Question

Managerial Epidemiology

The process of enacting legislation is a way of effecting change. Use the following website to conduct research this week on a piece of healthcare legislation that has been either presented or passed in the last 5 years:   

http://www.ncsl.org/research/health.aspx

Write a summary of the new laws (or proposed laws) and how they progressed through the legal system.

Did they experience any setbacks, or did they progress through the system as expected? If they experienced delays, why do you think these delays occurred?

Managerial Epidemiology Cases and Concepts - 180 Day Option, 3rd Edition
Steven T. Fleming 2014

Answer 1

The 2010 federal health reform laws made major changes in the way private health insurance is handled and regulated. Several of these changes were made in 2010 and 2011, with full effect by 2014-2017: NOTE: 2017 congressional proposals to repeal or replace the ACA have had no effect on these provisiosn as of 10/18/2017

• Access to insurance for people with preexisting conditions through federally-funded high risk pools. (beginning July 1, 2010)
• No preexisting condition restrictions for children;
• Restrictions on certain insurance practices;
• Reporting requirements;
• A small-business tax credit;
• Expanded dependent coverage;
• Coverage and access provisions;
• Expanding access to information on health insurance;
• Retirees’ access to health insurance
• Student Health Coverage
• Self-Insured Group Health Plans

  In response to the federal health reform law, the Patient Protection and Affordable Care Act (PPACA or just ACA)*, and separate state reform initiatives, some members of at least 48 state legislatures proposed legislation to limit, alter or oppose selected state or federal actions. The results on the state level, as of July 1, 2016, vary widely, as detailed below and in separate NCSL reports on Health exchanges and on Medicaid expansion.

  Update and Archive Notice:

  For seven years, 2010 to 2016, some states and courts played a central role in seeking or demanding achnge in the federal ACA. As of spring 2017, much health policy focus has shifted to discussions, proposals and congressional action on an alternative approach, commonly termed the "American Health Care Act (AHCA), .

• NCSL reports on the federal AHCA H.R.1628 are now online.
• The facts and descriptions on this page remain in place, but apply to the 201-2017 federal statute and are not updated to include any new 2017 legislation or court rulings.

• 2015-16 Court Updates

• On June 25, 2015 the U.S. Supreme Court voted 6-3 to uphold health insurance subsidies for people who purchased their insurance through a federal health insurance exchange. The ruling in King v. Burwell means that 6 million to 7 million people will continue to receive insurance subsidies. [Read more]
• In June 2012, the U.S. Supreme Court upheld most provisions of the Patient Protection and Affordable Care Act, but rejected the portion of the law that would have penalized states that did not comply with the expanded eligibility requirements for Medicaid, making expansion optional and a state decision.
  • See information at U.S. Supreme Court and the Federal Health Law.
• 2016 cases: Additional cases continue in 2016-17, especially on paying insurers for the cost-sharing assistance

• NCSL will continue to update and analyze the law and its effects on states. [More, with text of cases | 2016-17]

  Overview: Measures Enacted andPassed by States

  Between 2010 and 2016, at least 22 state legislatures had enacted laws and measures related to challenging or opting out of broad health reforms related to mandatory provisions of the Patient Protection and Affordable Care Act (ACA).

  Table 1: State Legislative Enactments and Ballot Results

  

  This table does not include federally authorized state options for or against exchanges and Medicaid expansion, non-binding resolutions or memorials urging actions by federal or state government, nor measures still pending at the state level.

  Missouri : 2010 law provides that it is against Missouri public policy to implement or operate a health insurance exchange in Missouri.

  2015-16 Sessions: A much smaller number of bills were considered - Earlier opposition enacted laws were expanded or amended in Arizona, Arkansas, South Carolina, and Tennessee. See NCSL's Innovations database for listings.

  2014 Sessions: As of Dec. 30 at least 181 bills and resolutions in 38 states include opposition to, or proposed legislative alternatives to substantive provisions in the ACA. For 2014,15 such bills have been signed into law, in ten states.

  2013 Sessions: As of December 2013, there were 81 bills in 32 states, territories or D.C. that relate to challenges, opposition or alternatives to health reform.

  NCSL 2013 Summary Report: States Opting-Out or Opposing Certain Provisions of the ACA.

  Summaries by state are contained in the NCSL Health Reform Legislation Database - 2011-13online .NCSL has compiled these and other ACA topic measures into an online database; visit this database web page. Select the keyword "Challenges, Opt-outs and Alternatives." For more complete Exchange and Medicaidlegislation, select those keywords in the database. These measures may include formal rejections of Medicaid expansion and prohibitions on running a state-based exchange. This number does not include all measures that may oppose HHS regulations or interpretations of implementation of the PPACA, such as mandated coverage of contraception, or optional steps such as administration and enforcement of insurance regulations.

  Summary of Enacted Provisions: The 22 state laws and measures related to challenging or opting out of broad health reform including the Patient Protection and Affordable Care Act (PPACA) vary, using at least three general approaches. Additional states have enacted measures considered non-conforming with the stated goals of the ACA, such as non-expansion of Medicaid, non-participation in the operation of the health exchange or marketplace, blocking individual health benefits such as contraception, or restrictions on navigators. These are detailed and tallied in other reports.

• BETTER CARE ACT OF 2017 | SENATE

  draft of the Senate version of H.R. 1628, the American Health Care Act (AHCA), the Better Care Reconciliations Act of 2017. Senate Majority Leader Mitch McConnell (R) has commented that the House AHCA failed to meet the Senate requirements to be considered for a reconciliation vote requiring only 51 votes to pass.

  This second iteration contains revised language to include two tax provisions from the Affordable Care Act (ACA) and some provisions that would help pay for low-income insurance premiums and is being sent to the Congressional Budget Office to see if it too meets the reconciliation standards. Once these procedural challenges have been met, the Senate plans to vote to amend H.R. 1628. Should the Senate pass the measure, it will be sent back to the House for its consideration. The Senate has sent the bill to CBO for an updated score.

  Several of the changes made in the Senate from the proposed language in the House respond to concerns raised by legislators and legislative fiscal staff as a result of survey responses provided to Senate Finance staffers two weeks ago by NCSL.

  The CBO's previous report estimated the bill’s proposed Medicaid changes will increase the number of uninsured Americans to 15 million to 22 million over a decade. The report drew concern from several Republican senators, including those whose states have undergone Medicaid expansion. There has also been debate on the legislation’s proposed tax cuts, which largely mirror the earlier passed House version. One of the tax cuts under discussion is the repeal of a 3.8 percent net investment tax.

  The lastest bill also includes several new proposals to help offset costs including:

  Premiums Stabilization: To assist individuals in a high-risk pool that are participating in the individual market the government would provide $5 billion per year from 2019-2021 to help offset the costs of their higher premiums.

  HSAs: New language would allow individuals to use HSAs dollars toward purchasing health plans.

  Better Care Reconciliation Implementation Fund: A new fund that will provide $500 million to help with administrative costs of implementing the law.

  Catastrophic Plans: Allows any individual to enroll in a catastrophic plan, and allows catastrophic enrollees to be eligible for tax credits, effective for plans beginning on or after Jan. 1, 2019.

  2018 Premium Changes:

• An Early Look at 2018 Premium Changes and Insurer Participation on ACA Exchanges

• The Choice: Return to a Broken Health Insurance Market or Move Toward Market Stability