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Health Care Edge

Is Obamacare Living Up to Its Preexisting-Conditions Promise? - Health Care Edge: Brought to you by ACS CAN

June 24, 2014

Is Obamacare Living Up to Its Preexisting-Conditions Promise?

By Sophie Novack and Sam Baker

INSURERS COULD BE SKIRTING THE LAW: Obamacare may be falling short in its promise to protect the sickest and most needy individuals. The law's pre-existing conditions protections for the first time prohibit insurers from refusing coverage to consumers because of their health status, but patient advocates say that still-limited regulation means the policy is not always translating into an on-the-ground reality.

 

Instead, advocates say that insurers are designing their benefits in a way that drives high-cost patients to other plans. A complaint filed against four insurers in Florida last month accuses the companies discriminating against HIV/AIDS patients by tiering their drug coverage to make medication up to 50 times more expensive than competing plans. The complainants argue that these practices go completely against the tenor of the law--that the protection is meaningless if the coverage is inadequate or unaffordable in reality.

"The protections are there; the statute is there; the regulations--those are not so clear," said Robert Greenwald, director of the Center for Health Law and Policy Innovation at Harvard Law School. "And enforcement--there's not a body of enforcement yet."

Top Health Care News

PRE-EXISTING: "According to the complaint, three of the insurers—CoventryOne, Cigna, and Preferred Medical—require their consumers to pay for 40 percent of the medication costs out of pocket. The fourth, Humana, requires consumers to pay 50 percent out of pocket." (Sophie Novack, National Journal)

PROBE FINDS VA WATCHDOG DOWNPLAYED IMPACT OF TREATMENT ERRORS AND DELAYS. A new report says that the Veterans Affairs Office of the Medical Inspector repeatedly dismissed legitimate reports of wrongdoing in the VA system, saying they do not have an impact on patient care. (Michael M. Phillips and Ben Kesling, Wall Street Journal)

POLL: 5 PERCENT SAY THEY'RE NEWLY INSURED: According to new data from Gallup, 5 percent of Americans were newly insured this year -- about half of them through Obamacare's exchanges. That's consistent with previous Gallup surveys that found a similar drop in the number of uninsured Americans. (Steve Ander and Frank Newport, Gallup)

Insurance

NOT EVERYONE LOVES TRANSPARENCY:The largest insurance company in Washington state is being blamed for the death of a bill that would have made public the rates insurers pay for health care services. Although the measure was billed as a way to give consumers more purchasing power, the insurance company says there's not much evidence that people make such nuanced, carefully researched decisions. (Jason Millman, The Washington Post)

BUSINESSES PREPARE FOR THE EMPLOYER MANDATE: Companies have been cutting hours and struggling with logistics in recent months. (Sandhya Somashekhar, Washington Post)

Providers

BIGGER HEALTH COMPANIES MAY BE BETTER FOR MEDICARE, BUT NOT FOR OTHERS: "Larger organizations have greater market power to demand higher prices from those plans for doctor visits and hospital stays. And higher prices paid by plans translate into higher premiums for consumers. (This doesn't apply to Medicare because its prices are set by the government, and no provider organization has so much market clout that it can force Medicare to raise prices.)" (Austin Frakt, New York Times)

THE FORGOTTEN LONG-TERM ACUTE CARE HOSPITALS: "'People don't want to think about us,' said Dr. Paul Scalise, chief of medicine at the Hospital for Special Care. 'I don't want to think about us, either.'

But more experts and policy makers are likely to have to start thinking about them soon. The cost of long-term acute care is substantial, about $26 billion a year in the United States, and by one estimate the number of patients in these facilities has more than tripled in the past decade to 380,000.

...Medicare, concerned about the high price of long-term acute care hospitals, is trying to trim reimbursements. Nearly half of the $7.3 billion cut from its budget by the Affordable Care Act came from reductions in payments to these facilities." (Gina Kolata, New York Times)

Abortion

WILL CONGRESS LIFT ITS BAN ON ABORTION FUNDING FOR PEACE CORPS RAPE VICTIMS? Unlike other federal employees, Peace Corps volunteers are banned from receiving federal funding for abortion coverage in the event of rape, incest, or life endangerment. The Senate is pushing to lift the ban and the appropriations committee passed a bill last week that includes language to eliminate the restriction, but the House has blocked the effort in recent years. The House Appropriations Committee will hold a markup Tuesday of the FY 2015 State and Foreign Operations Appropriations Bill, which includes budgeting for the Peace Corps. (Sophie Novack, National Journal)

SUPREME COURT DECLINES TO TAKE WISCONSIN ABORTION CASE: The high court declined to get involved in the legal fight over a new Wisconsin law requiring doctors performing abortions to have admitting privileges at a nearby hospital, which opponents say could close half the abortion clinics in the state. (Lawrence Hurley, Reuters)

  • The admitting privileges requirement has passed and faced legal battles in a number of states recently, including Mississippi, Alabama, and Texas.
  • Experts say it is likely the Supreme Court will take on an abortion case as soon as next session. (Sophie Novack and Sam Baker, National Journal)

Cigarettes

CIGARETTES ARE GETTING EVEN WORSE:Cigarettes are more addictive and have more cancer-causing chemicals than they did 50 years ago, making them even more of a health risk to smokers even as the U.S. smoking rate continues to fall. (Adrianna McIntyre, Vox)

Disease

OHIO MEASLES OUTBREAK MAKES AMISH RECONSIDER VACCINES: The U.S. is in the midst of the largest measles outbreak in recent history, with the majority concentrated in Ohio, where there have been 341 confirmed cases and eight hospitalizations, particularly among the largely unvaccinated Amish communities. (Sarah Jane Tribble, NPR)

CMS

PRESS OFFICE EMPTYING: Two more people are leaving the CMS communications office -- Julie Bataille, the CMS communications director, and Richard Olague, who had focused primarily on Obamacare's insurance exchanges (as has everyone, at least lately). Medicaid spokeswoman Emma Sandoe is already gone, as are several members of the HHS communications office.

Happening Today

  • House Appropriations full committee markup of the FY 2015 State and Foreign Operations Appropriations Bill, which maintains the ban on emergency abortion funding for Peace Corps volunteers and restrictions on foreign aid for family-planning groups. The Senate Appropriations Committee voted 19 to 11 last week to pass amendments that lift these restrictions, to be included in the 2015 State Department spending bill. The battle over these abortion funding provisions is a familiar one in the appropriations process. The markup will be at 10 a.m.

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