Issues

Health Reform and the Constitutional Challenges

Background

Shortly after President Obama signed the Patient Protection and Affordable Care Act (ACA)[1] into law, opponents filed a series of legal challenges in federal court, arguing that for various reasons the Act is unconstitutional. Because the cases have the power to potentially disrupt implementation of health reform, this health reform implementation brief provides an overview of these legal challenges, focusing on the major claims they raise, as well as on two cases filed by states. The Brief opens by summarizing the cases and describes the provisions of the U.S. Constitution that form the basis of the claims raised by the plaintiffs. It also reviews the preliminary procedural issues that the courts must address before reaching the merits of the Constitutional claims themselves. The Brief then considers past constitutional cases decided by the United States Supreme Court that bear on the outcome of the plaintiffs’ claims and concludes with a brief discussion of the implementation issues raised by the cases.

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Profiles of State Innovation: New Roadmaps for Redesigning Long-Term Care Delivery

Medicaid currently covers more than 40 percent of the nation’s long-term care needs. Yet close to 95 percent of beneficiaries needing long-term care are in fragmented fee-for-service programs, including a disproportionate number in institutions rather than consumer-preferred home- and community-based options. Overhauling the delivery of Medicaid long-term supports and services (LTSS) offers significant opportunities to improve health care quality, control costs, and enhance quality of life for millions of Americans.
 
Today, CHCS is releasing three Profiles of State Innovation Roadmaps that synthesize lessons from pioneering states for better managing the complex array of LTSS. Made possible by The SCAN Foundation, the roadmaps are intended to help states maximize new opportunities to improve long-term care delivery made possible through the Patient Protection and Affordable Care Act (ACA). The roadmaps showcase best practices in three critical areas:

1. Rebalancing LTSS to provide more home- and community-based options instead of institutional care;
2. Designing managed LTSS programs; and
3. Integrating care for adults who are dually eligible for Medicare and Medicaid.

For each of these areas, the roadmaps draw from existing state experiences to outline key mileposts for program design and implementation. Each roadmap also highlights relevant ACA provisions designed to support efforts to improve long-term care delivery.

Download the Profiles of State Innovation Roadmaps:

• Roadmap for Rebalancing Long-Term Supports and Services
  
• Roadmap for Managing Long-Term Supports and Services
  
• Roadmap for Improving Systems of Care for Dual Eligibles

Made possible through support from The SCAN Foundation.

September 2010

Health Reform GPS
Launched in April 2010 by the Robert Wood Johnson Foundation and the George Washington University School of Public Health and Health Services, Health Reform GPS is a comprehensive Web portal that offers users the information and insights needed to cover, analyze and implement the new health reform law. Among the portal’s offerings are regularly posted “Implementation Briefs” that explain the changes made by the law, provide background, describe the federal implementation process and timetable, and identify the questions and challenges policy-makers will be grappling with in the months ahead.

• In a comprehensive table, the editors of Health Reform GPS looked at key agency implementation actions to date, as well as the major provisions of the Affordable Care Act.
  
  
• Appeals of Claims for Benefits brief examines the standards established in the Affordable Care Act for patient’s rights to appeal denials of coverage by a group health plan or health insurer.
• Sara Rosenbaum, editor of Health Reform GPS, offers her commentary on the issue.
• A follow-up commentary released on September 22 summarizes the impact of a recently released rule by the Department of Labor, further explaining the appeals process established.
  
  
• Health Reform and ERISA brief delves into the background of the Employee Retirement Income Security Act (ERISA) and explores how the law will be affected by health reform.
• Sara Rosenbaum followed up with a brief comment that summarizes the Affordable Care Act’s effect on ERISA.

Burning a Hole in the Out-of-Pocket
While more Americans under 65 with health coverage from their employer faced problems paying medical bills between 2003 and 2007, increased out-of-pocket spending on health services played only a small part in the rising financial stress for families, according to a Robert Wood Johnson Foundation-funded study conducted by the Center for Studying Health System Change (HSC).

Policy Briefs, August 2010

In Focus: The Implications of Health Reform for U.S. Charity Care Programs: Policy Considerations (Kaiser Permanente Institute for Health Policy, August 11, 2010)
Over the next several years, the Affordable Care Act (ACA) will lead to a historic expansion of health care coverage, reaching a large portion of the nation’s 46 million uninsured individuals. However, it’s expected that nearly 20 million will remain uninsured. The following paper highlights the challenges of serving this uninsured population, and the role that charity care programs can play in meeting the needs of the uninsured.

Brief Analyzes Temporary Pre-Existing Condition Insurance Plan Program (Robert Wood Johnson Foundation, August 10, 2010)
One of the most popular provisions of the Patient Protection and Affordable Care Act during the debate leading up to its passage was the ban on insurers excluding patients with pre-existing conditions. While the blanket prohibition does not kick in until 2014, a Pre-Existing Condition Insurance Plan program will offer uninsured adults with pre-existing conditions coverage in special state-based “pools” in the interim.

A new policy brief from Health Affairs and the Robert Wood Johnson Foundation focuses on issues surrounding the Pre-Existing Condition Insurance Plan program, which will be operated by some of the states themselves and, in other states that have chosen not to take on this role, by the federal government.

The authors note that the $5 billion that Congress appropriated for the program is generally recognized as insufficient to cover all those who may be eligible until the broader reforms take effect. They conclude that although Congress specified a number of requirements for the program, difficult decisions may still have to be made about who is eligible, and what health care services will be covered, in order for the plans to stay within the spending constraints.

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Policy Briefs

Extra Federal Support for Medicaid (Robert Wood Johnson Foundation, July 14, 2010)
This new policy brief from Health Affairs and the Robert Wood Johnson Foundation examines the ramifications of extending the temporary increase in funding the federal government sends to states for Medicaid, authorized last year by the American Recovery and Reinvestment Act.   This additional funding will expire at the end of 2010, and despite considerable debate, Congress has taken no action to extend it through the first six months of 2011. 

Health Reform: How Consumers Will be Affected (Robert Wood Johnson Foundation, July 6, 2010)
The most common question people have about health reform is “How will I be affected?”  The answer, of course, depends on the individual, as different demographic groups will be affected very differently.

How Will the Patient Protection and Affordable Care Act Affect Seniors? (Urban Institute, Robert Wood Johnson Foundation, July 2010)
The population over the age 65 will be affected in a number of ways by the Patient Protection and Affordable Care Act (PPACA) even though the law is primarily aimed at non-elderly population.

Near-Term Changes in Health Insurance (Robert Wood Johnson Foundation, May 4, 2010)
Newly enacted health reform legislation mandates dozens of health insurance changes.  Many go into effect this year and next.  Read the new policy brief from Health Affairs and the Robert Wood Johnson Foundation.

CHCS Policy Brief (May, 2010)
This new brief summarizes the current publicly funded long-term care environment and the barriers to rebalancing LTSS.