As health reform's specifics continue to emerge, so do questions and answers from stakeholders

USA Today: Determining how the law will be applied will be the next big battle in health reform and lobbyists are gearing up to influence implementation. "Congress gave sweeping power to federal agencies, especially (HHS), to fill in gaps lawmakers left in the 906-page legislation — an effort that will take years. The law refers more than 1,000 times to Cabinet secretaries who will make decisions on how to carry out the law. For example, the law requires insurance companies to spend 80% of premiums on medical claims, as opposed to administrative costs, by 2011. But it directs the health department to decide whether gray-area expenses, such as health-and-wellness programs offered by insurers, count as care or overhead." Groups like America's Health Insurance Plans and the U.S. Chamber of Commerce are already trying to influence decisions on the new law (Fritze, 4/27).

The Philadelphia Inquirer: Employers are looking for answers to a host of health reform questions, and some health consultants are offering guidance. "What seems inescapable, they say, is that the American health-care marketplace likely will look vastly different when and if the plan is put into effect. ... Some health-care benefits managers have been telling (Brian) Pinheiro (a lawyer and partner at Ballard Spahr LLP in Philadelphia) that they see a future in which employers no longer provide coverage because the cost of dropping health insurance for employees, about $2,000 per person in federal penalties to employers, is far less than the current cost of providing family coverage, about $12,000 per employee" (Mondics, 4/27).

Politico: States are worried about the establishment of high-risk pools, mandated by the new health reform law. "On Friday, states must decide whether to help the Department of Health and Human Services set up or expand high-risk insurance pools by the June 21 deadline set in the law, or, in the alternative, leave HHS to do it all by itself. The pools, modeled after similar programs that already exist in more than 30 states, are designed to quickly provide coverage to adults with pre-existing medical conditions. People will qualify to join the pools, which will offer catastrophic coverage but still have high premium costs, if they've been without insurance coverage for six months." HHS has $5 billion to start up the pools, but states like Louisiana and Georgia have already opted out of assisting HHS (Haberkorn, 4/27).

The New York Times: An inquiry by House Democrats into a change in earnings estimates from major companies worried the health law would hurt their bottom lines has convinced them that "the companies were right to tell investors and the government about the expected adverse effects of the law on their financial results." The provision concerned elimination of a tax benefit for companies who give drug benefits to retirees. "The tax change, expected to generate $4.5 billion of revenue over the next 10 years, will help offset the cost of providing coverage to the uninsured. Within days after President Obama signed the law on March 23, companies filed reports with the Securities and Exchange Commission, saying the tax change would have a material adverse effect on their earnings." The companies included AT&T, Caterpillar, Deere and Verizon. "In a memorandum summarizing its investigation, the Democratic staff of the (House Energy and Commerce Committee) said, 'The companies acted properly and in accordance with accounting standards in submitting filings to the S.E.C. in March and April.' Moreover, it said, 'these one-time charges were required by applicable accounting rules.' The committee staff said this view was confirmed by independent experts at the Financial Accounting Standards Board and the American Academy of Actuaries" (Pear, 4/26).