Federal appeals court hears oral argument on subsidies case   03/25/2014
The nation’s second-highest court heard oral argument today in a lawsuit that challenges the availability of premium subsidies to lower-income Americans in some 35 states under the Affordable Care Act. While the court likely will not issue a decision for several months, comments made by two of the judges at argument suggest that premium subsidies in those states may be in trouble. At the hearing before a three-judge panel of the D.C. Circuit Court of Appeals, the plaintiffs argued that the wording of the ACA’s subsidy provision authorizes the federal government to provide premium subsidies only in states where the insurance exchange was “established by the state,” as opposed to by the federal government. Only about 15 states meet that description. Two judges, A. Raymond Randolph and Thomas B. Griffith, appeared to agree with the plaintiffs’ argument. If they rule in the plaintiffs’ favor, the federal government will have two opportunities for further review: It can ask the full D.C. Circuit to rehear the case, and it can then ask the U.S. Supreme Court to grant review. The AHA filed a friend-of-the-court brief supporting the government in the case (Halbig v. Sebelius), pointing out that “the ACA will not work without subsidies, and Congress knew it. Yet plaintiffs insist that Congress designed the ACA so that tens of millions of Americans, in more than half the states, would be walled off from subsidies altogether.”
GAO recommends HHS specify HIE priorities, time frames   03/25/2014
The Department of Health and Human Services should identify specific actions it will take to advance health information exchange, including priorities, milestones and time frames, the Government Accountability Office said in a report released yesterday. “Providers and stakeholders we interviewed cited key challenges to electronic health information exchange; in particular, they cited issues related to insufficient standards, concerns about how privacy rules can vary among states, difficulties in matching patients to their records, and costs associated with electronic health information exchange,” the report states. “[Centers for Medicare & Medicaid Services] and [Office of the National Coordinator] officials noted that they have several ongoing programs and initiatives to help address some aspects of these key challenges, but concerns in these areas continue to exist.” AHA provided input to GAO for the report.
Report shows potential impact of ACA coverage expansions   03/25/2014
At least 79 million U.S. residents under age 65 were uninsured or underinsured in 2012, before the Affordable Care Act’s major reforms took effect, according to a report released today by the Commonwealth Fund. The estimate includes nearly two-thirds of people living below the poverty level, nearly half of people living just above poverty, and 20% of middle-income people. “This report demonstrates that the health reform law was accurately targeted toward the needs of the uninsured and underinsured,” said Cathy Schoen, lead author of the report and senior vice president of the Commonwealth Fund. “However, if all states don’t expand Medicaid, millions will still go without health insurance and health care.” In states choosing not to expand Medicaid, more than 15 million underinsured and uninsured people have incomes below poverty – earning less than $23,550 a year for a family of four, according to the report. Unless their states expand Medicaid, there will be no new coverage options – either Medicaid or premium assistance – available to them. The report defines underinsured individuals as people who have health insurance but spend 10% or more of their income on medical costs, 5% or more if they are low-income.
Report examines charity care levels of 340B hospitals   03/25/2014
The AHA today said a report examining the charity care levels of 340B hospitals “ignores the fact that the 340B program enables hospitals to provide essential health care services to the nation's most vulnerable populations.” The Alliance for Integrity and Reform of 340B report found that some hospitals enrolled in the 340B Drug Pricing Program provided only a minimal amount of charity care. However, AHA Senior Vice President for Public Policy Analysis and Development Linda Fishman noted that the report is “based on Medicare’s worksheet S-10, which is still in the development stages and judged by Medicare policymakers to be not yet ready for use in payment calculations.” Fishman also said that 62% of all uncompensated care provided by U.S. hospitals is provided by 340B hospitals, and “charity care alone does not account for the myriad programs and services that hospitals provide, which are tailored to the needs of their own unique community.”
NH approves Medicaid expansion alternative   03/25/2014
The New Hampshire House today approved bipartisan legislation (SB 413) that will use federal Medicaid funds to help an estimated 50,000 low-income, uninsured adults obtain private health coverage. The bill now goes to Gov. Maggie Hassan, who said she will quickly sign it into law. About 38,000 uninsured adults would initially be covered by the state’s Medicaid managed care plan and transition to private coverage in 2016, while the rest would be covered by a program that subsidizes employer-based coverage. New Hampshire Hospital Association President Steve Ahnen called the vote “a great step forward for patients, providers, businesses and our state’s economy. By extending private health insurance coverage to more low-income, uninsured New Hampshire residents, we are taking steps to address one of the biggest challenges facing our businesses and health care system today – the rising cost of uncompensated care and the hidden tax that we all pay to support those without coverage who seek care in our hospital emergency rooms.”
Reminder: AHA webinar Thursday to review RAC survey data, trends   03/25/2014
Hospitals are invited to learn more about recent regulatory activity impacting the recovery audit contractor program and review results from the AHA's latest RACTrac survey during a webinar Thursday at 2 p.m. ET. The free web-based survey helps AHA gauge the impact of Medicare RACs and advocate for needed changes to the program. For more on the AHA's RACTrac initiative, visit www.aha.org/ractrac.