Essential Health Benefit Bill Clears Committee

Bill Monning, chair of the Assembly Committee on Health, knew the moment was a big one.

Monning introduced AB 1453, which laid out a plan for what essential benefits will be covered in California under the Affordable Care Act. The proposed set of benefits is modeled on the Kaiser small group HMO plan.

“This is one of the most important bills you will face this year,” Beth Capell of Health Access California told the committee.

The federal government requires states to choose essential benefits in 10 broad categories. In California, that process looked daunting because of the many health care mandates passed by the Legislature, including coverage of autism.

This package includes all current California mandates—including autism coverage—and everything in the package fits the federal profile as well, which means there would be no extra mandate costs to the state, Monning said.

The Kaiser small group plan covers reproductive services, acupuncture, prescription drugs and all of California’s current mandates, Monning said. “And best of all, it is affordable,” he said.

There was no stated opposition to the bill, but Nick Louizos of the California Association of Health Plans said his organization has some reservations about the bill. He was pleased, he said, to see the legislative discussion focus on selection of the benchmark plan.

The bill passed committee, and now heads to Appropriations.

Source: California Healthline, April 11, 2012.

California State Officials Consider Ways to Continue Health Reform

The Los Angeles Times reports California state officials are considering strategies for continuing health reform efforts if the U.S. Supreme Court strikes down the federal health reform law.

State lawmakers already have developed legislation to further implement the federal law, and the proposals could serve as a vehicle for statewide health reforms if the court strikes down the federal overhaul.

State health reform supporters say that lawmakers must enact an individual insurance mandate requiring all residents to purchase health coverage to spread risk and lower health costs.

Assembly member Bill Monning (D-Carmel)—chair of the state Assembly Health Committee—said he would support the individual mandate if federal funds still are available to support residents buying health insurance.

According to the Times, California nearly approved an individual mandate in 2008.

Meanwhile, health policy experts said California could consider other options to encourage healthy residents to join insurance pools. They said the state could impose an open enrollment period for health plans and incorporate penalties for people who sign up later.

California insurance industry representatives have said they will fight efforts to force insurers to accept sick residents without a requirement that healthy Californians participate in the market as well. Insurers said that premiums would rise substantially without healthy residents in the market, which could cause even more people to drop their coverage.

Source: California Healthline, April 2, 2012.

Future of Healthcare Leadership Summit

Join Bay Area business leaders for an in-depth look at sweeping changes in health care, driven by health reform, new technologies and financial pressures. A stellar lineup of health care leaders will share their expertise, insights and opinions about what these changes mean for employers, consumers and the local economy at the San Francisco Business Times Future of Healthcare Leadership Summit. Click here for the event flyer with conference details.

Wednesday, April 11, 2012
Hilton San Francisco Union Square

333 O’Farrell Street, Grand Ballroom B
7:30 am – Registration; 8:00 – 10:00 am – Breakfast and Program

What is the impact on your company’s bottom line? Will President Obama’s reform package survive a U.S. Supreme Court review? If not, will reform continue on other fronts? How will the state’s budget crunch affect the region’s health care system? Many observers say major changes are needed, as an aging population, huge increases in chronic conditions such as obesity and diabetes, and continuing health care cost inflation continue to threaten our economic as well as our physical and mental well being.

Our region is also in the midst of an unprecedented hospital building boom, driven by seismic safety guidelines, an aging infrastructure and competition between large health care systems. How is that building boom progressing?

Confirmed speakers include George Halvorson, Chairman & CEO of Kaiser Foundation Health Plan and Hospitals; Wright Lassiter III, CEO of Alameda County Medical Center; Cal Knight, President & CEO of John Muir Health; and Darryl Cardoza, Incoming CEO of Hill Physicians Medical Group.

Don’t miss the chance to hear some of the region’s leading health care experts discuss important issues and debates that will help determine the Bay Area’s short and long-term future.

For more information or to register for this event, please visit http://www.bizjournals.com/sanfrancisco/event/57611.

Supreme Court Concludes Hearings on Federal Health Reform Law Case

The U.S. Supreme Court concluded three days of oral arguments in the lawsuit challenging the federal health reform law yesterday.

Wednesday’s hearings consisted of a morning session on the severability of the law’s individual mandate and an afternoon session on the overhaul’s Medicaid expansion.

Audio and written transcripts of the morning session and the afternoon session are available from the Supreme Court’s website.

Wednesday’s afternoon session ended more than six hours of oral arguments over three days. The high court is expected to release its decision in late June (Bloomberg, 3/28).

Severability of Individual Mandate

In the morning session of Wednesday’s arguments, some of the justices seemed open to allowing the remainder of the overhaul to stand even if the individual mandate is deemed unconstitutional. Some observers noted that the justices’openness to allowing other provisions to stand could indicate that they have accepted that the individual mandate will be struck down.

According to AP, three liberal justices—Rth Bader Ginsburg, Elena Kagan,and Sonia Sotomayor—asked questions that intimated they believe the law can stand without the minimum coverage requirement. Meanwhile, Chief Justice John Roberts and Justice Antonin Scalia—both conservatives—also asked questions that suggest they were leaning the same way. Roberts noted that the law includes measures—such as a provision related to Native American health care—that are unrelated to the individual mandate.

Uncertainty Among Justices

While most of the justices seemed opposed to eliminating the entire law, they also “were clearly worried about the consequences if they pull out pieces of the law and that throws the rest of the health care system into chaos” (Gerstein/Budoff Brown, Politico, 3/28).

Ginsburg said that if portions of the overhaul needed to be changed as a result of the high court’s decision, “Congress can take care of it” rather than the courts. Kagan noted that it would represent a “revolution” for the court to guess which provisions Congress would have approved without the individual mandate.

Scalia said it is “totally unrealistic” for the court to comb through the 2,700 pages in the health reform law. “My approach would be to say that if you take the heart of the statute”—referring to the individual mandate—“the statute’s gone.”

Justice Anthony Kennedy, a likely swing vote, said it would be “more extreme” for the court to attempt to piece together the remaining parts of the overhaul. If they were to do that, “we would have a new regime that Congress did not order.”

Implications for California

The Kaiser Family Foundation has estimated that California could receive an additional $45 billion to $55 billion in federal funds between 2014 and 2019 if the reform law is upheld.

A friend of the court brief filed by California Attorney General Kamala Harris and attorneys general in 11 other states estimates that the law’s Medicaid expansion could extend health care to 11.2 million U.S. residents, including 1.9 million Californians.

Source: California Healthline, March 29, 2012.

Supreme Court Unlikely To Defer Ruling on Federal Health Reform Law

On the first day of oral arguments in the Supreme Court case against the federal health reform law, justices seemed supportive of the idea that they can rule on the law now, rather than defer judgment until after its penalties take effect.

The Supreme Court has posted audio transcripts and a written transcript of Monday’s proceedings on its website.

Monday’s Arguments

The nearly 90 minutes of arguments on Monday focused on whether the tax anti-injunction act— which states that cases cannot be brought until a plaintiff has paid a tax—prevents the court from ruling until 2015.

Both opponents of the law and the White House have argued that the law does not apply and have urged the Supreme Court to hear the case now rather than wait.

Arguing for the Anti-Injunction Act

In three minutes of opening remarks, Robert Long, the court-appointed lawyer who is making the argument that the anti-injunction act applies, described the health reform law as a “pay first, litigate later” law.

He noted that the penalty for not purchasing health coverage under the individual mandate carries all the hallmarks of a tax, including that it will be assessed and collected by the Internal Revenue Service.

Arguing Against the Anti-Injunction Act

According to Wall Street Wire, U.S. Solicitor General Donald Verrilli, representing the defendants, faced “less hostile questioning” than Long, which could indicate that the court is likely to rule that the anti-injunction act does not apply in this case.

Tuesday’s Arguments

On Tuesday, the court is slated to hear oral arguments on the constitutionality of the reform law’s individual mandate.

Verrilli will represent the federal government, while Paul Clement will represent the states and Michael Carvin will represent the National Federation of Independent Business.

Click here to hear Tuesday’s oral arguments.

Source: California Healthline, March 27, 2012.