SAMHSA222s Weekly Financing News Pulse: National Edition
October 1, 2010
10/1/10
1
SAMHSA222s Weekly Financing News Pulse: National Edition
National News
GAO Comptroller Appoints PCORI Members; HHS Clarifies
Coverage Regulations For Children with
Preexisting Conditions; NAIC Waiting to Issue MLR Recommendations
Polls Find Rising Support for Reform, Confusion Remains
Senate Rejects Resolution to Require
Rewriting Insurers222 223Grandfathered224 Status
HHS Awards $26.2 Million in Grants to Expand Primary Care Services for Individuals with Behavioral
Health Disorders Regulations
Update: House Approves
Methamphetamine Education, Treatment, and Hope Act of 2009
CMS Administrator Berwick Announces Richard Gilfillan to Head CMI
Update: President Signs Small Business Bill Including Program to Combat Medicare F
raud
Studies Released
OSF Study Offers Recommendations for Closing the Addiction Treatment Gap
AJPH Study Suggests Doubling State Alcohol Taxes to Reduce Alcohol
-
Related Disease and Injury
Heritage Foundation Suggests CBO Health Reform Predictions are Too Optimistic
KFF Briefs Examine Medicaid Spending, Medicaid Enrollment, and Health Reform Implementation
Brief Exa
mines the Role of Patient
-
Centered Medical Homes in Health Reform
Hewitt Associates Finds Health Reform Will Increase Employer-
Sponsored Health Care Premiums in 2011
Families USA Offers State
-
By
-
State Analysis of Health Reform222s Tax Credits
Avalere Health Study Finds Medicare Part D Premiums Rising in 2011
Around the Hill: Hearings on Health Financing
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SAMHSA222s Weekly Financing News Pulse: National Edition
October 1, 2010
10/1/10
2
National News
GAO Comptroller Appoints PCORI Members; HHS Clarifies Coverage
Regulations
For
Children
with Preexisting Conditions; NAIC Waiting to Issue MLR Recommendations
:
On September 23,
U.S. Government Accountability Office
(GAO)
Comptroller General Gene Dodaro appointed 19
members to the Patient
-
Centered Outcomes Research Institute
(PCORI),
established
under the national
health care reform law to conduct comparative effectiveness research. The 19
appointed
members
will
ser
ve
staggered six-
year terms along with the directors of the U.S. Agency for Healthcare Research and
Quality
(AHRQ) and the U.S. National Institutes of Health
(NIH)
( The Hill, 9/23 ; Kaiser Health News, 9/24 ). On September 24, the U.S. Department of Health and Human Services
(HHS)
issued clarification
on
June
regulations barring
health
insurers from denying coverage to children with preexisting
conditions. T
he clarification co
mes
after
several insurers
announced plans to withdraw from the
children
-
only market
, citing increased costs under health reform. Insurance officials say that, if they
continue offering new policies in the children
-
only market, the
new
rules will incentivize covering
children only when they become sick, drastically increasing insurer
costs. HHS clarified that insurers
may take actions to regulate
costs
, including setting
rates based on health status, charging higher rates
in the childre
n-
only market than for dependent coverage, and imposing surcharges for intermittent
coverage
.
HHS officials
also
say they would consider adopting a
national
open enrollment period for the
children
-
only market if insurers would agree to continue offering such
policies ( The Hill, 9/27 ; Kaiser Health News, 9/27 ).
In other health reform news, on September 28,
National Association of Insurance
Commissioners
(NAIC) officials announced that they would not finish recommendations
on
medical loss
ratio
(
MLR
)
forms and instructions
in time for HHS to release regulations in October. In a Se
ptember 14 letter ,
HHS Secretary Kathleen Sebelius222
requested that NAIC finish the recommendations
to allow
HHS
to
issue regulations in October and additional
guidance in December. NAIC officials say
that, rather than
se
nding
the form and instruction recommendations early, they will send
all of their MLR
recommendations simultaneously
, most likely after adopting
final recommendations at the NAIC retreat
in mid
-
October ( The Hill, 9/29 ; Kaiser Health News, 9/30 ).
Polls Find
Rising Support for Reform, Confusion Remains:
The September Kaiser Family
Foundation (KFF) Kaiser Health Tracking Poll
found that the percentage of Americans holding
a
favorable view of the national health care reform law rose from 43 percent in August to 49 percent in
September. In addition, the percentage of Americans holding an unfavorable view of the law declined
from 45 percent to 40 percent over the same period.
However,
KFF found that confusion over the law
remains high
, with 53
p
ercent
of respondents reported that they are confused about the law
.
In
addition, 26
percent of respondents favor
repealing the law. A related CNN
poll
found that 47 percent
of Americans favor repealing major provisions of the law and replacing them with new measures
,
while
49 percent support making no changes
or strengthening the law to increase government involvement.
CNN found that 43 percent
of respondents believe
that
the law will not significantly affect them
, 37
percent believe they will be worse off
under the law,
and 18 percent believe
that
they will be better off
under the law
( KFF, 9/27 ; CNN, 9/28 ; Kaiser Health News, 9/29 )
.
Senate Rejects Resolution
to
Require Rewriting
Insurers222
223Grandfathered224 Status
Regulations
:
On
September 29, the U.S. Senate
rejected a resolution proposed by
Sen. Mike Enzi
(R-
WY)
that would
require the Obama Administration
to rewrite regulations outlin
ing
how health
insurance plans obtain 223grandfathered status.224 The national health care reform law allows health plans
to obtain grandfathered status
if they existed when the law took effect and do not significantly alter
their coverage. Plans with the protected status are exempt from some
of the law222s requirements.
SAMHSA222s Weekly Financing News Pulse: National Edition
October 1, 2010
10/1/10
3
Senators supportive of the measure argued that the regulations were too restrictive a
nd ran counter to
President Barack Obama222s
assertion that individuals
can keep
their current health
coverage
. White
House officials said that Sen. Enzi222s resolution would have created 223significant uncertainty224 in the
insurance industry over grandfather
in
g requirements
( The Hill, 9/29 ; Kaiser Health News, 9/29 ).
H
HS Awards $26.2 Million in Grants to Expand Primary Care Services for Individuals with
Behavioral Health Disorders: On September 24,
HHS
awarded $26.2 million in grants to improve
primary care services for individuals with behavioral health disorders. To integrate primary care into
behavioral health services, HHS awarded four
-
year grants of up to $2 million to 43 community
behavioral health agencies. The remaining $5.3 million went to the
Nati
onal Council for Community
Behavioral Healthcare
(NCCBH) to establish a national resource center to foster the integration of
primary and behavioral health care services at the community level. Financed jointly by the U.S.
Substance Abuse and Mental Health Services Administration
(SAMHSA) and the U.S. Health Resources
Services Administration
, the center will offer training and technical assistance to community
-
based
behavioral health programs and develop models of integrated care. The majority of the gran
t funding
comes
from the national health care reform law222s Prevention and Public Health Fund
. In related news,
on September 27
, HHS awarded $68 million in health care reform grants to support community living for
seniors and individuals with disabilities. The following day, HHS awarded $320 million in health reform
grants to strengthen and expand the country222s primary care workf
orce. Of the $320 million, $253
million will fund six
U.S. Health Resources and Services Administration
(HRSA) programs that address
current and expected primary care labor shortages, $5.65 million will help 26 states to start
comprehensive health care wo
rkforce planning and implementation, and $4.2 million go to the Personal
and Home Care Aide State Training Program ( SAMHSA, 9/24 ; The Medical News, 9/27 ; The H
ill, 9/27 ; Kaiser Health News, 9/28 ; Kaiser Health News, 9
/29 ).
Update:
House Approves Methamphetamine Education, Treatment, and Hope Act of 2009: On
September 30,
the
U.S. House
approved the
Methamphetamine Education, Treatment, and Hope Act
of 2009 (
H.R. 2818
). The bill requires the Substance Abuse and Mental
Health Services
Administration222s
(SAMHSA)
Center for Substance Abuse Treatment
(CSAT) to educate primary care
providers on recognizing the signs of addiction and applying evidence
-
based practices when screening
and treating individuals who have or are at risk for developing an addiction. The bill also revises a
residential substance abuse treatment grant program for pregnant and parenting women to include
treatment for methamphetamine. The bill emphasizes treatment for targeted populations including
low
-
income women, women in rural areas, and women in regions with high addiction rates. In addition,
the bill requires the Director of SAMHSA222s Center for Substance Abuse Prevention (
CSAP) to establish a
clearinghouse offering information and educational mate
rials to employers and employees regarding
drug testing policies and programs in the workplace. Finally, the bill allows recipients of grants for
school and community methamphetamine and inhalant prevention programming to use their funds for
student
-
drive
n methamphetamine awareness projects. The bill now goes before the U.S. Senate
( THOMAS ).
C
MS Administrator Berwick Announces Richard Gilfillan to Head CMI
:
On
September 27,
Centers for Medicare & Medicaid Services
(CMS)
Director Donald Berwick
announced that Dr. Richard
Gilfillan
will head CMS222 Center for Medicare & Medicaid Innovation
(CMI).
Slated to being operations
January 1, t
he national health care reform law created the CMI to promote payment and service delivery
reform. Dr. Gilfillan is a family physician by training and
has
consulted
on health care financing and
SAMHSA222s Weekly Financing News Pulse: National Edition
October 1, 2010
10/1/10
4
delivery
. Dr. Gilfillan
most recently served as President and CEO of
Geisinger Health Plan
( Kaiser Health News, 9/28 ; Kaiser Health News, 9/28 ; The Hill, 9/28 ).
Update: President Signs Small Business Bill Including Program to Combat Medicare Fraud:
On
September 27,
President Barack Obama signed the Small Business Jobs and Credit Act of 2010
(
H.R.
5297),
which includes a program to reduce Medicare fraud. Under the law, the U.S. Department of
Health and Human Services
(HHS) will hire contractors to conduct yearlong predictive modeling
analyses to identify and prevent illegitimate claims in Medicare Parts A
and B. The program will begin in
the 10 states with the most Medicare waste, fraud, and abuse and expand to an additional 10 states if it
achieves 223more than nominal savings.224 If savings continue after the expansion to 20 states, the program
will expand
nation
-
wide the following year.
In addition
, if the national Medicare program continues to
realize savings, the program will expand to include Medicaid and the Children222s Health Insurance
Program (CHIP) ( Miami Herald, 9/30 ; Kaiser Health News, 9/30 ; THOMAS ).
Studies Released
OSF Study Offers Recommendations for Closing the Addiction Treatment Gap: The
Open
Society Foundations
(OSF) released a brief
offering recommendations for closing the addiction
treatment gap. E
xamin
ing
national data on addiction and addiction treatment, the brief
outlines the
current gap in treatment services
and issues recommendations for closing the gap
. The authors
offer
options under the national health care reform law, including improving benefits to include necessary
treatment a
nd support services
,
and
enhancing care coordination for individuals receiving substance
abuse treatment. In addition, the authors recommend monitoring the implementation of health reform
to ensure
that
new barriers to substance abuse services do not aris
e,
and maintaining safety net care so
that the uninsured can receive necessary services
( Open Society Foundations, 9/16 ; Join Together, 9/28 ).
AJPH Study Suggests Doubling State Alcohol Taxes to Reduce Alcohol-Related Disease and
Injury:
The
American Journal of Public Health
published a study
examining the impact of state alcohol
taxes on alcohol
-
related problems.
Reanalyzing data from 50 studies between 1955 and 2004, the
authors estimate that doubling state alcohol taxes wo
uld reduce alcohol
-
related deaths by 35 percent,
fatal car crashes by 11 percent, STI transmission by 6 percent, violence by 2 percent, and crime by 1.4
percent.
Researchers found no significant connection between alcohol taxes and suicide.
The
researche
rs suggest that doubling state alcohol taxes would significantly reduce alcohol-
related disease
and injury rates, while raising the cost of an average six
-
pack of beer by fifty cents and the cost of an
average bottle of liquor by up to a few dollars ( CNN, 9/24 ).
Heritage Foundation Suggests C
BO
Health Reform Predictions are
Too Optimistic
:
The
Heritage Foundation
released a brief
challenging the
Congressional Budget Office222s
(CBO) projections of
the
impact of
national health care reform law
on the federal budget. The brief contends that certain
aspects of the
law
, including the individual insurance mandate, cuts in Medicare spending, and the
requirement that large employers offer health coverage o
r
pay a fine
may not be implemented as the
law outlines. The authors suggest that the potential impact of the indiv
idual mandate is still uncertain
because
it is at the center of multiple federal lawsuits
,
and
contend that Congress
may
prevent future
Medicare cuts. Additionally, the brief projects that the law222s penalty for employers that eliminate
health
coverage is an in
sufficient
deterrent
and that many more employers than CBO estimates will drop
coverage to cut costs. Ultimately, the authors suggest that projecting the fiscal impact of the law is
SAMHSA222s Weekly Financing News Pulse: National Edition
October 1, 2010
10/1/10
5
223precarious224 and that CBO may be wrong in its assumptions ( Heritage Foundation, 9/23 ; Kaiser Health News,
9/24 ).
K
FF Briefs Examine
Medicaid
Spending, Medicaid Enrollment,
and
Health
Reform
Implementation
:
KFF
released three briefs examining state
Medicaid
spending, Medicaid enrollment,
and health reform implementation efforts. The first brief
presents
an annual survey of
state
Medicaid
officials,
finding
that FY2010 state Medicaid spending increased an average of 8.8 percent, the highest in
eight years. State Medicaid officials attributed the increas
e to the economic recession and project that
spending will increase 7.4 percent in FY2011. The second brief
examines Medicaid enrollment,
finding
that enrollment increased by 3.
7
million nationally from
December
2008
to
December
2009,
constituting
the largest annual enrollment increase to date. The third brief
examines state efforts to prepare for
national health reform implementation
in Connecticut, Massachusetts, Michigan, North Carolina, and
Washington
. The brief highlights
state-
level
concerns
over
the
staffing and financing needed
to properly
implement health reform ( KFF, 9/30 ; KFF, 9/30 ; KFF, 9/30 ; KFF, 9/30 )
.
Brief Examines the
Role of Patient
-Centered Medical Homes in Health Reform
:
Health Affairs
and the Robert Wood Johnson Foundation
(RWJF) released a brief
examining patient
-
centered medical
homes and their role in national health reform.
The brief explains how patient
-
centered medical homes
operate and compares several current projects to determine how well
they reduce hospitalizations,
emergency room visits, and
costs
per patient
. The authors suggest that,
as demonstration projects
established by the health reform law continue and evolve, the patient-
centered medical home model
will adapt to improve quality and reduce costs ( RWJF, 9/14 ; Kaiser Health News, 9/24 ).
Hewitt Associates Finds
Health Reform Will Increase Employer
-Sponsored Health Care
Premiums in 2011:
A
Hewitt Associates
study
found that employer222s share of
employees222 health
insurance premiums will increase an average of 8.
8 percent in 2011, up from
6.9 percent in 2010 and 6
percent in 2009. However, the analysis estimates that the national health care reform law222s consumer
protections will account for
only 1 to 2 percent of that increase. Hewitt Associates also found that
employees222 share of
premium
costs
will increase 12.4 percent in 2011, primarily
as a result of employers
shifting
those
cost
s
to employees.
The study found that employers222 total per
-
employee
health
premiums have more than doubled over the past 10 years, rising from $4,083 in 2001 to $9,821 in 2011.
Over that same period, employees222
annual
health spending increased from $1,229 to $4,386 ( The Hill, 9/27 ; Kaiser Health News
, 9/28 )
.
Families USA Offers State
-By
-State Analysis of Health Reform222s Tax Credits
:
Through October 6,
Families USA
is releasing state specific briefs
examining the impact of the national health care reform
law222s health insurance premium tax credits. Beginning in 2014, health reform makes
health insurance
premium tax credits available on a sliding scale for individuals making up to 40
0 percent of the federal
poverty level (FPL). The briefs explain how the credits work, project credit
eligibility, and estimate the
total value of the credits for state residents ( Families USA ).
Avalere Health Study Finds Medicare Part D Premiums Rising in 2011
:
A
n analysis
by
Avalere
Health
found that seven of the top 10 Medicare Prescription Drug Program (Part D) plans will increase
their premiums 3 to 43 percent in 2011. T
he other three plans will lower their premiums 2 to 11
percent
over the same period
. Avalere found that average monthly premiums for the top 10 plans will
increase 10 percent
in 2011
. In addition, the analysis noted that three million seniors will have to switch
SAMHSA222s Weekly Financing News Pulse: National Edition
October 1, 2010
10/1/10
6
Part D plans in 2011
because
their current plans will be discontinued
. An additional analysis
by Avalere
found an increase in the number of Part D plans offering
some form of coverage for individuals that
reach the Part D 223doughnut hole224 coverage gap. In 2011, one-
third
of Part D plans will offer
some form
of gap coverage, up from 20 percent in 2010
.
Avalere also found that
,
in 2011
,
8 percent more plans will
offer no
-
premium coverage for low
-
income beneficiaries
( The Hill, 9/23 ; AP, 9/24 ; Kaiser Health News, 9/24 ; Kaiser Health News, 9/29 ).
Around the Hill: Hearings on Health Financing
Congress is out of session through the
Novembe
r elections. The House will reconvene Monday, November 15.
The Senate will hold a series of pro forma sessions over the next month to prevent President Obama from
making recess appointments.
Senate Indian Affairs Committee
:
Problems in Indian Health Service Aberdeen Area
September 28, 10:15 p.m., 628 Dirksen
Senate
Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies
:
Defending Against Public Health Threats
September 29, 9:30 a.m., 124 Dirksen
House
Veterans222
Affairs
Subcommittee on Health:
Veterans222 Health Bills
September 29, 10:00 a.m., 334 Cannon
