Topics This Week:
1. Government Shut Down, What is happening?
2. Health Policy 101: How Is a Federal Budget Created and Passed?
3. October 1st Marks Launch of Health Insurance Exchanges
4. The Obama Administration Attempts to Better Market the Affordable Care Act
5. Health Policy 101: Insurance Exchanges
1. Government Shut Down, What is happening?
2. Health Policy 101: How Is a Federal Budget Created and Passed?
3. October 1st Marks Launch of Health Insurance Exchanges
4. The Obama Administration Attempts to Better Market the Affordable Care Act
5. Health Policy 101: Insurance Exchanges
1. Government Shut Down, What is happening?
After congress was unable to pass a spending bill for the next fiscal year, the Federal Government went into partial shutdown Oct 1st, with employees and services deemed ‘non-essential’ being temporarily furloughed. This translates to over 800,000 federal employees being sent home and the close of national parks, offices, and museums in the first government shut down in the last 17 years. The shutdown represents the latest in the conflict between Republican and Democratic Leadership over the implementation and funding of the ACA. In the weeks leading up to the shut down a spending bill repeatedly passed between the Republican controlled House and the Democratic controlled Senate which respectively removed and then reinserted funds for the ACA . Ultimately, the President and Democratic Senate refused to pass any bill that wasn’t “clean”, meaning that they would not compromise on implementation of, and funding for, the ACA. Meanwhile Republican leadership of the House strongly feel the need to on delay what they deem a ‘deeply flawed’ healthcare law. As the government shutdown continued, the House attempted to pass legislation that would fund specific parts of the government during the partial shutdown, but the Senate blocked the legislation with leadership claiming it was another attempt of the Republican fractions to cherry-pick programs to fund while leaving the ACA unfunded. As we move into the second week of the shutdown some republicans are moving away from asking for repeal of the full ACA and instead looking for a narrower approach. Last week a bipartisan group from the House proposed a 6 month funding bill contingent upon the repeal of the health law’s Medical Device Tax. As the shutdown marches on, the growing concern will be the debt ceiling and the need to pass a spending bill so that the country can keep payment on debts.
Source:
Roll Call
The Hill
The Hill
NY Times
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2. Health Policy 101: How Is a Federal Budget Created and Passed?
The Budget and Accounting Act of 1921 requires that the President submit a budget to Congress each year. This is typically done between the first Monday in January and the first Monday in February (however, the President has not submitted his budget yet this year). After the budget is submitted, the Congressional Budget Office publishes an analysis of the budget, which typically comes out about a month later. The House and Senate then undergo consideration of the President’s budget proposals. Typically, the House and Senate each pass a budget proposal by April 1, and a final budget, with amendments, is passed (typically) by April 15. The appropriations process (how to hand out the money within specific departments/programs) begins after May 15, and both the House and Senate eventually pass an appropriations bill. After these are passed, a committee meets to work out the differences between the two bills, and when that is completed, a final bill is sent to the President for final approval. The budget goes into effect from October 1 of that year until September 30 of the following year (this is the fiscal year). If the budget isn’t finalized by October 1, Congress will often pass a continuing resolution to fund the government for a short period of time, during which, it is hoped that the budget will be finalized. If a continuing resolution is not passed, then the government is not funded, and all non-essential departments close until a budget is passed.
Source:
AAMC OSR Health Policy 101
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3. October 1st Marks Launch of Health Insurance Exchanges
On October 1st Healthcare.gov opened and allowed Americans to purchase health insurance from private companies through structured online exchanges. The goal of this major tenant of the Affordable Care Act (ACA) is to allow greater transparency and comparability when purchasing a health insurance policy. Some states have created their own exchanges, but states that have opted out of creating their own will be served by using the federal exchange. The opening day of was not without troubles, however; 4.7 million unique visits in the first 24 hours caused long waits and occasional web site crashes as users attempted to create profiles and browse insurance options. Though interest in the exchanges was high during their opening days, the plans offered are for coverage starting in January 1st of 2014, when the ACA’s individual mandate will require all Americans to have coverage. Users will have until December 15th to use the exchanges to get insurance for the start of 2014 to avoid paying a penalty. Though there have been initial glitches, members of the Health and Human Services believe that in the next weeks and months the exchanges will run more smoothly as daily traffic decreases and bugs are fixed. The ACA is currently experiencing more than just technical challenges as of late, as it has been at the center of the budget debate and recent government shutdown. More on the shutdown to follow.
Source:
BBC
Kaiser Health News
Kaiser Health News
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4. The Obama Administration Attempts to Better Market the Affordable Care Act
President Obama’s Affordable Care Act (ACA) has been a contentious piece of legislation since its conception in 2010. Opponents of the ACA have spent millions of dollars in advertising to highlight what they feel are the flaws and dangers of the legislation, which they dub “Obamacare.” To go along with its recent roll-out of health insurance exchanges, the administration is attempting to respond with advertising of its own. The White House is using a variety of tactics ranging from promotions with former President Clinton to tweets with pictures of fuzzy baby animals.This information campaign is particularly important as there is a segment of Americans who state that they oppose Obamacare, but when asked support the provisions that the ACA entails. The administration is not the only group trying to market the image of health care exchanges and the ACA. The Kaiser Family Foundation and other organizations have made simple YouTube videos explaining the basics of the new law. More focus on changing the perception of the ACA by both opponents and proponents will likely continue, as January of 2014 and 2015 will see continued items of the legislation implemented.
Source:
Kaiser Health News
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5. Health Policy 101: Insurance Exchanges
What are they?
The Affordable Care Act (ACA) mandates that states develop Affordable Insurance Exchanges that will allow small businesses (<100 employees) and individuals to review, compare, and shop for both private and public insurance plans The exchanges will also make it clear if the individual or business is eligible for a tax credit. The ultimate goal of this initiative is to provide easy to understand, comparative information that will make choosing a plan easier. Exchanges will also create an administrative mechanism for easier enrollment. Because insurance companies can no longer deny applicants with pre-existing conditions, the exchanges will hopefully help reform the insurance market and make it more effective, as well as allow for monitoring of marketing practices. Additionally for an insurance plan to be included in the exchange it must meet a federal minimum requirement that stipulates what benefits must be included, among other things. While the individual and small business exchanges are technically separate programs, states have the option of combining the exchanges. There is no requirement for individuals or small businesses to use these exchanges, and an insurance market will continue to exist outside the exchange programs.
Why are they needed?
Historically small businesses have had a difficult time offering health insurance to employees, as premiums tend to be higher per worker due to the higher per person costs of administering a plan to a small group of people. The exchange program for small businesses (Small Business Health Options Program, aka SHOP) will make it easier for employers to compare plans and provide more choices to their employees without raising premiums. Both individual and SHOP exchanges must open enrollment by October 2013, and be fully functional by January 2014.
How will they function?
States have been given much latitude in determining how their exchanges programs will be executed. They may be an executive branch agency, and independent government authority, or a non-profit organization. States may also forge exchange partnerships with other states to cover a larger region. Additionally, if a state does not have a functional exchange in place by January 2014, or decides not do provide an exchange, the federal government will step in and partner with the state. States can also decide whether the exchanges will offer “any-willing-plan,” where any plan that meets minimum requirements would be part of the exchange, or states may be ‘active purchasers,’ where the state chooses what plans are in the best interest of their populations. It is estimated that by 2019, 28 million Americans will be covered through Affordable Insurance Exchanges.
Source:
AAMC OSR Health Policy 101
Your Legislative Affairs Team:
Alexandra Printz, National Delegate
Arindam Sarkar, Southern Region
Christos Theophanous, Western Region
Michael Hunter, Northeast Region
Rob Klemisch, Central Region