Is President Obama Banking On a Health Reform Shot In The Re-Election Arm?

Judicial review of national health reform’s individual mandate is thus far mixed, with some court rulings in favor and others against its constitutionality. In August, a split decision of a three-judge panel of the 11th Circuit Court of Appeals ruled that the individual mandate is not covered by the commerce clause. The Obama administration could have delayed health reform’s inevitable move to the highest court in the land, but decided against asking for a full circuit court review of the panel’s decision. This could mean a Supreme Court ruling by June 2012.

Winners and Losers in MedPAC Proposal to Fix SGR – Specialists would see Pay Cut

Last week the Medicare Payment Commission (MedPAC) unveiled recommendations that would change the way physicians in the Medicare fee-for-service program would be paid. The proposal would replace the Sustainable Growth Rate (SGR) formula and, over a ten year period, would employ statutory fee schedule updates. MedPAC’s estimates suggest this plan would save the program $100 billion as compared to the cost of “freezing” pay for physicians at the current level.

On a Roll – Rules to Implement Health Reform Issued Fast and Furiously

The health reform mandates keep rolling along.

On September 23, 2011, many plans are required to implement a second increase in their annual limits to $1.25 million per person, per policy year for non-grandfathered individual, small group and all large group plans. A year ago, the Patient Protection and Affordable Care Act (PPACA) eliminated lifetime limits and began phasing out annual limits over the next several years.

Feds May Be Pushing Minimum Medical Loss Ratio Consistency Across All Lines of Business

A federal response to the Florida Medicaid agency’s new 1115 waiver request shows that the Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (HHS) are moving toward a uniform minimum medical loss ration (MLR) standard for the nations’s health care system.