Republicans Take Aim to Overturn PPACA Provisions

Republicans took issue with the PPACA’s minimum medical loss ratio rules (MLR) and its so-called grandfather provisions at a House Energy and Commerce Health Subcommittee hearing.  Democrats voiced strong opposition to H.R. 2077 which would repeal the MLR and H.R. 1206 that would exempt brokers’ fees from the administrative costs category under the MLR.  Republicans said the MLR will lead to layoffs and slashed paychecks for insurance agents and brokers and that some states said the rules would destabilize their insurance markets, particularly in the individual market. However, the CMS spokesman said that the rule is slowing insurer rate increases.  On the other issue, Chairman Joe Pitts said, because current grandfathered plans still have to meet a number of the PPACA’s mandates, employers are forced to pay more to keep their current grandfathered plans, shop for more expensive plans or drop coverage for their employees all together.  He said the provision breaks President Obama’s pledge that U.S. residents who like their insurance can keep it and said the committee will soon move draft legislation to correct the disparity.  The Senate Appropriations Committee also acted on a party-line vote to reject an amendment Senator Lindsey Graham offered to the Treasury appropriations bill which would prohibit funds allocated for the IRS from being used to implement the PPACA.  A forthcoming House Republican report is expected to be critical of the CLASS Act as unsustainable and will seek a repeal of the long-term care program as enacted under the PPACA.

MedPAC Chairman Addresses Physician Payment Cuts

The Medicare Payment Advisory Commission Chairman Glenn Hackbarth said that using the Medicare savings under the PPACA to cover the costs of expanded coverage under the Act, without addressing the failed SGR formula for determining physician payments, could destabilize the program.  He said MedPAC will vote on a $200 billion ten-year plan to replace the payment system at the next meeting in October.  As initially described, the plan would be paid for by cutting payments to specialists while maintaining payment rates for primary care doctors and by cutting other services by 5.9% for three years and freezing such service payments thereafter.  The plan would also recommend that Congress direct HHS: to regularly collect data to more accurately determine work and expense values; use such data to identify overpriced fee schedule services and reduce their relative value units; to specify that the relative value unit (RVU) reductions should achieve an annual numeric goal for five years of at least 1% of fee schedule spending; and to increase the shared savings opportunity for physicians and health professionals who join or lead accountable care organizations with a two-sided risk model and compute spending benchmarks for two-sided risk ACOs using the 2011 fee schedule rates.

IRS on PPACA Affordability Safe-Harbor

In Notice 2011-73, the IRS is seeking comments on the PPACA’s shared responsibility safe-harbor provisions.  Instead of using household income, employers would be allowed to use employee compensation paid by the firm involved.

Another Court Rules Individual Mandate Unconstitutional

In a suit brought by plaintiffs without health insurance, the U.S. District Court for the Middle District of Pennsylvania said Congress cannot “invoke its Commerce Clause power to compel individuals to buy insurance as a condition of lawful citizenship or residency.”  The court granted a motion for summary judgment by a self-employed couple who said the insurance premiums would exceed their home mortgage.

HHS Announces "Million Hearts" Campaign

In announcing a new “Million Hearts” campaign, HHS Secretary Kathleen Sebelius said there are about two million heart attacks and strokes annually with about 800,000 possibly being preventable with basic health care.  The initiative will be led by CDC Director Thomas Frieden and CMS Administrator Donald Berwick and involve several organizations, including the American Heart Association, the American Medical Association, YMCA and Walgreen. The participating organizations plan to: raise awareness of heart disease, which accounts for one in three deaths in the U.S.; improve access to quality health care; encourage healthy behaviors, including diet and exercise; and urge U.S. clinicians to better manage the ABC’s of treatment, by encouraging the use of aspirin for at-risk patients and promoting blood pressure control, cholesterol management and smoking cessation programs.

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