From Passage to Implementation: Health Reform, A Year in Review

Since its passage one year ago today, the Patient Protection and Affordable Care Act (PPACA) has been the center of national debate, and the focus of much time and speculation on what the future will hold.

States have brought legal challenges to the law, which will likely be settled by the U.S. Supreme Court.   House Republicans have convened hearings, voted to repeal and continue efforts to defund the legislation.  Democrats and the Obama administration have engaged in a public relations campaign to educate the general public about the law and boost public support.

Lack of Standardization Surrounding Innovation: Regulations for Innovation Waivers Lack Specificity

Last week, HHS released rules that establish an application process for states to request a waiver of innovation requirements that apply to health exchanges under health reform.

Applications will either go through HHS or the Treasury Department, depending on which provision a state is seeking to waive.  Additionally, the regulations establish a state and federal public comment process as part of any waiver application.

What is in the Stars: Medicare Advantage Star Ratings Take Leading Role, Part 2

As we discussed yesterday, passage of the health reform bill created a quality bonus system using the CMS ratings. In Part I of this post, we touched upon the quality ratings and bonuses of premium reductions and rebates. Today, we will look at contract renewal and special election periods.

What is in the Stars: Medicare Advantage Star Ratings Take Leading Role, Part 1

Individual Mandate Remains Elephant in the Room – Obama Reaches Out to GOP on State Flexibility

The individual mandate as contained in the health reform law will continue to be the subject of controversy until the U.S. Supreme Court makes a final ruling on its constitutionality. The lower courts are divided, with three supporting the mandate and two ruling against, which signals the very real possibility that the provision could be struck down.

Yet the individual mandate is a critical fixture of the Patient Protection and Affordable Care Act (PPACA) because it spreads risk throughout the market and prevents adverse selection in any one sector. That is because requiring all people to purchase insurance—not just those who need coverage—is the only way to ensure financial viability. Without this mandate, the Obama administration will be scurrying to find a way to structure a plan to save health reform.