Questions continue about the health law's future

CQ HealthBeat reports on the courses available for the law's implementation as stakeholders await the Supreme Court's rulings. Politico Pro reports that the recent denials by the Department of Health and Human Services regarding state medical-loss ratio adjustment requests is very different than earlier experiences.  

CQ HealthBeat: Postpone Decision On Health Care Law? Some Argue It's The Right Thing To Do
Later this year, the Supreme Court could uphold the health care law, strike it down entirely or in part or take a third path that would allow implementation to continue and remove it as an issue in the presidential campaign. From a policy point of view, that third alternative might be preferable for those who back the law and believe it will become more popular the longer it's in place and as states move further down the path of establishing exchanges and the rest of the law's framework (Norman, 1/9).

Politico Pro: HHS Reverses Early MLR Approval Trend
HHS's recent track record on denials for state-specific adjustments to the medical loss ratio is a sharp turnaround from the early experience of the waiver program. Five of the first six states that applied were given temporary relief; eight of the next nine were denied. All were seeking a slower phase-in of the health care reform law's requirement for insurers to spend at least 80 percent of premium dollars on providing actual care. The early actions sparked concern among some health care reform allies that the administration was playing too loose with a key ACA provision requiring insurers to pay customers a rebate if their administrative spending ran too high (Millman, 1/10).

California Healthline: 'Value' in Health Insurance Acquires New Meaning
The Patient Protection and Affordable Care Act is set to test whether value-based insurance design can be a viable tool for aligning out-of-pocket costs and the value of medical services. National reform will further encourage value-based insurance design in 2014, when it allows employers to reimburse employees up to 30 percent of health insurance costs if workers meet health and wellness goals. The current reimbursement rate is 20 percent (Edlin, 1/9).

Also in the news, state-level action related to implementation -;

Kaiser Health News: Capsules: 'Almost Heaven' Meets 'Paradise' -; Virgin Islands And West Virginia Discuss An Exchange
From economy to climate, West Virginia and the U.S. Virgin Islands are as different as any two places in the United States. But that hasn't stopped them from discussing whether to work together to form a health insurance exchange under the federal health care law, say officials in West Virginia and the Virgin Islands (Galewitz, 1/9).

Kaiser Health News: Capsules: N.Y. Lawmakers Tackle Exchange Bill. Again.
New York Gov. Andrew Cuomo says creating a health insurance exchange for the state is a priority for 2012. ... Last year, a bill almost passed that would lay the groundwork for an exchange. It hit an impasse in the Republican-controlled state Senate. ... Although Cuomo has said the tab for running an exchange will be picked up by Washington, Republican Senate Majority Leader Dean Skelos' office released a statement expressing concern that the health law and the exchange could cost New York up to $3.75 billion in additional taxes (Mogul, 1/10).

Kaiser Health News/NPR Shots Blog: Texas Asks Feds To Delay Health Insurance Rebate Plan
Starting in 2012, health insurance plans in Texas -; and most of the rest of the country -; may have to cough up millions of dollars in rebates to customers. The rebates will come from health plans that spend too much on administrative costs instead of medical care. The change is part of the national health overhaul law, the Affordable Care Act (Feibel, 1/10).