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This Week in Health Care Reform - January 31st, 2014

A handful of new polls underscore what a handful implementation continues to be; the President delivers his State of the Union; meanwhile, a Republican triumvirate introduces their latest proposal to replace the health care law; updated enrollment numbers show steady progress; debt limit posturing ramps up; and, Medicare Advantage continues to weather drastic changes.


Health Care Reform

Work in Progress: Late last week, new polling data depicted an American electorate with increasingly negative views of the President’s handling of health care.  In the survey, released by Quinnipiac University, voters said they disapproved of how the President was dealing with the issue by a 59 percent to 36 percent margin.  While health care was second on the list of issues that were most important to voters (behind jobs and the economy), it’s clear that the myriad problems that have thus far marked the rollout of the new exchange marketplaces have not been without effect.  Still, the news isn’t all bad.  In a separate poll, negative perceptions of that rollout have begun to ease, at least, according to a new Associated Press-GfK poll.  However, two-thirds of those polled still believe that things aren’t going well.  But, with just over two months left before open enrollment closes, there’s room for improvement; although, less than half of Americans were even able to correctly identify March 31st as the deadline when asked.  Whether that’s a condition of the numerous missteps that have plagued implementation or just a reflection of the general sense of public confusion surrounding the specifics of the law remains to be seen.  But, one group of stakeholders wants the public to know that they’re not the only ones in the dark, as the vast majority of physicians (84 percent) felt that they didn’t have enough information to serve as a reliable resource to their patients. 

State of the Union: On Tuesday, lawmakers tuned in along with the rest of the country for the President’s State of the Union address.  While some feel the President adopted a more magisterial tone than in previous addresses, the focus was undeniably that of looking at the road before the country, rather than at the one behind it.  With so much of the speech dedicated to what the Administration plans to do in 2014 – with or without Congress’ help – it should come as no surprise that health care got more airtime in this year’s address than it has since the law was first passed.  And, as expected, the President used the opportunity to push the Affordable Care Act, specifically calling on critics to stop trying to repeal the law, while rallying supporters to get people signed up.  Still, even though plenty was said during Tuesday’s speech, some were more interested by what was intentionally left unsaid.

CARE Act: Republicans this week offered up their latest proposal to replace the health care law.  The bill, proposed by Sens. Richard Burr (North Carolina), Tom Coburn (Oklahoma), and Orrin Hatch (Utah), seeks to lower health insurance costs while retaining certain elements of the Affordable Care Act.  Analysts believe the proposal, entitled “The Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act”, provides a legislative blueprint for the GOP, articulating a much-needed vision for health care reform heading into November’s elections.  Specifically, the CARE Act would look to repeal the health care law’s mandates, taxes, and fees and replace the law with “common sense, patient-centered reforms.”  Democrats, however, dismiss the bill as just the latest, misguided attempt by their colleagues across the aisle to score political points ahead of election season.

Enrollment Momentum: The latest enrollment numbers coming from the exchange marketplaces offer welcome encouragement to what has been a beleaguered rollout.  Late last week, the Department of Health & Human Services (HHS) announced that 800,000 people have enrolled on the exchanges so far in January.  When combined with the 2.2 million sign-ups from October through December, about 3 million people have now selected a plan under the umbrella of the Affordable Care Act.  Despite falling short of the projected mileposts along the road to 7 million total enrollees, that January is shaping up to surpass December for most enrollees is cause for celebration, especially since many experts had predicted a sharp drop-off this month.  And, perhaps most encouraging of all, the Administration reports “a significant surge in the percentage of young Americans” enrolling.

Debt Limit Demands: As the nation once again finds itself dangerously close to the debt ceiling, the political discourse surrounding next steps appears to have taken a decidedly different tone.  Last year’s squabbles over the budget dissolved into rancorous, partisan debate, resulting in a 16-day partial government shutdown.  But this time around, there doesn’t seem to be any appetite for similar brinksmanship.  Last week, Treasury Secretary Jack Lew sent a letter to House Speaker John Boehner (R-Ohio) making the case that it was in the country’s best interests to raise the debt limit in early February.  In response, earlier this week, the Speaker conceded that last fall’s shutdown left his party with narrower options, as the last thing anyone on either side of the aisle wants is another knockdown, drag-out affair over the budget, especially heading into an election year.  While Republicans had hoped to exact some concessions in the coming negotiations, it’s now looking more like a clean debt ceiling increase is in the cards.

Medicare Advantage Cuts: Medicare Advantage continues to find itself the topic of conversation as the popular program, serving more than 14 million seniors and individuals with disabilities, navigates a vastly changed (and changing) health care landscape.  Evidence has already shown how disruptive previous cuts and the Affordable Care Act’s new health insurance tax (HIT) have been to beneficiaries’ coverage.  But, what’s only now starting to come to light is the impact that all of these changes have wrought on the provider network that serves this vulnerable population.  Already, physicians are struggling with what to tell their patients.  And, those frustrations have, in turn, found a ready-target, with providers directing their energies towards insurers, who they blame for opening up these gaps in care.  Insurers, however, have resisted these attacks by rightly pointing to the billions of dollars in payment cuts and new taxes they now face – both of which are being used to subsidize the coverage for the millions of people now eligible for insurance under the health care law.  With so much at stake, it’s vital that decision-makers continue to hear from the individuals and families that depend on the coordinated model of care that is Medicare Advantage.  Make sure your perspective is heard by visiting the Coalition for Medicare Choices and adding your voice to the thousands already speaking up on behalf of this crucial program. 

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Looking Ahead

Despite the challenges that have marked the Affordable Care Act’s rollout, a new study offers a glimpse at what the future might hold for the sweeping law.

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