insurance Program (CHIP) managed care regulations. The proposed rule would strengthen the delivery of quality care at the state level and in a cost-effective manner. Specifically, CMS proposed to modernize managed care in the following ways (CMS press release). Some of the focus areas of the new regulations include delivery system reform, payment/accountability improvements, beneficiary protections, improving quality of care. The full regulations are available on the Federal Register. AMCHP will continue to monitor this proposal and provide analysis.
In the May 2015 Agency for Healthcare Research and Quality (AHRQ) Evaluation Highlight, authors discussed: How Are CHIPRA quality demonstration states improving perinatal care? This highlight discussed two states in specific, Florida and Illinois, and their efforts in "developing and implementing initiatives to improve the quality and outcomes of perinatal care." Through the state examples, the report highlights how Florida and Illinois forged partnerships, developed quality processes, developed systems-level changes, and implemented a variety of initiatives. The Evaluation Highlight is available here.