Health reform implementation

A two-week, stopgap continuing resolution (CR) proposed by House Republicans includes more than $450 million in cuts to the Department of Health and Human Services, but it avoids hot-button issues such as funding for healthcare reform and Title X family planning.

The CR unveiled Friday afternoon includes $4 billion in reductions and is meant to avoid a government shutdown that would occur on March 4 without both chambers and President Obama agreeing to a spending bill.

A seven-month resolution passed by the House last week included $61 billion in cuts and provisions that would halt funding for healthcare reform, Title X family planning and Planned Parenthood. Senate Democrats are not likely to include those cuts in their spending bill, which could trigger a fight with Republicans in the lower chamber.

As unhappy governors protest they can't afford the law's Medicaid requirements, HHS stresses law's flexibility.

Battle over control of health law's exchanges roils North Carolina: A bruising battle over who gets to control a key element of Democrats' healthcare reform law has broken out in North Carolina, providing an early glimpse into an issue that's likely to consume many state legislatures over the next two years.

The law gives states until the end of next year to create health insurance exchanges where people can buy high-quality insurance plans with federal subsidies starting Jan. 1, 2014. In states that aren't ready by then, the federal government will run the exchanges.

Consumer advocates in the Tar Heel State are accusing the state's biggest insurer, Blue Cross and Blue Shield of North Carolina (BCBSNC), of attempting to control the board that would regulate the exchange. They say legislation supported by the insurer would give Blue Cross a permanent seat at the table and weaken the exchange's consumer protections. Read The Hill's story.

New money for rate review: The Department of Health and Human Services announced $200 million in new grants for states to enhance their rate review procedures. $150 million will go toward two- and three-year grants to boost reviews. $22 million will go to states with greater populations. And $27 million in bonuses will be paid for states that create programs that have the power to block unreasonable rates, Healthwatch's Jason Millman reports. 

And still more money: HHS also announced that $100 million is available for states to incentivize healthy behaviors among Medicaid recipients. Read The Hill's write-up.

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A bruising battle over who gets to control a key element of Democrats' healthcare reform law has broken out in North Carolina, providing an early glimpse into an issue that's likely to consume many state legislatures over the next two years.

The law gives states until the end of next year to create health insurance exchanges where people can buy insurance plans with federal subsidies starting Jan. 1, 2014. In states that aren't ready by then, the federal government will run the exchanges.

Consumer advocates in the Tar Heel State are accusing the state's biggest insurer, Blue Cross and Blue Shield of North Carolina (BCBSNC), of attempting to control the board that would regulate the exchange. They say legislation supported by the insurer would give Blue Cross a permanent seat at the table and weaken the exchange's consumer protections.

The advocates are particularly peeved because they say they'd been led to believe that the insurance industry was collaborating with other stakeholders in drafting exchange guidelines under the auspices of the North Carolina Institute of Medicine. Instead, they were caught off guard last week when a Republican state representative introduced legislation that advocates say greatly favors BCBSNC.

"They went behind out backs and filed a terrible piece of legislation," said Adam Linker of the liberal North Carolina Justice Center.

The nation’s top five health insurers made nearly $12 billion in profits last year, according to a senior House Democrat.

The insurers – UnitedHealth, WellPoint, Aetna, Humana and Cigna – were more profitable than the top five firms in the energy, construction, aviation, motor vehicle and part manufacturing industries, according to a new fact sheet from Rep. Pete Stark (D-Calif.).

According to Stark, three of the insurers padded their profits by more than $3.5 billion by boosting premiums. Meanwhile, Stark said, Aetna and WellPoint padded their profits by $800 million by spending less on medical care.

States can apply for $200 million in healthcare reform grants to develop programs preventing "unreasonable" health insurance rate hikes, the Department of Health and Human Services announced Thursday.

The sweeping healthcare overhaul enacted 11 months ago requires health insurers in the small-group and individual markets to justify rate hikes deemed unreasonable.

About $150 million announced Thursday will help states create and enhance rate review programs. Another $22.5 million will be given to states with higher populations, while $27.5 million will go to states with programs that allow them to block an insurance rate from going into effect — a power that many states currently lack.

“We know that rate review is an extremely effective tool to benefit consumers,” said Steve Larsen, director of HHS’s Center for Consumer Information and Insurance Oversight.

Poll shows 20 percent falsely believe the law was wiped out when House Republicans voted to scrap it in January.

New comments from the states come after the Obama administration asked a judge to clarify ruling that struck down reforms.

But action could stall in the Senate as the chambers differ on how to pay for the lost revenue.

A federal judge for the District of Columbia on Tuesday evening ruled that Democrats' healthcare reform law is constitutional, bringing the total to three.

Two other judges — one in Virginia, the other in Florida — disagree and have ruled against the law. The issue is likely headed to the Supreme Court after an appeals court weighs in.

Opponents of the law argue that its individual mandate violates the Constitution's Commerce Clause because it seeks to regulate inactivity. But the Obama administration says the decision not to purchase insurance is a form of economic activity because everyone participates in the healthcare market; people who don't have insurance and can't pay out-of-pocket, the administration argues, merely pass on their costs to people who have coverage.

Judge Gladys Kessler, a Bill Clinton appointee, agreed.

"Because of this cost-shifting effect, the individual decision to forgo health insurance, when considered in the aggregate, leads to substantially higher insurance premiums for those other individuals who do obtain coverage," she wrote in her ruling. "According to Congress, the uncompensated costs of caring for the uninsured are passed on by healthcare providers to private insurers, which in turn pass on the cost to purchasers of health insurance."