At the one-year mark, implications of health law emerge

Media outlets report on a range of issues related to implementation of the health law and its one-year anniversary — among them, the unexpected importance taken on by waivers, the marketplace impact on health insurance brokers, the geography of the health care workforce issues likely to result from coverage expansions and the continuing problems faced by lawmakers who are trying to repeal the measure's 1099 reporting provision.

CQ HealthBeat: Year One For The Health Care Law: Expecting The Unexpected
The word "waiver" does not appear in the section of the health care overhaul law that bans insurers from imposing lifetime or annual limits on benefits. But the 1,040 waivers covering 2.6 million people — granted by the Department of Health and Human Services for so-called "mini-med" plans — are an example of an unexpected development and a source of controversy in the rollout of the first year of the landmark law. While any major piece of legislation will bring surprises as it's put in place, the overhaul measure — which never went through a final scrubbing or conference committee — has encountered more than its share of turmoil in its first year of life. Other somewhat surprising events that have shaped the implementation debate included loud protests by cash-strapped states over Medicaid maintenance-of-effort requirements, the difficulties of fashioning a financially stable program for long-term care and a Republican takeover of the House that accelerated the drive for repeal. Then there's been the rapidly expanding court battle over the law's constitutionality (Norman, 3/16).

The Hill: Hatch Blasts Administration For Reform Law Transparency
Sen. Orrin Hatch (R-Utah), a fervent opponent of the health care reform law, is accusing the administration of implementing the health care reform law in secrecy. The Senate Finance Committee's top Republican says the administration is avoiding the typical regulatory public comment process and is ignoring GOP lawmakers' request for more information about the overhaul enacted almost a year ago. Fifteen of the 23 regulations the Obama administration have issued to implement the law have been interim final rules, bypassing the proposed rule stage that allows for public comment, according to a new Congressional Research Service (CRS) report released by Hatch's office. Three other final rules were issued without an earlier proposed rule (Millman, 3/16).

Kaiser Health News: Brokers Seek To Preserve Role In Health Insurance Marketplace
Kaiser Health News staff writers Jordan Rau and Julie Appleby, working in collaboration with The Washington Post, write: "Insurance brokers, worried their livelihoods are in jeopardy from the health law, are pressing Congress and state legislatures to safeguard agent commissions and guarantee them a key role in new marketplaces being created for consumers to obtain coverage" (Rau and Appleby, 3/16).

CQ HealthBeat: Battle May Be Brewing Between Brokers, Consumer Advocacy Groups
The chairman of the Senate Commerce Committee is urging the National Association of Insurance Commissioners not to reverse its stance that brokers' fees should be counted as administrative expenses under the health care law's medical-loss ratio (MLR) regulation issued earlier this year. A reversal of position by the NAIC would give a boost to legislation opposed by Chairman John D. Rockefeller IV that seeks to change the rule by no longer counting the fees as administrative costs (Reichard, 3/16).

Politico Pro: Democrats Face Tough Choice On 1099 Repeal
Unable to agree on an alternative, Senate Democrats faced a tough choice Wednesday: Clear a House-passed 1099 repeal bill or provoke another stalemate instead of getting rid of a widely disliked funding provision in the health care law. "We're trying to figure out ways to pay for it that will pass, that will get 60 votes," Senate Finance Committee Chairman Max Baucus said. "Right now, there's no way to get 60 votes." Democrats have been huddling and trying to come up with an alternative way of paying for the repeal, because the White House and several lawmakers oppose the House method, which would change the way excess health exchange tax subsidies are re-collected from consumers who are accidentally overpaid or experience changes in eligibility in the course of a year (Haberkorn, 3/16).

Kaiser Health News: Doctor shortages Under Health Law May Depend On Geography
Kaiser Health News staff writer Jessica Marcy reports: "States in the South and Mountain West, which traditionally have the lowest rates of primary care physicians, could struggle to provide medical services to the surge of new patients expected to enroll in Medicaid under the health overhaul and federal incentives may not provide much help, according to a report issued today by a Washington health research group" (Marcy, 3/17).