With the national health law’s political future now entrenched, a deluge of new rules is expected in the coming days and weeks as the Obama administration fleshes out the law’s complex components.
I expect my Twitter stream(s) to be flowing on many of these topics, as well as commentary on blogs, Facebook, the Wall Street Journal Health pages, and others.
States and insurance companies had put on hold the many changes necessary to comply with PPACA. The outcome of the 2012 Presidential campaign was murky enough for Secretary of HHS, Kathleen Sibelius to delay state decision making in regard to their intent to participate in Health Insurance Exchange organization and participation using Federal funds.
The anticipation so far has been focused on rules that determine how the new state-based insurance marketplaces called exchanges will operate. But also closely awaited are decisions about how the government will tax medical devices, allot the shrinking pool of money for hospitals that treat the uninsured, and determine how birth control insurance coverage can be guaranteed for employees of religious schools, universities and charities.
Other key decisions will be determined outside the rulemaking process, as the Obama administration selects participants in several experimental programs, including a new payment method for doctors, hospitals and other providers.
Medical Device Excise Tax. Last February, the Internal Revenue Service proposed a rule on how to apply this 2.3 percent tax, which kicks in at the start of January. The major unresolved issues concern which devices will be included and how the tax is applied and collected.
Among the questions: Should the tax apply to devices commonly used by veterinarians if the device is also used in human medicine? What about items sold in retail settings but also used in medical procedures, like dental instruments and latex gloves? Does the tax apply to kits—two or more medical tools packaged and sold together—even if the manufacturer of each individual component had already collected the tax when it was sold to the kit maker?
Brendan Benner, a spokesman for the Medical Device Manufacturers Association in Washington, D.C., said companies are making marketing and sales decisions based on what they expect will happen, but that presents problems. "When you don’t know what the answer to the question is, it’s hard to make a decision," he said.
Hospital Payments. Between 2014 and 2019, the government will cut $36 billion out of the money that goes to hospitals that treat large numbers of poor patients. The cuts were included in the health law under the rationale that many currently uninsured patients would be covered either through the expansion of Medicaid or through subsidized insurance.
The administration has to figure out how it will allocate those cuts among hospitals—a task made more complicated by last summer’s Supreme Court ruling that allows states to opt out of expanding Medicaid.
Insurance plans. For the administration, some of the trickiest decisions concern how insurance policies must be designed, priced and sold starting next October, when open enrollment begins for the new online marketplaces, called exchanges, that will offer plans to individuals and small businesses. For instance, the law allowed insurers to alter their prices for people based on their age, family size, where they live and tobacco use. The Department of Health and Human Services has to determine how insurers can go about setting those prices.
Bundled Payments The administration has already gotten off the ground two major changes to the way the government pays hospitals and doctors. One designates accountable care organizations that reward hospitals and doctors for working together to provide more efficient care. The other begins to pay hospitals on the quality of the care they provide through the value-based purchasing program. By January, the law calls for the government to launch another major initiative: bundled payments.
This report can also be found at Digital Health Space