ACA State Implementation
There are numerous aspects of the Affordable Care Act (ACA) that affect state programs, require state legislative and regulatory action, and establish grant opportunities for states. Your ARC staff is working proactively to influence state and private sector implementation activities on several fronts:
- Directly advocating AMA policy to state policymaking organizations (e.g.the National Association of Insurance Commissioners) that will influence regulatory and legislative policies during the implementation phase.
- Developing resources for use by physician members and component medical associations.
- Assisting the AMA’s Washington, D.C. Federal Affairs staff on federal implementation activities that impact the states.
- Coordinating with the AMA’s Private Sector Advocacy staff to develop resources on issues that directly affect practicing physicians, including implementation of ACA’s “administrative simplification” provisions.
A sampling of the ARC’s advocacy support resources on the following state ACA implementation issues can be accessed below.
The AMA has analyzed the impact that the Affordable Care Act (ACA) has on state health care laws and regulations, and has developed the following resources to guide states in determining the extent to which they can enforce and/or enact stricter laws or different approaches than exist in federal law.
The Affordable Care Act (ACA) authorizes state health insurance exchanges for the individual and small group markets. The American Health Benefit Exchanges and Small Business Health Options Program (SHOP) Exchanges will start on January 1, 2014. The exchanges will be open to all who need to purchase coverage in order to comply with the individual mandate, and those consumers who earn less than 400 percent of the federal poverty level (FPL) will receive subsidies to enable them to afford coverage. Also, the ACA establishes a high risk pool fund to provide a bridge to the exchanges for uninsured individuals with pre-existing conditions.
AMA May 11, 2012 letter commenting on final exchange rule
AMA October 24, 2011 letter commenting on Exchanges and Qualified Health Plans
AMA October 31, 2011 letter commenting on Exchange Eligibility
The Affordable Care Act (ACA) reforms the health insurance marketplace in numerous ways.The ACA prohibits or restricts several of the most onerous health insurer practices, including rescission and pre-existing condition requirements.The ACA also requires the states and the federal government to determine when insurers rate increases are unreasonable.The medical loss ratio requirements in the ACA could be the most important marktet reform provision and will have a profound effect on the health insurance marketplace for patients.
AMA ARC Work Plan on Medical Loss Ratio
Ensuring the integrity of the federally financed health care systems by combating waste, fraud and abuse is one of the key aims of health system reform and one of the primary financing mechanisms for implementing the Affordable Care Act (ACA). The ACA expanded current fraud and abuse laws, required states to implement a Medicaid Recovery Audit Contractor (RAC) program to identify overpayments and underpayments and recoup overpayments of Medicaid claims, and created new mechanisms amied at stopping fraud at the outset. The federal government has allocated substantial resources to this issue and the Obama Administration has created a new Center for Program Integrity within the Centers for Medicare and Medicaid Services (CMS) to oversee these activities.
Summary of final rule
State advocacy roadmap: Medicaid RACs
AMA January 10, 2011 letter commenting on Medicaid RACs
There are many public health initiatives contained into the Affordable Care Act (ACA). These measures focus on wellness and prevention as well as initiatives to improve the quality of health care. Much of the ACA public health provisions focus on promoting preventive services by requiring insurers to cover certain preventive measures and allowing insurers to create wellness incentive programs. In addition, the new law provides many opportunities for states to receive grants or participate in pilot programs on a myriad of issues from childhood obesity initiatives, community transformation grants and medical home pilot programs. Along with developing resources to aid state level advocacy on these topics, ARC will coordinate input and involvement of AMA experts in Prevention and Wellness, Patient Safety and Quality as the implementation process progresses.
AMA Public Health Improvement Campaign: A comprehensive state campaign focused on issues including but not limited to obesity, public safety and protecting the patient physician relationship.
The Affordable Care Act (ACA) significantly expands those covered by Medicaid.As a result of the new law, Medicaid must cover all non-Medicare eligible individuals under 65 years of age with incomes up to 133% of the federal poverty level (FPL) based on modified gross income.Through this change, Medicaid is expected to cover an additional 16 million people by 2014.The ARC will work to facilitate communication, strategies and information-sharing among federation organizations on issues relating to state implementation of the Medicaid provisions of ACA.
AMA Reforming Medicaid Campaign: A comprehensive state campaign focused on issues including but not limited to physician reimbursement and access to care, preventing mandatory participation requirements and Medicaid recovery audit contractors (RACs) and dual eligibles.
Scope of Practice issues may be implicated on issues ranging from the Patient Protection and Affordable Care Act's (ACA) increased emphasis on the health care team to the creation of several different types of pilot and other demonstration projects focused on primary care and community-based health care services. As a result, the ARC anticipates an accelerated push by non-physician providers at the state legislative and regulatory levels to expand scopes of practices, including direct access and independent practice to provide these primary care and community-based services.
ARC state implementation work plan: scope of practice issues
Truth in Advertising campaign with 32 million newly insured patients in 2014 and an ever-growing variety of health care providers, our Truth in Advertising legislation helps provide the clarify and transparency for necessary for patients for patients to make informed decisions about their health care.