A bumpy road for health re­form

Modern Healthcare - - Special Report -

The United States ap­proves the first com­pre­hen­sive health­care re­form in its his­tory af­ter a leg­isla­tive roller­coaster ride in the first weeks of 2010. The de­bate spills over from 2009 into the new year af­ter the House and Se­nate ap­prove dif­fer­ent re­form bills. Prospects for re­form leg­is­la­tion dim in Jan­uary as Repub­li­can Scott Brown un­ex­pect­edly wins a spe­cial elec­tion in Mas­sachusetts to fill the Se­nate seat long held by Demo­crat Ed­ward Kennedy, who died in Au­gust 2009. The vic­tory sends shock waves through the ranks of Demo­cratic law­mak­ers and de­prives them of the 60th vote needed to break Se­nate fil­i­busters. By March, House Democrats de­cide to cir­cum­vent Repub­li­can fil­i­buster at­tempts by drop­ping their own bill and back­ing a Se­nate re­form bill passed on Christ­mas Eve. A ran­corous de­bate en­sues in March, but the bill passes the House on a party­line vote. The Se­nate then ap­proves a pack­age of al­ter­ations to the orig­i­nal bill sought by House Democrats. Pres­i­dent Barack Obama signs the mea­sure into law on March 23 dur­ing a White House cer­e­mony.

Other high­lights:

An­them Blue Cross, a unit of Wel­lPoint, tells sub­scribers on Feb. 13 that it in­tends to raise premi­ums for in­di­vid­ual in­surance plans by an av­er­age of 25%. The Obama ad­min­is­tra­tion seizes on the an­nounce­ment as proof that in­surance re­form is needed, and it launches a se­ries of attacks on the in­surance in­dus­try.

Repub­li­cans vow to re­peal the health re­form law. Of­fi­cials in about 20 states, mostly Repub­li­cans, file le­gal chal­lenges or take other steps to block en­force­ment of the law, par­tic­u­larly the man­date that re­quires all Amer­i­cans to have in­surance cov­er­age. GOP can­di­dates de­nounce the re­form mea­sure dur­ing con­gres­sional cam­paigns and win con­trol of the House in the new Congress, al­though they fall short of con­trol of the Se­nate.

State and fed­eral of­fi­cials bat­tle in fed­eral courts over the law. The con­tests ap­pear des- tined to be re­solved by the U.S. Supreme Court. As the year closes, a fed­eral judge in Vir­ginia de­clares the in­surance man­date por­tion of the health­care law un­con­sti­tu­tional, sid­ing with Vir­ginia’s at­tor­ney gen­eral in that dis­pute. In Pen­sacola, Fla., U.S. District Judge Roger Vin­son rules in Oc­to­ber that the suit’s ar­gu­ments are strong enough to war­rant pro­ceed­ing to trial. A fed­eral judge in Akron, Ohio, also rules that a re­form chal­lenge suit filed by a con­ser­va­tive le­gal group can move for­ward. Mean­while, two other fed­eral judges—one in Vir­ginia and one in Michi­gan—up­hold the law. An­other fed­eral court in New Jersey dis­misses a chal­lenge to the law filed by a physi­cians group.

Sev­eral pro­vi­sions of the law go into ef­fect be­fore the end of 2010. These in­clude a ban on in­surance dis­crim­i­na­tion against chil­dren with pre-ex­ist­ing con­di­tions, cov­er­age of de­pen­dents up to age 26, a pro­hi­bi­tion on life­time ben­e­fits, an end to in­surance rescis­sions and tem­po­rary high-risk in­surance pools for peo­ple with­out cov­er­age be­cause of pre-ex­ist­ing con­di­tions.

Con­sul­tants en­joy a field day as providers at­tempt to set up the “ac­count­able care or­ga­ni­za­tions” called for un­der the re­form law.

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