More details of the health law revealed as implementation unfolds

News reports show new facets of the health law as the large-scale implementation process continues to unfold.

The law imposes stringent restrictions on physician-owned hospitals, which critics say cherry pick the lucrative specialty patients community hospitals depend on to stay afloat, Kaiser Health News/USA Today report. The law, a victory for established hospitals, requires new ones to open and gain Medicare's approval by Dec. 31 -- a deadline about 30 hope to beat -- and the existing 269 facilities will not be allowed to expand without special approval (Weaver, 10/28).

Meanwhile, "45 million people are about to lose a key tax break in health care. Starting in January, they'll have to get what amounts to a prescription from a doctor in order to get reimbursed for over-the-counter medications such as cold and flu remedies or allergy medicines," Fox News reports. "Robert Zirkelbach of America's Health Plans, an industry group, says, 'The changes are going to add an unnecessary cost to the system and make it more difficult for patients to obtain medication they currently rely on'" (Angle, 10/27).

Orlando Sentinel: However, most people's health plans will be relatively untouched by the overhaul next year. "If you were expecting dramatic changes in your workplace's health plan next year because of the health-care overhaul, here's some good news: Most employers aren't substantially changing their plans. Now, here's the bad news: Employees' health-care premiums are expected to jump 12.4 percent, on average, in 2011" (Shrieves, 10/27).

The Hill's Healthwatch Blog: "The National Association of Insurance Commissioners sent its medical loss ratio definitions to the Department of Health and Human Services for approval on Wednesday, but the debate is far from over. In a cover letter accompanying the submission, the NAIC warns that 'we continue to have concerns about the potential for unintended consequences arising from the medical loss ratio.'" The definition concerns a health law requirement that insurers spend at least 80 percent of premium revenues on health services (Pecquet, 10/28). 

MedPage Today: Against the backdrop of the unfolding law, court cases seeking to undo it continue to move forward. But, one health policy professor doesn't think they'll succeed: "The provision in the healthcare reform law that requires individuals to purchase health insurance is constitutional under the 'Commerce Clause' because of the objectives it achieves, a health policy expert claims." The professor, Sara Rosenbaum, at George Washington University, wrote in the New England Journal of Medicine, "The glide path to this new system is long and complex, but the law's end point is clear and visionary, and its constitutionality -- at least in this first round -- is incontrovertible" (Frieden, 10/27).

Kansas Health Institute: Despite calls for repeal, one insurer wishes it could just "get on with it." Andrew Corbin, chief executive of Blue Cross Blue Shield of Kansas, said, "We think that's the way it's going to be even if there are other changes in the legislation going forward. There's been a lot of controversy -- repeal, not repeal, modify, eliminate, a lot of those kinds of things -- but right now it's the law of the land and we'll have to deal with those changes as they come forward and we'd rather get on with it" (Shields, 10/27).