Do You Have Any Idea How Close the Affordable Care Act Came to Being Toast?

I expected Supreme Court Justice Anthony Kennedy to vote to toss the individual mandate. I had no doubt the other three conservative justices would want the whole of the Affordable Care Act thrown out.

I also expected the four liberal justices to support both the individual mandate as well as the entire law.

About everyone expected Roberts and Kennedy to vote alike.

If Roberts had gone with

The Supreme Court Ruling on Health Care, Its Impact on Medicaid, and 29 Republican Governors--Be Careful You Might Get What You Wish For

Conservatives wanted the Supreme Court to do the work of killing the Affordable Care Act (ACA) for them. They didn’t get their wish but the Court may have put conservatives into a political corner they will find very uncomfortable.

Under the new health law, the Medicaid program will be substantially expanded. Those making up to 133% of the federal poverty level (about $30,000 in annual income

The Supreme Court's Decision on the Affordable Care Act

In the immortal words of Rosane Rosana Dana, "Never mind."From the SCOTUS blog live in the court room: "Chief Justice Roberts' vote saved the ACA."On to the elections.

SCOTUS on PPACA (ObamaCare) June 28, 2012

Live blog while watching the decision on Scotusblog.

PPACA (ObamaCare) is upheld and will go forward! Individual mandate deemed constitutional.

I will blog later with more details.
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Well, that was an interesting morning and for many a bit of a surprise. The Supreme Court ruled that the individual mandate to purchase health insurance coverage is considered a "tax" and not a "penalty" and, as such, falls under Congressional authority and is constitutionally legal.

Undoubtedly there will be many announcements, blogs and video responses from the various parties with regard to this decision.

Below is a link to the PDF of the court's decision (all 67 pages):

SCOTUS Decision

Dave
www.davefluker.com

Awaiting the Supreme Court: What Could it Mean for CT?

Policymakers and politicians, in CT and across the country, are eagerly awaiting/dreading tomorrow’s Supreme Court ruling on the Affordable Care Act. We’ve outlined a few possible scenarios and the potential impact on CT. All scenarios have an upside, and there is a way through for every possibility. No matter the decision, we are much farther along than before the ACA. Everyone is affected by rising costs, growing un/underinsurance, and lagging quality of care. And more importantly, after the ACA debates, virtually everyone understands that. A lot of important reforms happening now in CT are independent of the ACA and will likely continue. We can continue our momentum for reform. The status quo is no longer acceptable to anyone.

What Would Health Insurance Cost if the Supreme Court Overturns the Individual Mandate But Leaves the Insurance Reforms in Place?

That will be the big question on Thursday if the Court throws out the mandate and the parallel insurance reforms that would require health plans to take all comers without regard to their health status and require insurers to cover pre-existing conditions.

But before we get to that scenario, let’s look at another possibility.

The Court Overturns Both the Individual Mandate and the Insurance

Courant editorial critical of Senate failure to add consumers to exchange board

Yesterday’s Hartford Courant editorial voiced disappointment that the legislature and administration could not agree to add consumer and small business voices to the CT Health Insurance Exchange Board this session. The editorial notes that a bill adding a significant number of both voices passed the House but stalled in the Senate. The editorial notes both the need for the expertise of consumers and the perception that the lack of balance will taint the Board’s work with suspicion.

Martin Vs. Blue Shield CA (The Next Feller-Freed)

After the Feller-Freed and Serencsa-Lichtman class action settlements with Anthem Blue Cross (Blue Cross of California) I assumed it would simply be a matter of time before similar action was taken against Blue Shield of California. That action was announced by Consumer Watchdog last week.

Blue Shield recently announced (and I blogged) the closure of the majority of their current individual health plans to be replaced by new plans July 1,2012.

Until this case is settled there really isn't a lot to talk about. I will blog when we get information regarding any potential settlement with Blue Shield and the plan migration choices that might be available to those on closed or closing individual plans.

Dave
www.davefluker.com

Update: Anthem Blue Cross CA Closing Clear Protection Plus 1000 PPO

Anthem Blue Cross California has announced the options available to those who are currently members of the Clear Protection Plus 1000 PPO plan.

In my prior blog (CP Plus 1000 Closing) Anthem Blue Cross CA announced the closure of the plan on June 30, 2012. Today, Anthem provided clarification on the options available to those who are enrolled on the plan or those who will enroll before the end of the month. The options are as follows:

*Members currently on the Clear Protection Plus 1000 policy may remain on their policy and add family members to the policy subject to medical underwriting. They may do so until or unless they request a plan change via current underwriting procedures.

*Members may elect to change plans during a special open enrollment period from September 1, 2012 to September 30, 2012 with no medical underwriting. Clear Protection Plus 1000 members can move to the following plans during the open enrollment period:

*CoreGuard Plus 750 (06B6)
*CoreGuard Plus 1500 (06B7)
*Clear Protection Plus 3300 (06B4)

Any other plan changes besides the three plans above would require medical underwriting. The Clear Protection Plus 3300 (06B4) is currently a plan change option under the existing plan movement matrix.

Dave
www.davefluker.com

Thoughtleaders give CT health insurance exchange a C, again

CT thoughtleaders gave our state’s health insurance exchange a C grade again this month. For overall reform CT earned a C+ this month. CT’s reform efforts have not varied much over the last four months, earning a C or C+ in each Thoughtleader Survey. CT also earned a C+ for effort this month, as in the past. This month patient-centered medical homes were the highest rated at a B. Engaging Consumers in Policymaking continued to lag other areas, earning only a D grade. Themes among thoughtleader suggestions to improve progress include engaging consumers and small businesses in policymaking, and fostering collaboration, cooperation and respect. The Thoughtleader Survey is part of the CT Health Policy Project’s Health Reform Dashboard project at www.cthealthreform.org.

Only State Health Care Advocate gets a vote on the health insurance exchange

Budget implementer legislation passed late yesterday included only a provision to give the State Health Care Advocate a vote on the CT Health Insurance Exchange Board. The bill did not add any independent consumer or small business members. While the Health Care Advocate is a respected and valued member, she serves at the pleasure of the Governor. Consumers will still have no independent voice on a board dominated by insurance interests and charged with deciding what health insurance options will be available on the Exchange. Furthermore, without real consumer membership, the Exchange Board does not comply with federal regulations. Despite legislation passed last year prohibiting any Board member affiliated with the insurance industry, three current members have only insurance experience. The vote is particularly disappointing in light of the unanimous and bipartisan approval by the House in the regular legislative session of a bill that would have added two new consumer members, as well as two small business representatives. It is hard to understand why the inclusion of consumers and small business members continues to be such a problem given the broad support among rank and file lawmakers. Ellen Andrews

What is at stake for CT in Supreme Court decision?

A great Health Affairs blog by Sonya Schwartz, of the National Academy for State Health Policy, outlines the likely impact on active states, like CT, of various Supreme Court ACA scenarios. She uses a Richter Scale of impact from 2.0 if the entire ACA is upheld to 8.0 if the entire law is invalidated. It is one of the more readable, but substantive, analyses I’ve seen.

HHS awards HealthyCT $75.8 million loan to develop new statewide nonprofit insurer

Today HHS announced approval of HealthyCT’s CO-OP application to develop a new non-profit insurance company for CT consumers. The federal $75.8 million loan is meant to cover start up costs and reserve funds for the new insurer. The CO-OP opportunity (Consumer Operated and Oriented Plan)was created in the national health reform Affordable Care Act, to foster more competitive markets and develop non-profit, consumer-driven insurance options. The HealthyCT model and application focus on improving the quality, coordination and continuity of care for the citizens of Connecticut, primarily in the individual and small group markets. HealthyCT plans to offer high-quality, coordinated medical care with strong physician-patient relationships at its foundation and encourage the use of patient-centered medical homes. HealthyCT was sponsored by two CT physician organizations – the CT State Medical Society and the CSMS IPA, but will be open to providers willing to work with HealthyCT and meet established criteria. As a non-profit health insurer, any surplus funds will go back into the plan to help keep premiums stable and improve the quality of care.

Blue Shield HIPAA Plan Update

To follow up on my May 25th blog post regarding Blue Shield of California HSA 4000 plan closure for HIPAA, I wanted to post an update.

After several days of run around and legalese, I finally was able to determine that Blue Shield of California's current HIPAA portfolio is heavily weighted on DMHC (CA Dept of Managed Health Care) registered health plans (3) with only 1 CDI-registered plan (California Dept of Insurance). A normal arrangement would be 2 plans from each registration and, in the case of Blue Shield prior to 6/1, 3 DMHC and 2 CDI registered plans.

California Health & Safety Code requires an insurance company selling individual plans in California to offer two "popularly marketed health plans" to the HIPAA risk pool for each registration. Over the last several years most insurers have registered PPO plans with the Dept of Insurance (CDI) as opposed to the DMHC.

Blue Shield of California is opening a new portfolio of plans on July 1. The entire portfolio of PPO plans (Shield Secure Plus, Shield Secure, Shield Wise and Shield Savings) are registered with the DMHC in total with no new PPO plan registered with CDI. It totally took me by surprise as I can't remember the last time a carrier in California registered a PPO plan with DMHC.

So, because Blue Shield only has one remaining PPO plan registered with the CDI, that is the plan they offer in the HIPAA portfolio (Spectrum 5000).

Until such time as Blue Shield of Californa (and Life & Health) registers a second PPO plan with CDI, there will be no additional plans for HIPAA and the portfolio will consist of:

*Access+ HMO (DMHC)
*Access+ Value HMO (DMHC)
*Spectrum PPO 5500 (DMHC)
*Spectrum PPO 5000 (CDI)

Dave
www.davefluker.com

Blue Shield CA Extends Medicare Supplement Special Enrollment Period

Blue Shield of California has announced the extension of their "special enrollment period" for Medicare Supplement plans in California to November 30, 2012. Previous end date was September 30, 2012.

The special enrollment period is basically a full-time "birthday rule". In California, those who are covered by Original Medicare and a Medicare Supplement Plan (Medi-Gap) (A-N) have the right, on their birthday, to move to any other insurance companies' like or lesser Medicare Supplement Plan with no medical underwriting. California is one of the few states that has a "birthday rule" in regard to Medi-Gap plans.

The current Blue Shield CA special enrollment period allows those covered by a Medicare Supplement with another insurer to move to a "like or lesser" Supplement plan with Blue Shield with no medical underwriting in any month, not just the month of your birthday.

Additionally Blue Shield CA has also extended the "new to Medicare" $20 per month discount for the first year. This discount for those who are new to Medicare (either turning 65 or enrolling in Part B for the first time) makes their Medi-Gap plans very competitive for that first year. With the California birthday rule, a person can change to another carrier should the rates increase after the discount and lower rates are available from another insurer in California.

Dave
www.davefluker.com

CT Health Reform Dashboard – CT up to 13.8%

CT has jumped ahead in progress in health reform to 13.8% of the tasks completed, according to the June CT Health Reform Dashboard. This is up from 12.1% last month. While we are closing in on the major January 1, 2014 deadline for many reforms, much remains to be done. At this rate, it will take 4.2 years to achieve reform – down from 5.6 years last month. The dashboard can be found at www.cthealthreform.org.