Special report: 2011 was another unforgettable year in healthcare
The first week of 2011 ushers in the 112th Congress, with a new Republican majority in the House led by Speaker John Boehner (R-ohio). House GOP members vow immediately to “repeal and replace” the Patient Protection and Affordable Care Act that President Barack Obama signed into law in 2010. Excitement on Capitol Hill in the first week of the new year soon turns to tragedy when a shooting spree outside a grocery store in Tucson, Ariz., leaves Rep. Gabrielle Giffords (D-ariz.) in critical condition and six others dead. House GOP members change their tone slightly, referring to the Affordable Care Act as a “job-destroying” rather than a “job-killing” bill, but they are no less committed to their goal of abolishing the law. And they soon make good on their promise, as the lower chamber votes 245-189 to repeal the reform act with help from all 242 House Republicans and three Democrats. With no chance of passing in the Senate, the repeal bill is seen largely as a symbolic move. Still, Republicans continue to chip away at the law throughout all of 2011, even as the Obama administration and HHS stay the course, releasing regulations and announcing programs that the law established.
Long delayed, the proposed rule for accountable care organizations is released on the last day of March and is met with much skepticism by healthcare providers, as the 429-page regulation promises more federal scrutiny, a host of clinical quality measures to achieve and downside risk for participants in the program.
In April, House GOP members are successful in overturning a piece of the Affordable Care Act when Obama signs a law repealing the contentious 1099 provision that would have required businesses starting in 2012 to report information to the Internal Revenue Service on payments of goods totaling $600 or more.
In May, HHS announces the “Pioneer
ACO” program to help ready-made ACOS enter the Medicare program quickly and have other providers follow.
Later in the year, the CMS Innovation Center announces two innovation-related programs: the “Innovation Advisors” program, a $6 million initiative intended to help leaders gain the skills to carry out system reforms for Medicare, Medicaid and Children’s Health Insurance Program beneficiaries at their respective organizations; and the “Innovation Challenge,” for which HHS will invest up to $1 billion in projects nationwide that test ways to deliver better healthcare quality and save money—with preference going to models that focus on hiring and training healthcare workers quickly.
In early December, HHS releases final regulations on the medical-loss ratio, which requires individual and small group insurance plans to spend at least 80% of insurance premiums on medical care and large group plans to spend at least 85%. Throughout 2011, the CMS’ Center for Consumer Information and Insurance Oversight denies North Dakota and Delaware’s requests for medical-loss-ratio adjustments; grants Maine’s full request; and makes adjustments to the requests from New Hampshire, Nevada, Kentucky and Iowa. The states of Florida, Indiana, Louisiana and Michigan complete applications, while applications from Kansas, North Carolina, Oklahoma and Texas are undergoing a “review for completeness.”
Several states take dramatic and sometimes diametrically opposed approaches to healthcare reform, with Vermont approving legislation to create a single-payer system and Florida aiming to use private insurers for Medicaid managed care.