House Republicans Address PPACA IssuesHouse Republicans Address PPACA Issues

Rep. Joe Pitt’s also said his health subcommittee will work on legislation to “replace” the provisions of the PPACA as a follow-up to the House-passed measure to fully repeal the law.  The measure was said to include H.R. 5, medical malpractice reform that would cap damages, tax incentives for individuals to purchase health insurance, state high risk pool incentives, among other provisions.  He also indicated that the committee will move H.R. 452, legislation to repeal the PPACA Independent Payment Advisory Board.  Ramping election year opposition to the PPACA, House Energy and Commerce Committee Chairman Fred Upton renewed his request to the White House for internal White House memos and other materials leading up to the passage of the health reform law.

Essential Health Benefits Guidance

The CMS Center for Consumer Information and Insurance Oversight released a web document providing illustrative information on the health plan benchmarks that constitute minimum “essential benefits” under the PPACA.  The document, Essential Health Benefits: Illustrative List of the Largest Three Small Group Products by State, shows the information gathered from each state as well as the largest three federal FEHBP plans (Blue-Cross/Blue-Shield standard and basic options and the GEHA plan).  The CCIIO also indicated that health insurance agents and brokers will be able to receive the same commissions inside the federal health insurance exchanges which are to be established in states which do not set up their own exchanges.  The CCIIO also released a report showing the sixteen PPACA-related initiatives involving more than 50,000 health care providers designed to improve patient safety, promote coordination of health care across settings, invest in primary care transformation, create new bundled payments and meet the medical needs of dual-eligibles.  In related news, the Patient-Centered Outcomes Research Institute (PCORI) issued a draft PPACA comparative effectiveness agenda which shows that the agency’s focus will center around five areas, including the comparison of various treatment, diagnosis, and prevention options; the improvement of health care systems by focusing on ways to improve access to care, patient self-care, and the use of non-physician providers; the communication and dissemination of research by focusing on using tools like electronic health records to expand patient and physician knowledge; how to overcome health disparities across different patient populations; and the acceleration of patient-centered and methodological research by using registries and clinical data networks to support the research.

PPACA Constitutionality Suits

The Department of Justice filed a brief arguing that, despite the lack of a so-called severability provision under the PPACA, the Supreme Court should not strike down the entire law even if the court holds one part, such as the individual mandate, unconstitutional.  However, the brief said, if the mandate is held invalid, both the guaranteed issue and community rating provisions of the law could not work and should also be invalidated.  In another matter, the court rejected an amicus by the Freedom Watch Foundation arguing that Supreme Court Justice Elena Kagan recuse herself from considering PPACA-related suits because her impartiality might reasonably be questioned due to her service in the Obama Department of Justice.  Supreme Court Chief Justice Roberts previously said in a report that he had confidence in the court’s justices to make the appropriate decision of when or if to recuse themselves from deciding PPACA and other cases.

New Medicaid Rules on Medicaid Drug Transparency

CMS issued a proposed rule on payments for Medicaid outpatient drugs which would require the use of the average manufacturer price (AMP) in an attempt to prevent state overpayment and to improve price transparency.  The agency said that the rule could save taxpayers and states an estimated $17.7 billion over five years.  In related Medicaid news, HHS released new federal poverty guidelines for determining Medicaid and other program eligibility.  The 2012 poverty line for individuals is $11,170 in annual income and $23,050 for a family of four.

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