Post-Shutdown Bill Leaves ACA Intact

Two weeks ago, our federal government shutdown on the promise by House Republicans that they would continue to fund the government only if the ACA was repealed. However, the final, bipartisan agreement reached yesterday that brought the federal government shutdown to a close left the ACA fully intact.  Infact, the bill that the President signed into law included just one, relatively small, ACA provision: The legislation calls for new procedures by which HHS must strengthen income verification for individuals applying for federal tax subsidies to help pay for premiums of health plans purchased on the insurance exchanges. 

                                                       

Under the rule, HHS still would require applicants' income be verified against their IRS and Social Security records, and when that cannot be achieved, checked against employer records submitted to Equifax. The rule also allows state exchanges to check a statistically valid sample of applicants in cases where an applicant claims income more than 10% below what IRS and Social Security records show, and where there is no Equifax data ("The Economy Hub," Los Angeles Times, 10/16). 

Despite two weeks of intensive, 24/7 repairs, healthcare.gov remains badly broken.  This is especially problematic for states whose have chosen to let the federal government run their exchanges.  Many media outlets have also reported that the technical glitches associated with open enrollment for state health exchanges may have received more attention if not for the shutdown.  Perhaps now that the government has re-opened for business, the ACA will see the triumphant roll-out many supporters predicted.

Public Health: How is it Affected by the Government Shutdown?

A special thanks to to Nili Yolin and the American Health Lawyers Association for providing this update. Their alert is posted below:

In the early morning of October 1, the federal government officially went dark. The shutdown came in the aftermath of the Senate's decisive vote to reject a House of Representatives plan that would have kept the government funded for several more months but delayed implementation of key portions of the Affordable Care Act (ACA) for one year.

The impact of the shutdown will be felt across all health care sectors as many federal employees face furloughs of unknown duration. In particular, the U.S. Department of Health & Human Services (HHS) announced in its Contingency Staffing Plan (Plan) that more than half of its employees will be furloughed. HHS' Plan is based on federal guidance that allows agency programs to continue only if they either do not rely on annual appropriations, or they involve the safety of human life or the protection of property.¹ According to HHS, the following programs and services will continue:

• Funding for Medicaid and the Children's Health Insurance Program will continue uninterrupted because funding has already been set aside for these programs;
• Funding for Medicare will likewise continue uninterrupted but only in the short term. If the political impasse stretches beyond several weeks, the program could be disrupted by the reduction in HHS staff;
• The Centers for Medicare & Medicaid Services (CMS) will continue to implement the ACA, "including coordination between Medicaid and the Marketplace, as well as insurance rate reviews, and assessment of a portion of insurance premiums that are used on medical services";²
• State and federal health insurance exchange programs will open as planned, though it is not clear how the information technology (IT) that underpins the exchanges will function since they are operated by government contractors;³
• The National Institutes of Health (NIH) will continue to provide patient care for current NIH Clinical Center⁴ patients;
• The U.S. Food and Drug Administration (FDA) will be able to operate only for "vital activities" such as high-risk recalls and other "critical public health issues";
• The Substance Abuse and Mental Health Services Administration will continue programs such as the Suicide Prevention Lifeline using the balance of available grants; and
• Other programs supported through mandatory funding such as the Centers for Disease Control and Prevention (CDC) Global HIV/AIDS Program will continue.

However, several programs important to public health will be disrupted if a congressional compromise cannot soon be reached. For example:

• Outside of matters related to "imminent threats to the safety of human life or protection of property," CMS, FDA, NIH, and other federal agencies will not publish regulations or other guidance during the shutdown;
• CMS will not fund task forces that work to prevent health care fraud and abuse, and will scale back on Medicare provider audits;
• The CDC seasonal influenza program, which tracks flu outbreaks and certain infectious diseases, will come to a halt;
• No action will be taken on any grants related to medical research, improvement of the health care system, and monitoring of substance abuse programs;
• No new patients will be admitted to the NIH Clinical Center. NIH-funded researchers may continue to work for as long as their money holds out but additional funds will not be released during the shutdown; and
• FDA will not be able to support much of its food-safety activities, such as routine inspections and public notification programs. FDA's laboratory research and some compliance and enforcement activities will be suspended.

Although providers can take comfort in the fact that Medicare and Medicaid program reimbursement will proceed, a government shutdown for any period of time beyond three or four weeks could impede certain critical administrative functions, such as Medicare claims processing, and therefore impact their pocketbooks. Likewise, while substantial ACA implementation will continue, long-term furloughs could affect certain components of the law (such as the exchanges) because they depend on government employees to help run the IT component, among other aspects of the program. Thus, the magnitude of the shutdown's impact will depend on how long it endures.

Confused about Obamacare? Ask your local pharmacy!

Pharmacies across the country are becoming part of the effort to educate the public about the Affordable Care Act.

As part of a partnership between HHS (The Department of Health and Human Services) and Rite-Aid, licensed insurance agents will be available in nearly 2,000 Rite-Aid Stores to give FREE advice about Obamacare.

Agents will provide answers to questions about health benefits under the new law, as well as help people apply for coverage, financial assistance, or Medicaid coverage starting October 1 - the first day of open enrollments on health insurance exchanges.

Other U.S. pharmacy chains have also announced their plans to help provide health insurance enrollment.

• CVS Caremark will provide free health insurance enrollment at its stores.

• Walgreens has teamed up with Blue Cross/Blue Shield to promote the new healthcare law benefits.

• SoloHealth, which operates more than 3,200 digital health screening kiosks in Walmart, Sam's Club, and Safeway, announced Monday that it now includes information about the new healthcare law on it's screens.

• Winn-Dixie Pharmacy, Thrift White Pharmacy, and BI-LO Pharmacy will also help customers learn about Obamacare.

 

Informed Consent or Blurred Lines?

You may be familiar with the flyers, perhaps from your college days: NEED EXTRA CASH? ENROLL IN THIS STUDY.  You may have even participated and, when you did, you signed a form to give "informed consent" to your participation in the study. Like many legal documents, this form likely contained complicated clauses and statements that purported to explain the risks and benefits of the research study to you.

[motherwoman.org]

The ambiguous and jargon-filled language of study consent forms may, in fact, be due for a makeover. Yesterday, at a Health and Human Services public meeting in Washington D.C., federal informed consent regulations were under the microscope as stakeholders weighed in on how these regulations should be applied to participant-based research studies.

The catalyst for the public meeting? A national premie study with 20 participating research centers that looks at how much supplemental oxygen premies should receive.  The HHS Office of Human Research Protections raised a red flag earlier this year when they determined that prominent research centers at Yale, Stanford, Duke, and Emory didn't advise parents that their babies faced potential risks of blindness, neurological damage, or death.

"It would have been appropriate for the consent for to explain that the study involves substantial risks and that by participating in this study, the level of oxygen an infant receives would in many instances be changed from what they would have otherwise received," HHS said.

This public meeting is only the beginning of HHS's evaluation of the informed consent process.

Read more here: http://www.kansascity.com/2013/08/27/4441247/study-of-premature-babies-with.html#storylink=cpy

Read more here: http://www.kansascity.com/2013/08/27/4441247/study-of-premature-babies-with.html#storylink=cpy

Create Your Personal "Obamacare" Account

Online Profile
HHS Secretary Sebelius announced Monday that consumers can now open personal healthcare accounts online at healthcare.gov in anticipation of the innaugural October 1 open enrollment for plans offered through state health insurance exchanges.  Starting in September, you can begin comparing plans side-by-side through the online marketplace in your state.

The new personal account information is available only in English, for the time being. But HHS stated that personal account will be coming soon to the Spanish-language marketplace, at cuidadodesalud.gov.

The new online insurance marketplaces will be geared to people who don't have coverage through their jobs, most of whom will be eligible for tax credits to help pay their premiums. Insurance benefits take effect Jan. 1. That's also when the law will require most Americans to have health insurance or face fines. In return, insurers will be barred from turning away people with medical problems, often referred to as preexisting conditions. The administration hopes to sign up at least 7 million uninsured people next year.

Marketplace Checklist
In addition to creating your online profile, you can also answer a few simple questions about your current health insurance status in order to generate a personalized "Marketplace Checklist."  This checklist will provide you with information about how to get ready for open enrollment and allow you to gather all the necessary information to hit the ground running in October.

Still don't understand what a health insurance exchange is? Don't worry! The government has also launched training videos and infographics to further help Americans understand the exchanges.

Individual Marketplace

Small Business Call Center
HHS also launched a special call center on Monday for small businesses, at 800-706-7893.  Small businesses will have access to a separate marketplace, and may also be eligible for tax credits.

Learn more about how your small business can provide coverage through Obamacare by watching this short video!

Small Business Marketplace

A 30+ Year Injunction Vacated, the ACA To Thank

On May 31, the 11th Circuit Court of Appeals vacated a 30+ year injunction that prevented disclosure of Medicare claims data.  It did so in the name of the public's interest in increased transparency and the ACA's efforts to facilitate it. 

In 1979, a district court in Florida issued a permanent injunction against HHS (then the U.S. Department of Health, Education & Welfare) barring the department from releasing lists identifying physicians who received a certain level of Medicare reimbursements. Even though HHS had made such a disclosure two years prior and had amended its regulation to specifically allow such disclosures, the Florida court invoked an exemption from the the Freedom of Information Act and the Privacy Act to enjoin HHS from individually identifying how much specific physicians receive in Medicare payments. 

However, two years ago the court reopened the case.  When doing so, it allowed two key parties to intervene -- Real Time Medical Data, LLC, a company that uses Medicare claims data to assist hospitals with marketing and strategic planning, and Dow Jones and Company, Inc., which publishes The Wall Street Journal.  Both companies arguments pointed to changing times with regards to transparency.

Real Time Medical Data argued that since the 1979 ruling, there has been a shift in balance between physician privacy interests and the public interest in disclosure of Medicare reimbursement amounts.  To bolster that argument, it noted that a specific ACA-created program expressly permits disclosures of Medicare Part B (physician insurance) to qualified entities to generate provider performance reports. Qualified entities are companies, not unlike Real Time, who have been approved by The Centers for Medicare & Medicaid Services (CMS) to collect claims data for evaluating quality performance of providers and suppliers. 

Dow Jones made similar arguments, noting Medicare claims data could be invaluable in identifying fraudulent conduct of physicians and physician groups.

Although the court does not anticipate an immediate release of Medicare claims data after this ruling, it's cases like this one that are steps in the right direction -- toward a more transparent and palpable healthcare system.