Health Care Reform Update

A weekly compilation from Aetna of health care-related developments in Washington, D.C. and state legislatures across the country


Week of March 18, 2013

When last year’s U.S. Supreme Court decision upholding the bulk of the Affordable Care Act (ACA) failed to quash efforts to derail the law, experts predicted the presidential election would do so. Either a Republican president would sign its repeal or President Obama’s re-election would make continuing repeal efforts entirely futile. Repeal efforts, however, appear to be alive and well. Just last week House Republicans unveiled a budget plan that promises to cut the deficit in 10 years while repealing the ACA. In the states, the House of Representatives in Oklahoma last week approved a bill that declares the ACA “null and void” and would prohibit efforts to enforce the law. The bill would place the state at odds with federal law and is consequently ineffectual. But these actions point to continuing political battles over the ACA, guaranteeing that legislative time will continue to be spent in pursuit of repeal.


The House Budget Committee voted last week to adopt the budget resolution drafted by Budget Committee Chairman Paul Ryan (R-WI).  This measure was approved on a straight party line vote, with support from Republicans and opposition from Democrats.  The full House will consider the Ryan budget this week.  The Ryan budget calls for $4.633 trillion in deficit reduction over the next 10 years.  Spending reductions would include $1.783 trillion from repeal of the ACA, $129 billion from changes to Medicare, and $810 billion from changes to Medicaid and other health care programs.  This budget includes Medicare proposals calling for a premium support system beginning in 2024, and Medicaid proposals calling for a block grant system that would provide enhanced flexibility to the states

The Senate Budget Committee approved, also along party lines, a budget drafted by Chairman Patty Murray (D-WA).  The Murray budget calls for $975 billion in new revenue and $975 billion in spending cuts over 10 years. The Senate budget also includes $100 billion in new spending in the short term on job creation and infrastructure initiatives. In a markup session held late last week, considerable discussion arose between Senate Republicans and Democrats over the budget’s deficit reduction projections – pegged at $1.85 trillion over 10 years. Ranking Republican Member Jeff Sessions (R-AL) suggested that the budget would achieve only $700 billion in deficit reduction over 10 years. The spending cuts in the Murray budget include $275 billion in health care savings “by further realigning incentives throughout the system, cutting waste and fraud, and seeking greater engagement across the health care system.”  The budget will be considered on the Senate floor this week.


CALIFORNIA: Legislation stemming from the special session on ACA implementation would provide coverage for an estimated 670,000 individuals who continually move in and out of Medicaid because of fluctuating income levels that affect their eligibility. The bill would allow California to request HHS approval to offer a “narrow bridge” plan on the exchange, providing affordable coverage through Medicaid managed care plans for individuals who recently lost their Medicaid coverage. Last week, lawmakers also amended the market reform bills to retain the 19 geographic rating regions established by California law in 2012. The original bill would have shrunk the state’s current 19 rating regions to six regions in 2014 and 13 regions in subsequent years.




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