Policy Price

Federal

Although the House vote to repeal health care reform is symbolic only (given the Democratic Senate and White House), it is a necessary first step leading to committee by committee action over the coming months on discrete provisions of health care. One such item, medical malpractice liability reform, got a hearing last week before the House Judiciary Committee as Republicans paraded several witnesses before the committee to showcase the need for legislation from the physicians’ perspective. Since it is very unlikely that the American Medical Association’s wish list would ever become law, the best result from the committee process would be a bill that skirts the more controversial items (e.g., cap on damages) and focuses on attainable and meaningful reforms, such as health courts, stronger pre-trial evaluation and settlement pathways.  This would be a path Aetna would strongly support.

States

ARIZONA: Governor Jan Brewer has announced that she will request a waiver from the federal Centers for Medicare and Medicaid Services so that the state can set Arizona Health Care Cost Containment System (AHCCCS) eligibility below levels mandated by the PPACA. In March 2010, Governor Brewer signed a fiscal year 2011 budget that stripped funding for the state’s Children’s Health Insurance program (KidsCare) and cut 5 million from AHCCCS, effectively repealing an expansion of AHCCCS to childless adults approved by voters in 2000. However, following enactment of the PPACA, the state rescinded the scheduled cuts to comply with the law’s “maintenance of efforts” (MOE) requirement. The MOE requirement prohibits a state from having eligibility standards, methodologies, or procedures for adults that are more restrictive than those in effect on March 23, 2010, until a health insurance exchange in the state is fully operational, and for all children in Medicaid and CHIP through September 30, 2019. The MOE requirement provides an exception for non-pregnant, non-disabled adults earning more than 133 percent of the federal poverty level if a state is projected to have a budget deficit. Arizona faces a mid-year budget deficit estimated at 5 million. A .4 billion shortfall is projected for the 2012 fiscal year.

CALIFORNIA: The U.S. Supreme Court has agreed to review whether health care providers and patients have the right to sue California over budget reductions made to Medi-Cal reimbursements. The high court will review three legal challenges to California’s proposed and adopted reimbursement cuts. The Supreme Court’s ruling on the case could have major implications for efforts to address California’s budget deficit. Last week, Gov. Jerry Brown (D) released a budget proposal that would reduce Medi-Cal payments to health care providers by 10 percent to cut program spending by about 9 million in fiscal year 2011-2012. In addition, the case could have implications for other states seeking to address budget deficits by cutting Medicaid payments. With federal courts in California blocking the cuts, 22 states have joined California in appealing the issue to the Supreme Court.  The court is expected to hear oral arguments in the case next fall. A decision is expected in late 2011 or early 2012.

CONNECTICUT: Speaker Chris Donovan, members of the Public Health and Insurance Committees and a variety of advocates held a press conference last week to announce the Public Health Committee has raised the SustiNet bill based on the recent recommendations of the SustiNet Board. Few details were provided, but the original report recommends that SustiNet become a licensed insurance plan. “We don’t need health insurance anymore, we need to move towards health assurance — health care that will be there for us, and the SustiNet plan will do that,” Donovan said. Lawmakers will face a .7 billion budget deficit by July 1. Rep. Betsy Ritter, D-Waterford, co-chairwoman of the Public Health Committee, said the plan will have to go before multiple legislative committees, with the actual bill some weeks away. A financial analysis on upfront costs is not yet available. Aetna is working with the Connecticut Association of Health Plans (CTAHP) and AHIP to secure an objective fiscal analysis of SustiNet’s, as a public option, true cost to the state, and of the strong, positive impact health insurers have on the state’s economy.

DELAWARE: In his State of the State speech, Governor Jack Markell emphasized the need for state government to spend more efficiently.  He specifically noted that the demands state employee health insurance and pensions are putting on the state budget are unsustainable. The Governor specifically stated he is open