Health reform law faces political, implementation challenges

Politico: States with "the most progressive health policies" are having a hard time implementing their part of a $5 billion series of high-risk insurance pools because their states offer a more generous guarantee of coverage. "Five states — Vermont, Maine, New York, New Jersey and Massachusetts — have 'guaranteed issue' of insurance: individual subscribers cannot be turned away because of a health condition. Moreover, all five states have some form of community rating, which bars insurers from charging exorbitant rates based on health, gender and other factors." So, in these places, there is less demand for the federally funded high-risk pools. The states want to get their share of the $5 billion set aside for the pools, but "they will have to work much harder to comply with the program, all the while uncertain how many residents it could serve." These states are still hashing out pool details with the federal government (Kliff, 7/20).

NPR: A battle over abortion in the pools continues. "Last week, the Obama administration said it would not allow funding for elective abortions in the new program, which it's calling 'Pre-existing condition insurance plans,' despite claims to the contrary by anti-abortion groups. That set off a backlash by abortion-rights groups, who claim the administration is knuckling under to a few anti-abortion Democrats." Neither side is happy, NPR reports, and abortion-rights supporters are questioning if the government even has the authority to say, because "the final deal on the health law was that it was supposed to neither expand nor contract abortion availability" (Rovner, 7/19).

The Washington Times: "Douglas Johnson, legislative director for National Right to Life Committee, an anti-abortion group, acknowledged that his side had won a round. 'If they now do what they say they are going to do, that would be good,' Mr. Johnson said of the Obama administration. 'But in our view, they are doing it because the spotlight has been put on them, and we blew the whistle'" (Lengell, 7/19).

The Hill: "Ohio's Republican delegation on Monday wrote to Gov. Ted Strickland (D) urging him to restrict abortion coverage in that state's high-risk pool created under the healthcare reform law. The signees acknowledge the Obama administration's declaration last week that the federally funded pools would restrict coverage to rape, incest and cases where the life of the mother is in danger. But in the absence of formal guidance from the federal government, they're asking the governor to clearly spell out abortion coverage restrictions." House Minority Leader John Boehner was among the Republicans signing the letter (Pecquet, 7/19).

Kaiser Health News reports on some specific changes that will result from the new bill, starting in the fall, that will "take some of the worry out of emergency room visits. … The law is designed to prohibit insurance plans from charging higher co-payments or coinsurance amounts for out-of-network emergency services or from imposing other coverage limitations that would not apply to in-network care. The provisions go into effect on Sept. 23, but plans are not required to implement the change until the beginning of the new insurance plan year" (Andrews, 7/20).

The Washington Post: In other health law implementation news, disease management programs are focused on saving money for the health care system: "Starting next year, most health insurance plans will be required to spend 80 to 85 percent of the premiums they collect on medical claims or other activities that improve members' health. ... The Obama administration is drafting regulations that will determine which, if any, disease management programs insurers will be able to count as improving members' health. Consumer advocates argue that only programs whose effectiveness has been scientifically proven should be included. But insurers warn that if the rules are so strict that most of their disease management programs don't qualify, they will be forced to curtail or even drop them" (Aizenman, 7/20).

Roll Call: the Republican message to repeal the health law "is becoming part of a broader theme that with unchecked power, Democrats have run amok, expanding government and inflating the national debt. … Congressional Democrats have assailed Republicans for repeating the 'repeal and replace' mantra without offering any specific alternatives to the new health care system. ... For House Republicans, repeal of the health care law has become a permanent part of the leadership's talking points. House Republican Conference Chairman Mike Pence (Ind.) said action on 'repeal and replace' would truly begin after the midterm elections" (Stanton and Kucinich, 7/20).

Politico, in a separate story, reports that House Republican Conference Chairman Mike Pence said Monday that said Republicans need to "repeal the Pelosi Congress" to enact their health reform ideas. "Pence's statements came in response to a question on whether repealing health reform legislation is simply a Republican Party talking point. He said a Republican plan would have used savings from medical malpractice reform to provide coverage for people with pre-existing conditions who can't get insurance" (Aujla, 7/19).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.