Health Care Reform Today

• Tom Richards
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  Tom Richards

  

  Tom Richards

  President Individual and Family Plans, Online Experience and Health Care Reform

As we turn the corner into 2012, health care reform is at a crossroads. Nearly two years old, the Patient Protection and Affordable Care Act of 2010 (PPACA) is deep into implementation, but also facing significant fiscal, judicial and political challenges. The legislation continues to generate conversation, controversy and debate on all fronts. In 2012, we will face impacts to the legislation coming from all three branches of the federal government as well as the states.

Fiscal, Judicial and Political Challenges

The country will continue to face difficult fiscal decisions brought about in part by the failure of the “Super Committee” to reach an agreement in November. Health care reform may certainly experience impacts as a result. 2012 will also bring a major, but uncertain, U.S. Supreme Court ruling on the future of the health care law.

Combine all this with another tumultuous election year for all members of the U.S. House of Representatives, 33 U.S. Senate seats, 10 governor seats and, of course, the presidency, health care policies are bound to be a major factor in the electorate's decisions next November.

Let's take a look at each of these areas of impact.

Following two years of legal challenge to the legislation, in late March the Supreme Court will hear oral arguments challenging the legislation based on four key areas:

• Anti-injunction Act: Are private individuals and states barred from challenging the constitutionality of the individual mandate by the Anti-injunction Act, which prohibits legal challenges to taxes until after the tax is collected? Oral arguments are slated for March 26.
• Individual Mandate: Did Congress exceed its authority under the Commerce Clause in requiring that individuals maintain "minimum essential coverage" beginning in 2014 or pay a tax? Called "the minimum coverage provision" by the Court, arguments will occur on March 27.
• Severability: If the individual mandate provision is nullified as unconstitutional, is it "severable" from the rest of the legislation—allowing some or all of the remaining provisions to stand—or is the entire law nullified? Will be heard on March 28.
• Medicaid: Did Congress exceed its authority in expanding the Medicaid program? Will also be heard on March 28.

The Supreme Court is expected to rule on these issues some time in June.

Following that ruling, we have the presidential election in November, which has the potential to create even more volatility in the political landscape.

With the continued emphasis on the federal deficit, the legislature continues to center on key spending areas, including the funding of PPACA. Additionally, legislation continues to be introduced to shift the focus of the various provisions.

Couple these dynamics with the number of seats up for re-election at the federal and state levels, and the landscape could change dramatically in one day!

We recognize that this dynamic environment can create uncertainty for individuals, business leaders and their advisors. Cigna will redouble our efforts in 2012 to help you stay abreast of the regulations and, more importantly, their implications for you. And, we'll continue to work with all stakeholders to help customers improve their health and gain access to quality care. Regardless of which path PPACA takes, better health is always a better path.

Exchanges and Other Provision Work

We will be hearing more and more about both the federal and state exchanges. These marketplaces where individuals and small employers can purchase health coverage are slated to open in January 2014. The exchanges require a tremendous work effort that must be completed between now and 2014 at the federal, state and industry levels to ensure that they are ready for enrollment in the fall of 2013.

Cigna will continue foundational and technical work for our participation in the exchanges; and we will also continue to work with state and federal officials to shape how the exchanges will operate. For more information on our position, read our Exchanges advocacy paper.

In 2012, major areas of interest for the industry will include the finalization of reporting for Medical Loss Ratio and the issuance of rebates where required. Work will also continue on building the capability to issue the new Summary of Benefits and Coverage that meets the government's standards as HHS works to refine the regulations. We will also be updating our preventive care guidelines and interpreting guidance on Essential Health Benefits, a pivotal provision that will be defined state by state.

We'll also begin work to pay fees and upcoming taxes on our industry, including the Patient-Centered Research Fee (formerly the Comparative Effectiveness Research Fee). This 2011 provision calls for an annual assessment on insurers and group health plans to fund a Patient-Centered Outcomes Research Trust Fund, which is intended to be used to conduct research into the effectiveness, advantages and risks of medical treatments, services and drugs.

Keeping You Informed On Reform in 2012

2012 is shaping up to be an exciting year on many fronts. Amid all the uncertainty, the PPACA is the law of the land. While we continue to support increasing access and improving health — two of the goals of reform — we're also working to influence the final regulations to ensure that Cigna, our clients and our customers are well positioned in the environment to come.

We look forward to continuing as your source for information and insights on this important and dynamic piece of legislation.