On June 21, the Institute of Medicine (IOM) released a report, suggesting that federal and state governments review and revise public health laws to ensure that they adequately address the current health care landscape.  Created at the request of the Robert Wood Johnson Foundation (RWJF) and presenting the findings of a committee of experts, the report also stresses the importance of evaluating the effects of non-health care legislation, noting that such legislation can have a significant impact on public health.  Finally, the report recommends that states require health agencies to require 10 essential public health services.

From the report:

On June 29, Families USA released a report examining Medicaid cuts outlined under U.S. Rep. Paul Ryan’s (R-WI) $3.5 trillion FY2012 budget proposal, approved by the U.S. House on April 15.  In addition to repealing most provisions of the national health care reform law, the budget would also convert Medicaid into a block grant program beginning in 2013, reducing state payments by 5 percent in 2013, 15 percent in 2014, and 33 percent in 2021.  Based on an economic modeling tool used by the U.S. Department of Commerce to assess the impact of major events on regional economies, Families USA’s analysis finds that the Medicaid cuts would risk a total of 35,210 jobs and $4.2 billion in economic activity.  The report estimates that the cuts would harm program enrollees, reduce business activity, and contribute to job losses.  The report also provides state-level estimates of the impact of each cut on business activity and jobs.

From the report:

The Robert Wood Johnson Foundation and Health Affairs have published a brief examining the impact of extending the additional Federal Medical Assistance Percentage (FMAP) funding offered under the American Recovery and Reinvestment Act (ARRA).  The authors assert that without extending the funding states will be forced to cut additional funding in order to balance their budgets.  The brief examines arguments both for and against extending the funding.

From the report:

Medicaid is the joint federal and state health insurance program for low-income Ameri­cans. To help states through the recession and weak recovery, federal stimulus legislation en­acted in 2009 included a temporary increase in the dollars that the federal government sent to states for the program. Originally due to expire at the end of 2010, some additional funding was extended through June 30, 2011. Now that extra assis­tance has expired. Despite the stalled econ­omy and states’ ongoing fiscal pressures, no additional federal Medicaid money is being considered at this time. This brief describes what has happened, as well as the options for states. 

Full report: Extra Federal Medicaid Support Ends (PDF | 526.90 KB)

Robert Wood Johnson Foundation and Health Affairs.  (2011).  Extra federal Medicaid support ends.  

The Kaiser Family Foundation has Long Term Care and Dual Eligibles: Overview and Managed Care Opportunities released a brief explaining Section 1115 Medicaid demonstration waivers, outlining how they are approved and financed, how states have used them, and how health reform affects them.  KFF notes that the waivers have traditionally authorized the testing of novel coverage methods not normally allowed under Medicaid.  The authors note that some states are now using the waivers to begin expanding health coverage under Medicaid in preparation for full implementation of health reform.  In addition, the brief notes that some states use the waivers as a means to reduce costs and address budgetary shortfall.

From the report:

Section 1115 of the Social Security Act gives the Secretary of Health and Human Services authority to waive provisions of major health and welfare programs authorized under the Act, including certain Medicaid requirements, and to allow a state to use federal Medicaid funds in ways that are not otherwise allowed under federal rules. The authority is provided at the Secretary’s discretion for demonstration projects that the Secretary determines promote Medicaid program objectives.

Full report: Five Key Questions And Answers About Section 1115 Medicaid Waivers (PDF | 865.26 KB)

Kaiser Family Foundation.  (2011).  Five key questions and answers about section 1115 Medicaid waivers.

In compliance with a request by U.S. Rep. Henry Waxman (D-CA), on May 26, the Congressional Budget Office (CBO) provided an analysis of legislation that would permanently prevent the use of funds appropriated to implement the national health care reform law.  Previously, the CBO and the Joint Committee on Taxation estimated that temporarily preventing the use of those funds through the remainder of FY2011 would reduce current fiscal year deficits by $1.4 billion but increase deficits by $6 billion through FY2021.  The CBO asserts that it is not possible to determine the specific impact of a permanent block on health reform implementation spending but estimates that such a change would have a “much greater” budgetary impact than the temporary measure.  The authors project that the legislation could potentially end Medicare prescription drug coverage under the Medicare Prescription Drug Program (Part D), because changes to Part D outlined under health reform could not be implemented, particularly the closure of the “doughnut hole” coverage gap.  The authors also estimate that such legislation could prevent the Centers for Medicare & Medicaid Services (CMS) from making annual Medicare reimbursement rate adjustments, prevent enforcement of the law’s individual mandate, preclude the U.S. Department of Health and Human Services (HHS) from establishing health exchanges in states that do not establish their own, and prevent the implementation of recommendations issued by the Medicare Independent Payment Advisory Board (IPAB).

From the report:

The Congressional Budget Office (CBO) and the staff of the Joint Committee on Taxation (JCT) have previously estimated the effects of legislation that would temporarily prevent the use of appropriated funds to implement PPACA and the Reconciliation Act. Specifically, earlier this year, CBO and JCT estimated the budgetary effects of enacting section 4017 of H.R. 1, the Full-Year Continuing Resolution Act, as passed by the House of Representatives on February 19, 2011. That provision would have prevented the use of funds appropriated in H.R. 1—that is, any funding for fiscal year 2011—to implement PPACA and the Reconciliation Act. CBO and JCT found that such a temporary prohibition, extending through the remainder of fiscal year 2011, would reduce the budget deficit by about $1.4 billion in 2011 but would increase deficits by almost $6 billion over the 2011-2021 period.The H.R. 1 was ultimately supplanted by H. R. 1473, the Department of Defense and Continuing Appropriations Act of 2011, which did not include a provision like section 4017 of H.R. 1.

Full report: Budgetary Effects of Legislation Preventing the Use of Appropriated Funds to Implement the Affordable Care Act (PDF | 87 KB)

Congressional Budget Office. (2011). Budgetary effects of legislation preventing the use of appropriated funds to implement the Affordable Care Act.

On May 31, the Commonwealth Fund released a brief offering state policy recommendations for establishing a health exchange based on California’s experience.  California was the first state to create its own health exchange after the approval of health reform.  In particular, the authors highlight aspects of California’s exchange that reduce adverse selection and promote cost-conscious consumer behavior.

From the report: 

On September 30, 2010, just six months after the passage of the Affordable Care Act, California became the first state in the nation to create its own insurance exchange in response to the provisions of federal health care reform. On April 20, 2011, the Board of the California Health Benefit Exchange held its first meeting. Although its fifth and final member had yet to be appointed, the board hired an interim director and outlined an ambitious process to develop a comprehensive business plan and budget for the exchange.

This accelerated timeline is consistent with California’s desire to be, in the words of the state’s Health and Human Services secretary and Exchange board chair Diana Dooley, the “lead car” in implementation of federal health care reform. Because of the speed with which it has approached this task as well as the sheer size of its coverage expansion, the decisions California has made will be influential both regionally and nationally. What transpires in the state will have implications for other states as they address difficult issues, including minimizing adverse selection, promoting cost-conscious consumer choice, and seamlessly coordinating with public programs. This brief reports on California’s decisions, evaluates the likelihood that these choices will advance the goal of providing affordable access to high-quality care, and analyzes the extent to which these decisions can serve as a blueprint for other states.

Full Report: State-Based Coverage Solutions: The California Health Benefit Exchange (PDF | 937 KB)

Commonwealth Fund. (2011). State-based coverage solutions: the California health benefit exchange. Weinberg, M. and Wellington Haase, L.