*FEDS will urge states to do something – anything on exchanges – and wrap around what the state does. Story idea: is your state creating it’s own exchange? If not, why not. What will it be like for the federal government to run an exchange in your state? If you’ve got a Republican governor, is he/she opting for the Medicaid expansion? How will that decision impact your state?*Having the feds come in and set up an exchange feeds into criticism that health law is “big govt.”*On Medicaid: GOP govs include Florida and Texas (absolutely no), South Carolina, Mississippi (concerned). Dem govs: Montana, Arkansas: concerned. *If Obama wins, more states may be ready to start exchange but they’ll be far behind.
*Story idea: If your state is moving ahead , what are some of the hurdles it is facing? Are insurers willing to participate in the exchanges, are your state’s computer systems up to coordinate a “one-stop shopping” element of the ACA where Some peopleSupreme Court ruling allows GOP to say penalty for not purchasing coverage is a tax. Romney offers states a waiver from health law; Republicans say they will repeal the bill and take their time to put other measures in its place. Likely to be standard GOP steps: medical malpractice reform, allow insurers to sell across state lines, allow small businesses to pool together to purchase insurance.Obama and Dems talk about allowing kids up to 26 to stay on a parents’ health plan, insurers can’t cancel coverage once you get sick, Medicare drug “donut hole” closing. Individual provisions, not “affordable care act” or “Obamacare.”
*STORY IDEA: WHAT WOULD AN IMPLEMENTATION DELAY MEAN TO YOUR STATE? States must still upgrade computer systems, create governing organizations, and define what “essential benefits” insurers must include in policies sold on the exchanges.*Delaying subsidies and Medicaid expansion (feds pick up 100 percent of those newly eligible) for one year would save about $60 billion.*While sequestration shields Medicaid from any cuts and Medicare is limited to two percent (providers only), potential health care cuts include eliminating 2,300 new and competing research project grants at the National Institutes of Health, 300 fewer grants issued by the National Cancer Institute and up to 100,000 children would lose Head Start services, according to officials at the Department of Health and Human Services. Overall, sequestration would reduce non-defense discretionary programs by 7.8 percent.*Some providers are pushing for a delay: The National Association for Home Care and Hospice is pushing for a two-year delay in implementation of the Affordable Care Act following the Supreme Court's decision to uphold the health reform law's individual mandate. NAHC President Val Halamandaris said the group plans to continue to work with both Democrats and Republicans to revamp the law, which NAHC says can and should be improved.*A delay would mean that people waiting for subsidies, exchanges, and Medicaid expansion would have to wait another year for coverage. Could further erode public support.
*STORY IDEA: WHAT will people/employers do in your area– get insurance or pay the penalty? Penaltyis $95 first year, rising to $695 or beyond, whichever is greater, 2016 and beyond. For families it’s $2085 or 2.5 percent income, whichever is greater. No jail time – yet. ADMIN OFFICILS SAYS ONLY 1 PERECENT WILL PAY PENALTY – BUT OTHERS THINK IT MIGHT BE HIGHER*Medical device makers successfully got a repeal of health law’s 2.3 percent excise tax on medical devices through the House on the argument that it will hurt their ability to create jobs. If the economy does not improve, will drug makers or insurers make similar arguments? *According to my friends at Politico Pro: The American Hospital Association and the Federation of American Hospitals are readying a Capitol Hill lobbying blitz in an effort to persuade lawmakers to cancel the 2 percent Medicare cut that goes into effect next January as part of sequestration. Their hope is to match the intensity displayed by the defense sector, which has been a vocal opponent of the automatic cuts from the start and quickly mobilized their allies in Washington to pressure Congress to overturn them.*Will use similar argument that medical devices did: Several health care lobbyists said the goal is to demonstrate how the cuts would limit access to care and result in a loss of jobs.*Will the Medicare provider cuts in the law stick: Congress never allows Medicare Doctor Payment cuts to go through as planned due to severity of cuts – 31 percent or so next January. Unlikely this will happen.*WSJ REPORT FROM APRIL: Whether the health-care overhaul will prompt employers to drop their health insurance is a subject of intense debate. Several studies have found that most employers don't expect to do so once workers have the option of buying policies through insurance exchanges, set to begin in 2014. But consultants say employers with lower-wage workers may be more likely to shift workers to exchanges.
STORY IDEA: Does your state, your area, have enough docs, clinics, nurses to handle the increased workload?
Not a complete list of provisions. Cultural competence training is incredibly important
Mac revised webinar 11 8-2012
Challenges Ahead for the ACA Mary Agnes Carey Senior Correspondent Kaiser Health News“From the White House to Community Clinics: What’s Next for Healthcare Reform? Nov. 8, 2012
ACA Timeline• March 23, 2010: President Obama signs the health care law, known as the Affordable Care Act, into law.• June 28, 2012: Supreme Court upholds health law’s “individual mandate” provision requiring that most Americans have health insurance by Jan. 1, 2014, or pay a fine. The court also rules that the government could not compel states to expand Medicaid, the federal and state program for the poor, by threatening to withhold federal money to existing Medicaid programs.• Nov. 6, 2012: President Obama re-elected, Democrats retain control of the Senate, Republicans keep control of the House. With Democrats in charge of White House and Senate, implementation of ACA moves forward.
Implementation Challenges• Just 13 states and D.C. have passed authorizing legislation for health insurance exchanges.• If a state does not set up an exchange, federal government will do it for them. Now that election is decided, some governors may decide to move ahead with ACA implementation.• Republican and Democratic governors concerned about how they will pick up their share of Medicaid expansion.
Political Hurdles• House Republicans – In current Congress, voted 33 times to repeal law or sections, or to defund ACA. In next Congress, House GOP will likely have many committee hearings examining every element of implementation: exchanges, Medicaid expansion, impact of ACA on jobs and economy. – House GOP also will try to cut funding for implementation of ACA.• Public split on law - “individual mandate” still unpopular.• Fiscal Cliff: Changes to ACA could be part of a larger deal to reduce the federal deficit. Some analysts have predicted scaling back of current subsidy levels and possible changes in taxes on medical device and insurance industry, for example.
Possible Implementation Delays?• Will Obama administration delay ACA implementation of health law? Exchanges and Medicaid expansion scheduled to begin in 2014.• Delay could - – Help save billions in a larger budget deal – Help provide financing for delay in “sequestration,” the automatic budget cuts set to begin in January.• Giving states, providers more time could mean smoother rollout but delay benefits to millions of Americans.• Administration says law will be implemented on time.
Other Pressures• Is penalty for not purchasing coverage too low to induce people to enroll? – Will they simply say it’s cheaper to pay the penalty than to buy health insurance?• Will Medicare payment provider cuts and other taxes and fees proceed as planned?• Will employers decide it’s cheaper to pay fine for employees who get subsidies or if coverage is deemed “unaffordable” than to offer coverage?
Health Workforce Demands• Millions more covered under ACA puts new demands on health care workforce.• Expected shortfall of primary care providers by 2015: nearly 30,000.• 40% of practicing physicians are older than 55, about one-third of nursing workforce is over 50.• Economists say one-third of physicians could retire in the next 10 years.• By 2025, physician shortage could grow by as much as 25%.• ACA provides $11 Bln in funding to Community Health Centers.
ACA Health Workforce Provisions• Increase the number of Graduate Medical Education , or GME, training positions by redistributing currently unused slots. – Priorities given to primary care and general surgery and to states with lowest resident physician-to-population ratios.• Ensure residency programs available in rural and underserved areas.• Increase workforce supply and support training of health professionals through scholarships and loans.• Train medical residents in preventive medicine and public health; promote training of a diverse workforce; and promote cultural competence training of health care professionals.