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Opponents lash out at reform provisions


A few states have threatened to shut down Medicaid programs, and some say they won't set up local insurance exchanges if they have to meet all the requirements of the Patient Protection and Accountable Care Act.

WASHINGTON-There's great uncertainty about the future of the individual mandate and of health reform overall. Recent court rulings challenging the law and moves by reform critics in Congress are raising concerns.

State officials question how much of their limited resources to invest in exchanges and the host of new programs. A few states have threatened to shut down Medicaid programs, and some say they won't set up local insurance exchanges if they have to meet all the requirements of the Patient Protection and Accountable Care Act (PPACA).

Critics want a speedy Supreme Court decision on the constitutionality of the law and the individual coverage mandate. With split decisions in four district courts, the normal course is for the U.S. Court of Appeals to review the cases before taking them to the high court. Republicans have petitioned to fast-track the process before President Obama can replace a conservative court member with a more liberal jurist.

In addition to repeal of the 1099 rule, the House Judiciary Committee is moving forward with medical malpractice reform legislation. A bill would cap punitive damages at $250,000, establish a three-year statute of limitations for filing suits, and limit attorney's fees in some cases. President Obama expressed interest in revising malpractice policy, but the House bill faces considerable opposition from Democrats and trial lawyers, while some Republicans fear the legislation would undermine state liability limits.

One Democratic proposal that the Committee almost approved, according to a report in Politico, was to eliminate health insurance companies' exemption from antitrust laws. It's a popular idea that has some Republican support.

In addition to legislative action, several House committees are mapping agendas for aggressive oversight of health policies. The Ways & Means Committee examined the impact of PPACA on Medicare, with a focus on funding cuts for the Medicare Advantage program.

House Energy & Commerce Committee chairman Fred Upton (R–Mich.) has planned oversight hearings on a number of key issues. As part of a broad investigation, Upton is examining the Center for Consumer Information and Insurance Oversight (CCIIO), now part of the Centers for Medicare and Medicaid Services (CMS). Upton sent a letter seeking information on its authority, structure and how it decides "who does not have to comply with the massive new regulations" imposed by PPACA.

Similarly, Sen. Orrin Hatch (R-Utah), ranking Republican on the Senate Finance Committee, has asked CMS Administrator Don Berwick to explain why there are more than 700 waivers and why some may be denied.

Upton also plans to examine proposals for permitting consumers to purchase insurance across state lines.


Additional targets for cost-cutting Republicans are the new entities established by PPACA to advise on benefits, effectiveness and payment methods. The critics see these organizations as examples of federal government over-reach into state and private sector activities, and they also have their eye on the billions of dollars allotted to these programs.

For example, Republicans want to dissolve the Prevention and Public Health Fund, which is supposed to dispense some $15 billion over 10 years to support state health initiatives. They also don't see a need to spend $10 billion over 10 years to fund the Center for Medicare and Medicaid Innovation, a new entity to support research and testing of reimbursement and coverage approaches. And there's skepticism about the need for federal investment in comparative effectiveness research when private plans and local organizations are supporting technology assessment on their own. Some Republicans would like to shutter the Patient-Centered Outcomes Research Institute and use its $500 million a year budget for other purposes.

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