SAMHSA222s Weekly Financing News Pulse: National Edition
March 4, 2011
3/4/11
1
SAMHSA222s Weekly Financing News Pulse: National Edition
National News
Obama Administration Files Briefs in Health Reform Appeals
HHS Offering $200 Million in
Health Reform
Grants to Improve State Insurance Rate Review
Senator
Grassley
Introduces Bill to Combat Health Fraud
Senate
Finance Committee Considering Bill to Allow States Earlier Access to
Health Reform Waivers
Update:
President Signs Short
-
Term CR
,
Maintains Funding for
Health Reform
Studies Released
HHS Finds ERRP
Paid
$535 Million
for Health Claims
Through 2010
GAO Finds $48 Billion in Improper FY2010 Medicare Payments
Congressional Republicans and RWJF Release Estimate
s
of
Health Reform
222s
Impact on
States
KFF Chartpack Outlines Key Aspects of Medicaid
KFF Brief Examines Health Exchange Subsidies
RWJF Examines Health Reform222s Impact on Individuals with
Comorbid Mental and Physical Disorders
Around the Hill: Hearings on Health Financing
To Subscribe to SAMHSA222s Weekly Financing News Pulse, please go to the following link and choose 223Health Care
Financing224: https://service.govdelivery.com/service/multi_subscribe.html?code=USSAMHSA&
origin=http://www.samhsa.go v/enetwork/success.aspx
For questions or comments, please contact
Rasheda Parks
( Rasheda.Parks@samhsa.hhs.gov ).
SAMHSA222s Weekly Financing News Pulse: National Edition
March 4, 2011
3/4/11
2
National News
Obama Administration Files Briefs in Health Reform Appeals
:
On
February 28, the
Obama
Administration
filed a memo
in the multi
-
state lawsuit challenging the national health care reform law222s
individual insurance mandate. On January 31,
U
.S. District Court Judge Roger Vinson
ruled that the
law222s individual insurance mandate exceeds Congress222 constitutional authority
to regulate interstate
commerce
. H
owever,
Judge Vinson did not explicitly bar
health
care reform
implementation
during the
appellate process
.
The
administration
222s
memo argues that
health reform implementation should
continue
during that
process,
urging
Judge Vinson
to clarify his ruling. The memo notes
that the
individual mandate applies
to
only 10 of the law222s 450 provisions and
suggests
that halting
implementa
tion will
negatively
affect
the federal health care system
( Politico, 2/28 ; The Hill, 2/28 ; The Olympian, 3/2 ). Also on February 28, the Obama Administration filed a brief with the
4th
U.S. Circuit
Court of Appeals
arguing that health reform222s individual mandate is a constitutional use of Congress222
power to regulate interstate commerce. The filing is part of the administration222s appeal of U.S. District
Court Judge Henry Hudson222s ruling
in
Virginia Attorney General Ken Cuccinelli222s
(R) health reform
lawsuit
.
In that case, Judge Hudson ruled
that the national health care reform law222s individual insurance
mandate is unconstitutional. Oral arguments are scheduled for May.
Finally,
Kaiser
Health News
(KHN)
has begun
publishing a
n updated 223 scoreboard ,224
tracking health reform court case
s
and
offering
information on each of
the
22 case
s,
including
the plaintiff, jurisdiction, and current status
of the case
( AP via Yahoo!, 2/28 ; Kaiser Health News, 3/1 ).
HHS Offering $200 Million in
Health Reform
Grants to Improve State Insurance Rate Review
:
On
February 24, the
U.S. Department of Health and Human Services
(HHS) announced
the availability of
$200 million
for
states to improve their
health insurance rate review processes
. A
vailable through the
national health care reform law,
the funding includes $150 million to
creat
e
and enhanc
e
rate review
programs, $27.5 million
specif
ically
for states that
already
have the authority to prevent rate increases
,
and $22.5 million
reserved for
more populous
states. Under health reform
,
states must review rate
increases of 10 percent or more
and
are required to
establish their own thresholds by 2012.
In the first
round of rate review grants, HHS awarded $46 million to 45 states and the District of Columbia ( The Hill, 2/24 ; Kaiser Health News, 2/25 ).
Senator
Grassley
Introduces Bill to Combat Health Fraud:
On March 2, Sen. Charles Grassley
(R-
IA) proposed legislation
(
S. 454
)
to
reduce
fraud in Medicare, Medicaid, and the Children222s Health
Insurance Program (CHIP). The bill would require Medicare, Medicaid, and CHIP providers
to provide
Congress with
health financing data upon request. The bill would also require Medicare claims and
payment data to be publicly available
and
strengthen
Medicaid provider oversight. The bill now goes
before the Senate Finance Committee
( The Hill, 3/2 ; Kaiser Health News, 3/3 ).
S
enate
Finance Committee Considering Bill to Allow States Earlier Access to
Health Reform
Waivers
:
The
Senate Finance Committee is considering a
bill (
S. 248
) that would give states earlier
access to waivers exempting them from certain provisions of the national health care reform law
.
Under
h
ealth reform
, states may obtain waivers exempting them from select
provisions
,
including the
individual insurance mandate
and
health plan minimum benefit requirements. Currently, health reform
will make
those
waivers available in 2017
; however, u
nder the bill, those waivers would become
available in 2014, when many of the law222s provisions take effect. To qualify for a waiver,
states must
establish an alternative plan that insures as many individuals as the original law without increasing the
federal deficit
( The Wall Street Journal, 3/1 ; Kaiser Health News, 3/1 ).
SAMHSA222s Weekly Financing News Pulse: National Edition
March 4, 2011
3/4/11
3
Upda
te:
President Signs Short
-Term CR,
Maintains Funding for
Health Reform
:
On
March 3,
President Barack Obama
signed legislation (
H.J.
Res
.
44
) that funds the federal
government through
March 18.
The measure reduces
federal
spending by $4 billion
; h
owever, u
nlike the
long-
term
U.S.
House
spending bill (
H.R. 1
), the
short
-
term
bill does not eliminate funding for health reform
implementation. White House and Congressional officials are currently negotiating
a continuing
resolution (CR) to fund the government through the remainder of the
current
fiscal year ( CQ, 3/2 ; Kaiser Health News, 3/3 ).
Studies Released
HHS Finds ERRP Paid
$535 Million
for Health Claims
Through 2010:
On March 2
, the U.S.
Department of Health and Human Services
(HHS) released a report
examining the national health care
reform law222s Early Retiree Reinsurance Program (ERRP). Under the program, health reform allocates $5
billion for businesses, unions, and state and local governments to cover health care costs for early
retirees between the ages of 55 and 65.
The report found that
,
as of December 31, 2010,
HHS had
approved
ove
r 5,000 employers for participation in the program
and
paid $535 million for 4.5 million
individuals
222
health services
. The report highlights methods that
participating plans use
to reduce costs
for individuals with high-
cost and chronic health conditions.
Running through December 2014, the
program
will cover 80 percent of the costs of
retirees222
claims between $15,000 and $90,000
and offer
coverage for early retirees222 spouses and dependents
( HHS, 3/2 ; Kaiser Health News, 3/3 ).
GAO Finds $48 Billion in Improper FY2010 Medicare Payments:
At a House Energy and
Commerce Subcommittee on Oversi
ght
hearing o
n March 2, the Government Accountability Office
(GAO) presented a report
examining fraud and improper payments in Medicare
. The report found that
$48 billion of th
e
$509 billion in FY2010 Medicare outlays went to fraudulent or otherwise improper
payments. The report argues that the
Centers for Medicare & Medicaid Services
(CMS) is not doing
enough to prevent fraud, and suggests implementing fraud prevention
measures
including
improved
physician profiling and payment reform ( Politico, 3/2 ; Kaiser Health News,
3/3 ).
Congressional Republicans and RWJF Release Estimate
s
of
Health Reform
222s
Impact on
States
:
On
March 1,
Congressional
Republicans
and the
Robert Wood Johnson Foundation
(RWJF)
released
reports examining the impact of the national health care reform law on state health costs. The
Congressional Republicans222
report
projects that the
law222s Medicaid
expansion will cost states $118
billion through 2023. The
GOP
report also offers state
-
by
-
state cost projections for the Medicaid
expansion.
RWJF222s report
estimates
that the Medicaid expansion and health exchanges
subsidies
will
bring states
a combined
$82.
3 billion in new federal
funding
but offers no assessment of states222
net
spending change
. The
RWJF report also notes
that Medicaid beneficiaries
insured under the expansion
will
have lower costs than
existing
beneficiaries because they are less likely to have health problems
( The Hill, 3/1 ; Kaiser Health News, 3/2 ).
KFF Chartpack Outlines Key Aspects of Medicaid
:
On
February 25, the
Kaiser Family Foundation
(KFF) released a chartpack
outlining five aspects of the Medicaid program. The chartpack explains how
Medicaid fits into the broader
health care system
,
provid
ing
charts and graphs
examining
components
of the program. KFF posits that Medicaid is an integral part of the health system
,
Medicaid
spending
growth is driven by increasing enrollment and spending on
seniors and individual
s with disabilities
,
and
that
Medicaid brings states federal revenue and creates jobs
. Additionally, the authors argue that
SAMHSA222s Weekly Financing News Pulse: National Edition
March 4, 2011
3/4/11
4
Medicaid increases access to
care through private providers
and
that
health reform222s Medicaid
expansion will
significantly
reduce the number of uninsured
Americans
, with the federal government
financing the majority of the expansion ( KFF, 2/25 ).
KFF Brief Examines Health Exchange Subsidies:
On February 15,
KFF
released a brief
examining
federal health exchange subsidies
available under the national health care reform law. Noting that
t
he
subsidies
will be available to individuals who are ineligible for public coverage and earn up to 400
percent of the
fe
deral poverty level (FPL)
, t
he authors
project that 19 million individuals will be eligible
for the subsidies by 2019. The brief explains that
,
unlike tax credits, the subsidies are advance payments
made
directly
to individuals. The authors explain
how the advance payment process will
work a
nd
discuss potential tax reporting issues that may arise ( KFF, 2/15 ; Kaiser Health News, 2
/25 ).
RWJF Examines Health Reform222s Impact on Individuals with
Comorbid Mental and Physical
Disorders
:
The
Robert Wood Johnson Foundation
(RWJF) released a report
examining the national
health care reform law222s impact on individuals with comorbid mental and physical health disorders
. The
report notes that individuals with mental illnesses are more likely than those without mental illness to
be uninsured and have physical health ailments. The authors posit that health reform222s expanded
coverage
will benefit this population, particularly through broader
Medicaid e
ligibility
. The brief
suggests that health reform offers policymakers an opportunity to address mental and physical illness
comorbidities in a manner that improves care
,
reduc
es
care fragmentation
,
and disseminat
es
evidence
-
based practices for treating comorbid illnesses in routine care settings ( RWJF, February ; Kaiser Health News, 2/25 ).
Around the Hill: Hearings on Health Financing
House Energy and Commerce Commit
tee:
Impact of Health Care Overhaul on Medicaid and the States
March 1, 9:00 a.m. 215 2123 Rayburn
Senate Finance Committee: Preventing Health Care Fraud
March 2, 10:00 a.m. 215 Dirksen
House Energy and Commerce Subcommittee on Oversight and Investigations:
Waste, Fraud and
Medicare/Medicaid
March 2, 10:00 a.m. 2322 Rayburn
House Ways and Means Subcommittee on Oversight: Health Care Fraud Prevention and Punishment
March 2, 2:00 p.m. 1100 Longworth
