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Aetna Health Reform Weekly - 5/19/14

Story Content Provided by Aetna on 5/19/14

Insurers working with the not-for-profit Health Care Cost Institute have announced an initiative designed to bring greater transparency to health care by giving consumers free access to an online tool featuring comprehensive information about the price and quality of health care services. The tool is expected to become available in 2015. Several major health benefits companies, including Aetna, will provide information on health care costs to HCCI, which will maintain and manage access to the information. For consumers, the initiative will mean consistent and accurate transparency for their health care shopping experience. For employers, the move will mean greater employee engagement in managing rising health care costs. Costs continue to be a concern in the post-Affordable Care Act (ACA) era, as health care costs continue to rise three times faster than wages. Aetna will continue to offer consumers access to its own cost transparency tools.


The Senate Finance Committee held a hearing last week on the nomination of Sylvia Mathews Burwell to serve as Secretary of Health and Human Services (HHS). Burwell was introduced at the hearing by Sen. Tom Coburn (R-OK), who delivered a strong endorsement of her nomination. Chairman Ron Wyden (D-OR) also praised Burwell and emphasized that he intends to have her nomination approved by the Senate as quickly as possible.

Committee members asked the nominee numerous questions about her management philosophy, while also emphasizing that it will be important for her to be transparent about implementation of the Affordable Care Act (ACA) and other issues. Sen. Johnny Isakson (R-GA) asked Burwell to revisit the ACA's medical loss ratio (MLR) requirements. He expressed concern that independent agents have been put out of business by the MLRs and have been replaced by navigators. Sen. Mike Crapo (R-ID) voiced concerns about the ACA's cuts in the Medicare Advantage program. Burwell suggested that the MA program has experienced "cost overruns" in the past, and that premiums have dropped and enrollment has increased since the enactment of the ACA. She noted, however, that it is important to closely monitor the policies that are now in place.


ARIZONA: Governor Jan Brewer and Tom Betlach, the director of the Arizona Health Care Cost Containment System (Medicaid), petitioned the state Supreme Court last week to review an appellate court decision upholding the right of Republican legislators to challenge the state's expansion of Medicaid. Brewer, who supported the expansion over the opposition of her party's leadership, is arguing that allowing a judicial decision in this case would be tantamount to the court serving as a referee over legislative disputes. She also argued that rolling back the expansion would remove approximately 150,000 people who have been added to the program and negatively impact the state budget.

HAWAII: The Hawaii Insurance Division will allow small employers and residents to keep their 2013 health insurance plans, which do not comply with the ACA, through 2016. According to State Insurance Commissioner Gordon Ito, "what this means is that our small businesses can continue with their 2013 plans through 2016 and potentially into 2017, depending on their renewal." He also said it is important for small businesses to understand the differences between the benefits and potential downside of staying with 2013 plans vs. moving to an ACA-compliant 2014 plan.

IDAHO: Governor Butch Otter has issued an executive order establishing the Idaho Healthcare Coalition (IHC) to lead the development of an integrated, coordinated health care system for the state. The coalition will expand on the work of the Idaho Health Care Council. The executive order outlines IHC membership and details the responsibilities of the IHC, which include facilitating the transition of primary care to patient-centered medical homes (PCMH); establishing quality outcome measures and methods; and promoting payer reimbursement practices that are based on health outcomes. The executive order will be in effect for a two-year period.

MASSACHUSETTS: The Center for Health Information and Analysis (CHIA) released its annual report on hospitals' financial performance titled the Massachusetts Acute Hospital Financial Performance Report - Fiscal Year 2013. Key findings include: Massachusetts' overall acute hospital financial performance improved from fiscal year 2012 to fiscal year 2013 with 84 percent, or 54 acute hospitals, reporting positive total margins. The statewide median total margin increased from 3.8 percent in FY2012 to 4.1 percent in FY2013. Operating margins also improved -- fewer hospitals had negative operating margins in FY2013 compared to FY2012. The median total margin varied by region, from the highest of 8.9 percent in the Fall River region to the lowest of 0.5 percent in the Lower North Shore region.

NEVADA: Staff members of the Silver State Health Insurance Exchange last week shared their analysis of possible options for moving forward after a problematic exchange launch for 2014. The possibilities under consideration include remediating the current system, transferring an operable system from another state, and switching to the federally facilitated marketplace. No formal recommendation was made to the board. But a recent assessment prepared by a consultant emphasized that speedy action by state officials is needed to prepare for the next open enrollment in the fall.

NORTH CAROLINA: The legislature convened a 2014 "short" session last week that is expected to focus on environmental issues, teacher pay and budget issues. The Department of Health and Human Services budget and operations also will be discussed, and limited debate is expected on health care cost transparency and mandates. The session is expected to last six to eight weeks. Given the focus of the mid-term elections, the 2014 session is not expected to include controversial agenda items.

OREGON: According to media reports, the Federal Bureau of Investigation (FBI) has launched a probe into how Oregon implemented the ACA's health insurance exchange. The state is now going forward with a federal exchange for 2015 coverage after abandoning a problem-plagued state-based exchange effort. A recent review of Oregon's exchange problems on behalf of Oregon Gov. John Kitzhaber's office criticizes both the state's handling of the launch and Oracle, which was paid to help set up the system.


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