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This Week in Health Care Reform - April 25th, 2014

The White House sits down with different stakeholder groups before taking a victory lap; what the demography of the 8 million new enrollees tells us and what it means for the health care law’s next steps; the brain-drain continues atop the Administration’s health care org chart; and, the reach, scope, and practice of telehealth hopes to expand.


Health Care Reform

Meeting of the Minds: Late last week, the White House convened separate meetings in Washington with members of the National Association of Insurance Commissioners (NAIC) and health insurance executives.  The meetings, scheduled just two days after the official close of the special enrollment period on the exchanges, were ostensibly meant to coincide with the announcement of updated enrollment numbers later that day.  In addition to the invitees, attendees included the President, the Vice President, and other senior members of the Administration.  Given the abundance of lessons learned from the just-closed inaugural open enrollment period, both meetings provided the respective stakeholders the opportunity to discuss the challenges they see in the road ahead.  For state regulators, that meant reiterating their stated position as being effectively located to better anticipate and handle potential issues.  Insurance company executives, however, had little to publicly divulge coming out of their sit-down with the White House other than to say both sides shared a “gracious back and forth.”  As for those enrollment numbers, just hours after those meetings, the President announced that 8 million Americans had now signed up for coverage, proving, he went on to say, that the law was working and calling on opponents to abandon their efforts to repeal it.  Critics, however, weren’t as ready to declare the law a success, pointing to the dramatically higher premiums being shouldered by Americans, in addition to so many of them also having to choose a new plan or doctor.  Politics aside, experts maintain that the 8 million enrollee figure, while an important number, certainly isn’t the only one that matters

Demographics & Next Steps:
Coming out of their meetings with the NAIC and health plan executives, the White House released additional data detailing the demographics behind the 8 million newly acquired enrollees.  Of pressing interest, that 35 percent of those enrollees are under 35 years of age.  Drilling further, more than a quarter of those signing-up for coverage (28 percent) are between the ages of 18 and 34, a group whose presence is instrumental in ensuring a healthy and diverse risk pool.  While critics point to that number as being far below the 4-in-10 minimum experts believe to be ideal, analysts have already moved on to the larger questions surrounding the health care law, namely, where does it go from here?  For some, costs continue to overshadow any good news that the Administration hopes to couch around the law’s enrollment numbers.  But, for others, the bigger issue, with millions having now obtained coverage, will be one of access to care.  Regardless, of growing concern to stakeholders is how to keep all these newly covered lives enrolled going forward. 

More Changes for the Administration: O
n the heels of the announcement earlier this month that Department of Health & Human Services (HHS) Secretary Kathleen Sebelius was resigning her post, another top health official announced that he was also leaving the Administration.  On Tuesday, Jonathan Blum, Deputy Administrator at the Centers for Medicare & Medicaid Services (CMS), and the director in charge of reforming Medicare under the Affordable Care Act, made public his intention to resign from the position.  Announced in an internal memo from CMS Administrator Marilyn Tavenner, his resignation comes just weeks after the agency’s latest proposal to scale back payments to Medicare Advantage was met with vociferous opposition from patient groups, medical societies, insurers, and lawmakers.  Despite the controversy surrounding the cuts the popular program has seen during his tenure, under his stewardship Medicare overall saw annual per capita cost growth slow to historic lows, although experts debate how much of that can be attributed to the reforms brought about under the health care law.

Telehealth Progress:
The Federation of State Medical Boards (FSMB) has descended on Denver where it’s currently holding its annual meeting through tomorrow.  As has been covered in previous newsletters, ahead of the annual meeting, a workgroup made up of a variety of stakeholders was brought together with the sole purpose of drafting a set of guiding principles for telehealth to be offered up for consideration this week.  Leading into the meeting, letters of support for those principles have been directed to FSMB, most recently from Health IT Now, a broad-based coalition of patient groups, provider organizations, payers, and employers, whose central focus is to build support for the deployment of health information technology as a means of improving quality of care.  Assuming the document is ratified before the group adjourns on Saturday, the next obstacle to overcome will be garnering support at the state-level for the guiding principles, whose sole objective is to remove the barriers that stand in the way of the practice of, what many believe to be, the future of health care.

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Looking Ahead

Despite the seeming (albeit, hard-won) success of the Affordable Care Act, opponents are continuing to work behind the scenes on building consensus around an alternative approach to health care reform.  And, heading into November, the twin issues of the economy and the health care law promise to provide equally tricky footing to both parties.

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