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The Supreme Court’s Consideration of the Affordable Care Act: Legal Arguments, Policy Implications and Political Repercussions (audio)

There was no bigger story in Washington, DC this week than the Supreme Court’s consideration of the Affordable Care Act (ACA).

But what did the oral arguments really mean? What are the next steps for the justices? And what role will Congress play going forward?

To help decipher the chatter, MLA Partner Bruce Brown, former clerk to Chief Justice Warren Burger, and I break things down in a “Quick Take” session – the Supreme Court’s Consideration of the ACA: Legal Arguments, Policy Implications and Political Repercussions.

The Supreme Court’s Consideration of the Affordable Care Act: Legal Arguments, Policy Implications and Political Repercussions (audio)

The Northern Tiger: What the U.S. Could Learn From Canada

Today, the Aspen Institute‘s program on Manufacturing and Society in the 21st Century is releasing a timely new study focusing on how Canada has successfully addressed fiscal and competitiveness problems similar to those the U.S. is currently facing.

With support from the Canadian Council of Chief Executives (CCCE) and authored by Jeremy Leonard, the report describes how Canada, “under governments of all political stripes…has profoundly restructured its economy, gotten its fiscal house in order, created a competitive business tax environment, and come into its own as a strong economic player in North America and beyond.”

From the paper:

A better understanding of the evolution of Canada’s economy is of great importance to U.S. businesses and policy makers along a number of dimensions. Most obvious is that Canada is not only the top U.S. export  market, but the segmentation of production has also led to cross-border value chains, and increasing interdependence of the manufacturing sector on either side of the border. Canadian and U.S. manufacturers no longer sell each other finished products, they make things together for consumption in North America and around the world. As businesses take a more continental approach to location decisions, Canada’s business environment may present opportunities for U.S. and non-North American firms and vice versa, depending on the specific requirements of the business task in question. More cross-border collaboration and communication at the industry and business level will help to further optimize continental supply chains…

…Beyond cross-border lessons learned from the economic experiences over the past 15 years, the more important observation is that Canada and the United States have become for all intents and purposes an integrated economic space, making things together rather than selling finished goods to one another. Firms on either side of the border are thus partners more than they are competitors. In this sense, Canada and the United  States have “outgrown” NAFTA and require complementary sets of agreements with regard to energy supply, security and a whole host of other issues. The Beyond the Border initiative addresses many of them and for that reason must move forward successfully. But energy remains an area where discussions need to take place in order to avoid trade “irritants” such as the rejection of the Keystone XL pipeline.  Canada has a strong hand in terms of supply, and the United States certainly has the demand.

Click here for the full report.

As Americans, at both the federal and state level, look at ‘getting government right’ in this age of austerity, there are lessons from Canada in the ’90s that have relevance today. The Canadian government, in which CCCE CEO John Manley played a key role as Industry, and later, Finance Minister and Deputy Prime Minister, has asked the following six basic questions of existing programs and acted accordingly:

  • Is it in the public interest?
  • Is it a legitimate role for government?
  • Is it federal or provincial?
  • Is it public or private?
  • Is it affordable?
  • How can we make it more efficient?

Canadian Provincial governments followed suit with the result that, while in 1995 it had proclaimed Canada an “honorary member of the Third World,” The Wall Street Journal now praises the country as “a favored destination for investors seeking refuge from the turmoil sweeping the euro zone and the continuing uncertainty over the U.S. fiscal position. The country is now the world’s third-biggest issuer of sovereign debt to be rated triple-A by all three major credit-ratings…”

There are lessons to be learned from the ‘northern tiger’.

The Northern Tiger: What the U.S. Could Learn From Canada

501(c)(4) Social Welfare Organizations Facing Increased Scrutiny

Super PACs have garnered most of the attention this campaign season, given the massive spending of such organizations. According to The Daily Beast, a total of 363 Super PACs had spent $373 million this election cycle as of March 12, 2012.

We know a lot about Super PAC contributors and expenditures because of FEC disclosure requirements applicable to Super PACs. Much less is known about the operations of 501(c)(4) social welfare organizations, which are significant political players but subject to no meaningful disclosure requirements by the Internal Revenue Service. Many organizations have related 501(c)(4) and Super PAC organizations, such as American Crossroads on the Republican side and Priorities USA Action on the Democratic side.

While well-known to political law experts, three features of 501(c)(4)s have attracted broader attention in the last few months. First, 501(c)(4)s, like other nonprofits, are not required to disclose their donors. The effect is that contributors may remain anonymous by donating to a non-profit organization, which in turn contributes to a Super PAC. For example, American Crossroads receives contributions from its sister 501(c)(4), American Crossroads GPS and Priorities USA Action similarly receives contributions from Priorities USA, its 501(c)(4) counterpart. The Super PAC discloses the 501(c)(4) as the contributor. The contributors to the 501(c)(4) are not disclosed.

Interest groups are beginning to push companies that fund politically-oriented non-profits. Recently, groups such as Common Cause and labor unions organized to pressure such companies with boycotts, shareholder pressure, and even the divestment of pension funds.

501(c)(4)s are “social welfare organizations” under the IRS code. Such groups must be primarily engaged in the promotion of social welfare. While they may engage political activity, such activity cannot constitute the organization’s “primary activity.” There is no specific test for whether a 501(c)(4)s primary activity is political.

Political spending by non-profits has exploded. According to Roll Call,

In 2010, the first election after Citizens United, non-disclosing tax-exempt groups spent $133.3 million on candidate-oriented expenditures, according to the Center for Responsive Politics.

In 2012, election-related nonprofit spending is expected to soar even higher. Crossroads GPS collected an estimated $32.6 million in 2011 – far more than the $18.4 million raised by the group’s affiliated super PAC, American Crossroads. Together, the groups have said they will spend $240 million. The conservative super PAC FreedomWorks for America received $1.4 million – nearly half of its $3 million budget – from its affiliated nonprofit FreedomWorks, according to the CRP. Two Democrat-friendly super PACs – Priorities USA Action and American Bridge 21st Century, have received more than $200,000 apiece from their respective nonprofit affiliates.

The Center for Responsive Politics reported that the percentage of spending from groups that do not disclose their donors has risen from 1 percent to 47 percent since the 2006 midterm elections and that 501c non-profit spending increased from zero percent of total spending to 42 percent in 2010.

This activity has increased pressure – both partisan and non-partisan – on the IRS to step up its scrutiny of 501(c)(4)s. Legislation has also been introduced to increase disclosure by 501(c)(4)s.

In my view, it is unlikely that any meaningful regulation will occur during this election cycle, and 501(c)(4)s will continue to be used as vehicles to fund Super PACs and to make direct political expenditures. Moreover, attempts at regulation raise First Amendment concerns, among others, and will be opposed vigorously by certain non-profit organizations.

Nevertheless, and especially in light of the increased scrutiny, 501(c)(4) organizations must be careful to maintain a legitimate social welfare purpose and be able to demonstrate, in the face of an audit, that political activity is not their primary activity. Corporations and other potential donors to 501(c)(4) social welfare organizations would also do well to keep in mind this controversy as they plan their political giving strategies.

501(c)(4) Social Welfare Organizations Facing Increased Scrutiny

FTC Releases Final Privacy Report: It’s ‘Game On’ Since the EU and White House Weighed in Earlier This Year

Today, the Federal Trade Commission released its long awaited final privacy report.

Entitled, “Protecting Consumer Privacy in an Era of Rapid Change: A Proposed Framework for Businesses and Policymakers,” the paper contains recommendations from the FTC that Congress “consider enacting general privacy legislation” consistent with the Obama Administration’s call for a consumer privacy bill of rights last month and advocates for legislation on data security and breach notification legislation, and a new call to regulate data brokers.

The final Commission report reiterates three main themes from the December 2010 staff privacy report, including privacy by design, simplified choice, and greater transparency.

The FTC will continue to focus on implementing Do-Not-Track mechanisms, exploring mobile applications, enforceable codes of conduct working with the Department of Commerce, and holding a workshop later this year on large platform providers.

Today’s FTC proposal represents the beginning of a new, more concrete phase of the ongoing transatlantic privacy dialogue that will play out in the next 12-18 months in Washington, DC and in Brussels. Expect there to be many fits and starts along the way on both sides of the pond as respective proposals are considered and amended.

FTC Releases Final Privacy Report: It’s ‘Game On’ Since the EU and White House Weighed in Earlier This Year

Weekly Health Policy Update: HHS Exchanges Rules, IPAB Repeal, and MACPAC Report

Weekly Health Care Wrap-Up.

HHS Releases Revised Exchange Rules

On Monday, the Department of Health and Human Services (HHS) released 644 pages of rules finalizing several provisions related to the establishment of health insurance exchanges. While much was not surprising, the new guidance does include provisions targeted at brokers and private internet websites that could be game changers for the industry.  Specifically, the rule released this week creates a process for individuals purchasing qualified health plans (QHPs) through web-based brokers to access refundable tax credits to subsidize their premiums.  It further allows brokers to help consumers apply for these premium tax credits and cost sharing subsidies. More information about these provisions is available in this week’s State of the States: Health Insurance Exchanges.

HHS Issues Final Rule on Medicaid Expansion

Late today (Friday) CMS released additional guidance about Medicaid eligibility and enrollment processes as well as risk adjustment, reinsurance and risk corridors. More details will be included in next week’s wrap up.

Dems Back Away from IPAB Repeal

Democrats this week started to back away from legislation to repeal the Independent Payment Advisory Board (IPAB) — a 15-member board created as part of the Affordable Care Act (ACA) designed to hold Medicare spending to a set level — as Republicans indicated they would attach medical malpractice legislation to the bill to offset its costs. Specifically, Republican leadership plans to finance the $3.1 billion cost of repealing IPAB with Representative Phil Gingrey’s bill to institute “caps” on medical malpractice awards nationwide. The legislative pairing is expected to clear the House easily. Significant traction in the Senate will be more difficult to achieve.

MACPAC Release Report to Congress

The Medicaid and the Children’s Health Insurance Program (CHIP) Payment and Access Commission released its report to Congress this week.  MACPAC, created by the CHIP reauthorization legislation of 2009, is designed to provide counsel on Medicaid and CHIP policy, as MedPAC does for Medicare.  Of note, the report focuses on Medicaid beneficiaries with disabilities and examines eligibility, enrollment, population characteristics, services, spending, and quality measurement efforts for this population. The complete report can be found here.

CMS Announces Initiative to Reduce Admissions for Nursing Home Residents

CMS announced this week it would commit $128 million to organizations that will partner with nursing facilities to implement evidence-based interventions that both improve care and lower costs. The initiative is focused on long-stay nursing facility residents who are enrolled in the Medicare and Medicaid programs, with the goal of reducing avoidable inpatient hospitalizations. Eligible organizations include physician practices, care management organizations and other public and not-for-profit entities. These “enhanced care and coordination” providers will collaborate with States and nursing facilities, with each enhanced care and coordination provider implementing its intervention in at least 15 partnering nursing facilities.  Additional information can be found here.

From the States

New Jersey. On Thursday, the New Jersey legislature passed legislation, A2171, authorizing the state to set up a health insurance exchange. However, it is still not clear whether Governor Chris Christie (R) will sign the bill since he has repeatedly said he intends to wait for the Supreme Court to rule on the ACA before he moves to implement an Exchange.

Rhode Island. Last week, Rhode Island released a draft RFP for technical services to set up its health insurance exchange and replace its current benefit eligibility determination system. Given the technical investment and related nature of both systems, Rhode Island is procuring both upgrades as a single project. The draft RFP describes Rhode Island’s Unified Health Infrastructure Project (UHIP) as a new, consolidated program that can be used for health insurance and other human service programs. This RFP is the first step to build the initial technical platform and capacity for the UHIP.

Around Town

The U.S. Preventive Services Task Force released new recommendations regarding pap smear and cervical cancer screenings.

The CBO released new numbers this week projecting future Medicare and Medicaid costs.  Medicare spending is expected to nearly double in the next 10 years, while Medicaid is projected to grow even faster.  The new CBO report can be found here.

The Commonwealth Fund this week released a new report ranking 306 localities on 43 performance measures, showing wide variation in care quality and performance among communities.  The report can be found here.

Health Insurance Exchanges: State of the States update.

On Monday, the Department of Health and Human Services (HHS) released 644 pages of rules finalizing several provisions related to the establishment of health insurance exchanges. While much was not surprising, the new guidance does include provisions targeted at brokers and private internet websites that could be game changers for the industry.  Specifically, the rule released this week creates a process for individuals purchasing qualified health plans (QHPs) through web-based brokers to access refundable tax credits to subsidize their premiums.  It further allows brokers to help consumers apply for these premium tax credits and cost sharing subsidies.

This proposed rule change has the potential to upend some of the planning that has occurred to develop state-run exchanges. States and their vendors have been moving forward, developing models and IT systems that depend on exchanges being the only option for purchasing subsidized health insurance. By allowing competition between privately run web portals and state-run health exchanges, or even allowing private web portals to become the “shopping” platform for QHPs in a state, this rule change could, in some states, threaten the business models of state-run exchanges and their IT partners.

Meanwhile, Rhode Island released a draft RFP for technical services to set up its health insurance exchange and replace its current benefit eligibility determination system. Given the technical investment and related nature of both systems, Rhode Island is procuring both upgrades as a single project. The draft RFP describes Rhode Island’s Unified Health Infrastructure Project (UHIP) as a new, consolidated program that can be used for the state’s health insurance exchange and other human service programs. This RFP is the first step to build the initial technical platform and capacity for the UHIP. See the attached PDF for additional information for IT procurement by the states.

In addition on Thursday, the New Jersey legislature passed legislationauthorizing the state to set up a health insurance exchange. The question now on everyone’s mind is whether Governor Chris Christie (R) will sign it. While New Jersey has begun planning for an exchange, Governor Christie has said he wants to wait until the Supreme Court rules on the ACA before investing a large amount of time and money in developing an exchange.

Under the bill, the governing board of New Jersey’s exchange cannot include any executives currently working in the health care industry and the exchange would be an “active purchaser,” limiting the types of insurance plans that can be sold on the exchange marketplace.

Stay tuned for more information on the federally-facilitated exchange, which is expected in the coming weeks.

Weekly Health Policy Update: HHS Exchanges Rules, IPAB Repeal, and MACPAC Report

Canada, the “Oil Curse,” and a Third Way on the Oil Sands?

Last week Alberta Premier Alison Redford referenced the “oil curse” in a speech at the Wilson Center. The “Oil Curse,” or “resource curse,” is a theory that energy-rich countries perform worse economically for a variety of reasons, including a lack of economic diversification, and mismanagement and corruption by government and energy companies. Advocates of this theory include New York Times columnist Thomas Friedman and Peter Maas, who authored an interesting book entitled Crude World in 2009. Crude World provides case studies of oil-rich countries such as Saudi Arabia and Nigeria, where the ruling elite profit from energy production while the masses live in poverty.

Alberta, though a province and not a country, is certainly energy-rich with the third-largest proven reserves of crude oil in the world. It is hard, however, to make the case that Alberta suffers from any “oil curse.” In 2011, Alberta’s growth domestic product grew by 4.0% with the unemployment rate being around 5.5%. The development of the oil sands also provides economic benefits to the United States. For instance, more than 900 U.S.-based companies currently supply goods and services to oil sands related projects and pipelines.

Why does Alberta prosper while other energy-producing countries suffer? While there are likely a variety of reasons, Alberta arguably prospers due in part to the fact that Canada is a democracy and, therefore, its government is accountable to its citizens on a range of issues, including: the level of revenues raised from production and how the resulting funds are used; the manner in which the resource is used; and whether existing regulations are sufficient to protect public health and the environment.

In her speech, Premier Redford touted the benefits of the oil sands, describing the resource as a “blessing.” She also acknowledged the public health and environmental concerns, including the greenhouse gas intensity associated with production. To address these concerns, Premier Redford talked about a new website launched by Alberta Province that provides information on oil sands’ impact on the environment. Premier Redford also discussed new provincial regulations that will require that producers reduce their tailings and the province’s carbon tax, which provides funding for technological upgrades that reduce the environmental footprint of production.

All of this brings up the question as to whether there is “third way” possible for oil sands production where various interests, including government, industry, and NGOs collaborate with one another instead of merely talking past each other. Premier Redford certainly expressed a desire to deepen the dialogue with both the supporters and critics of the oil sands. In the Q&A portion of the event, one attendee asked whether a stakeholder collaboration process could be similar to the timber industry and NGOs cooperation on sustainability challenges in the Amazon rain forest. Premier Redford agreed this could serve as a good model for the oil sands.

The path forward won’t be easy – in a democracy, progress is never easy with such complicated issues and so many loud and conflicting voices. That being said, the mere fact that Alberta is a democracy allows this conversation and debate to take place. Debate can lead to consensus, which can in turn achieve progress towards one of our world’s most pressing challenges – meeting a growing demand for energy in a sustainable manner that responsibly addresses climate change.

Canada, the “Oil Curse,” and a Third Way on the Oil Sands?

Attorneys General Spring Meeting: ‘State-Federal Partnership’ Theme Is the Message

The National Association of Attorneys General (NAAG) convened last week in Washington, DC for its annual Spring Meeting.

As a former Attorney General and president of NAAG, I know my fellow AGs really enjoy these gatherings. The informal setting provides a great opportunity to exchange experiences and to learn from one another. Camaraderie, a strong ethic of bipartisanship, information sharing, and working together make State AGs a unique community.

With State AGs playing increasingly important roles across the country in their states as well as on the national stage affecting federal and state and local public policy, this year’s event was appropriately titled “Opportunities and Challenges in State-Federal Relationships.” So it wasn’t surprising to see a number of top bill speakers at this year’s event, including U.S. Attorney General Eric Holder, Director of the new Consumer Financial Protection Bureau (CFPB) and former Attorney General of the State of Ohio Richard Cordray, and FTC Commissioner Julie Brill.

Click here to watch video of the speakers’ presentations from the gathering.

By and large, the speakers who presented spoke a great deal about how their offices are actively working to partner with State AGs. This theme was pursued by CFPB Director Cordray regarding his agency’s ongoing efforts to reach out to AGs across the country. HUD Secretary Shaun Donovan praised the work of the AGs for reaching a landmark settlement on National Mortgage Foreclosures. U.S. AG Holder, in his remarks, also reached out to AGs to voice his intent to face shared challenges across the country and to address issues of mutual concern.

With each of the presenters pursuing this theme of ‘State-Federal Partnership,’ the work of State Attorneys General is clearly a growth area in public policy, given the likelihood of extensive collaboration between federal agencies and State AGs.

Attorneys General Spring Meeting: ‘State-Federal Partnership’ Theme Is the Message

Weekly Health Policy Update: PCOR, IPAB Repeal, and Canceled Regulations

Weekly Health Care Wrap-Up.

HHS Releases Revised Exchange Rules

On Monday, the Department of Health and Human Services (HHS) released 644 pages of rules finalizing several provisions related to the establishment of health insurance exchanges. While much was not surprising, the new guidance does include provisions targeted at brokers and private internet websites that could be game changers for the industry.  Specifically, the rule released this week creates a process for individuals purchasing qualified health plans (QHPs) through web-based brokers to access refundable tax credits to subsidize their premiums.  It further allows brokers to help consumers apply for these premium tax credits and cost sharing subsidies. More information about these provisions is available in this week’s State of the States: Health Insurance Exchanges.

HHS Issues Final Rule on Medicaid Expansion

Late today (Friday) CMS released additional guidance about Medicaid eligibility and enrollment processes as well as risk adjustment, reinsurance and risk corridors. More details will be included in next week’s wrap up.

Dems Back Away from IPAB Repeal

Democrats this week started to back away from legislation to repeal the Independent Payment Advisory Board (IPAB) — a 15-member board created as part of the Affordable Care Act (ACA) designed to hold Medicare spending to a set level — as Republicans indicated they would attach medical malpractice legislation to the bill to offset its costs. Specifically, Republican leadership plans to finance the $3.1 billion cost of repealing IPAB with Representative Phil Gingrey’s bill to institute “caps” on medical malpractice awards nationwide. The legislative pairing is expected to clear the House easily. Significant traction in the Senate will be more difficult to achieve.

MACPAC Release Report to Congress

The Medicaid and the Children’s Health Insurance Program (CHIP) Payment and Access Commission released its report to Congress this week.  MACPAC, created by the CHIP reauthorization legislation of 2009, is designed to provide counsel on Medicaid and CHIP policy, as MedPAC does for Medicare.  Of note, the report focuses on Medicaid beneficiaries with disabilities and examines eligibility, enrollment, population characteristics, services, spending, and quality measurement efforts for this population. The complete report can be found here.

CMS Announces Initiative to Reduce Admissions for Nursing Home Residents

CMS announced this week it would commit $128 million to organizations that will partner with nursing facilities to implement evidence-based interventions that both improve care and lower costs. The initiative is focused on long-stay nursing facility residents who are enrolled in the Medicare and Medicaid programs, with the goal of reducing avoidable inpatient hospitalizations. Eligible organizations include physician practices, care management organizations and other public and not-for-profit entities. These “enhanced care and coordination” providers will collaborate with States and nursing facilities, with each enhanced care and coordination provider implementing its intervention in at least 15 partnering nursing facilities.  Additional information can be found here.

From the States

New Jersey. On Thursday, the New Jersey legislature passed legislation, A2171, authorizing the state to set up a health insurance exchange. However, it is still not clear whether Governor Chris Christie (R) will sign the bill since he has repeatedly said he intends to wait for the Supreme Court to rule on the ACA before he moves to implement an Exchange.

Rhode Island. Last week, Rhode Island released a draft RFP for technical services to set up its health insurance exchange and replace its current benefit eligibility determination system. Given the technical investment and related nature of both systems, Rhode Island is procuring both upgrades as a single project. The draft RFP describes Rhode Island’s Unified Health Infrastructure Project (UHIP) as a new, consolidated program that can be used for health insurance and other human service programs. This RFP is the first step to build the initial technical platform and capacity for the UHIP.

Around Town

The U.S. Preventive Services Task Force released new recommendations regarding pap smear and cervical cancer screenings.

The CBO released new numbers this week projecting future Medicare and Medicaid costs.  Medicare spending is expected to nearly double in the next 10 years, while Medicaid is projected to grow even faster.  The new CBO report can be found here.

The Commonwealth Fund this week released a new report ranking 306 localities on 43 performance measures, showing wide variation in care quality and performance among communities.  The report can be found here.

Health Insurance Exchanges: State of the States update.

On Monday, the Department of Health and Human Services (HHS) released 644 pages of rules finalizing several provisions related to the establishment of health insurance exchanges. While much was not surprising, the new guidance does include provisions targeted at brokers and private internet websites that could be game changers for the industry.  Specifically, the rule released this week creates a process for individuals purchasing qualified health plans (QHPs) through web-based brokers to access refundable tax credits to subsidize their premiums.  It further allows brokers to help consumers apply for these premium tax credits and cost sharing subsidies.

This proposed rule change has the potential to upend some of the planning that has occurred to develop state-run exchanges. States and their vendors have been moving forward, developing models and IT systems that depend on exchanges being the only option for purchasing subsidized health insurance. By allowing competition between privately run web portals and state-run health exchanges, or even allowing private web portals to become the “shopping” platform for QHPs in a state, this rule change could, in some states, threaten the business models of state-run exchanges and their IT partners.

Meanwhile, Rhode Island released a draft RFP for technical services to set up its health insurance exchange and replace its current benefit eligibility determination system. Given the technical investment and related nature of both systems, Rhode Island is procuring both upgrades as a single project. The draft RFP describes Rhode Island’s Unified Health Infrastructure Project (UHIP) as a new, consolidated program that can be used for the state’s health insurance exchange and other human service programs. This RFP is the first step to build the initial technical platform and capacity for the UHIP. See the attached PDF for additional information for IT procurement by the states.

In addition on Thursday, the New Jersey legislature passed legislationauthorizing the state to set up a health insurance exchange. The question now on everyone’s mind is whether Governor Chris Christie (R) will sign it. While New Jersey has begun planning for an exchange, Governor Christie has said he wants to wait until the Supreme Court rules on the ACA before investing a large amount of time and money in developing an exchange.

Under the bill, the governing board of New Jersey’s exchange cannot include any executives currently working in the health care industry and the exchange would be an “active purchaser,” limiting the types of insurance plans that can be sold on the exchange marketplace.

Stay tuned for more information on the federally-facilitated exchange, which is expected in the coming weeks.

Weekly Health Policy Update: PCOR, IPAB Repeal, and Canceled Regulations

Swimming With Polar Bears and Other Arctic Challenges

On the heels of last week’s oil and gas meeting in Norway, in which the Norwegians and Russians worked on collaboration on issues in the Bering Sea, two other Arctic nations, Canada and the U.S., are gathering to talk about Arctic issues in a North American context.

The Pacific NorthWest Economic Region (PNWER) Arctic Caucus, a broad, bipartisan group of Canada-U.S. leaders, convened yesterday in the U.S. Senate Visitors Center. Canada, itself, is set to assume the next chairmanship of the international Arctic Council, which promotes cooperation among the eight Arctic states of Canada, Denmark (including Greenland and the Faroe Islands), Finland, Iceland, Norway, Russia, Sweden, and the U.S. as well as six international organizations representing Arctic Indigenous Peoples.

Canada’s Ambassador to the U.S., Gary Doer, had to miss the gathering, but he sent his envoy, Kevin O’Shea, who said Doer’s claim to fame is that he is the only diplomat who has swum with polar bears and lived to tell about it…

The two U.S. Senators from Alaska came by to give remarks, but couldn’t stay long due to a series of votes on the Senate floor, including key votes on the Keystone XL project. In her remarks, Senator Lisa Murkowski had remarkable bipartisan praise for President Obama and Secretary Clinton for their commitment to addressing Arctic issues by participating robustly in the Arctic Council.

Senator Murkowski went on to raise questions for consideration, including, for example, should the U.S. propose that the Arctic Council be officially recognized by treaty? Should the Arctic Council develop a ten year strategic plan?

And beyond Arctic issues, Senator Murkowski pondered whether or not Canada and the U.S. should adopt a NORAD-style approach to cross-border infrastructure development for bridges, tunnels, and other crossings.

Dave Ramsey, a member of the legislative assembly from Canada’s Northwest Territories (NWT) and its Minister of Industry, Tourism and Investment and Minister of Transportation, described his jurisdiction in this way:

We have a population just over 43,000 people, which wouldn’t fill half of FedEx Field at a Redskins game. And yet the territory for that small population is larger than Texas and California combined. Canada’s Arctic contains one fifth of all the oil and gas reserves in the world. And NWT has tons of resources, including gold, uranium, zinc, and rare earth metals. NWT produces 15 percent of the world’s diamonds.

For additional helpful information on issues that the Arctic Caucus is dealing with, follow the work of the U.S. Arctic Research Commission.

As the U.S. Senate debates various provisions related to Canada-U.S. energy policy, including Keystone XL, the Arctic Caucus is showing itself to be an important forum for bipartisan cooperation and policy dialogue on issues shared by the U.S. and Canada, including energy and many more.

Swimming With Polar Bears and Other Arctic Challenges

Weekly Health Policy Update: Exchange Funding, Text4Baby, and Actuarial Value Guidance

Weekly Health Care Wrap-Up.

HHS Officially Extends Exchange Establishment Grant Funding Timetable

The Department of Health and Human Services (HHS) this week officially extended the deadline for states to apply for Level One and Level Two exchange grants. Previously, the final deadline to apply for grant funding was June 15, 2012. HHS’s new deadlines for Level One and Level Two funding range from August 1, 2012 to November 3, 2014. Level One Establishment grantees may apply for additional funding under Level Two Establishment grants once they meet Level Two Establishment criteria. The Period of Performance for Level One Establishment grants is up to one year after the date of award while the Period of Performance for Level Two Establishment grants is up to three years after the date of award.

Senator Snowe Announces Retirement

In surprising news this week, Senator Olympia Snowe (R-ME) announced that she would retire from the U.S. Senate at the end of 2012. Snowe, one of the Senate’s most vocal moderates, is a member of the powerful Senate Finance Committee and the ranking member of the Senate Committee on Small Business. As a regular “swing vote,” Snowe was often in the center of health care negotiations in the Senate and was the only Republican to support the Senate Finance Committee’s version of health reform legislation. Several other members of the Senate Finance Committee have also announced their retirement, including Senators Jon Kyl (R-AZ), Kent Conrad (D-ND) and Jeff Bingaman (D-NM).

CMS Announces Text4Baby Initiative

The Centers for Medicaid and Medicaid Services (CMS) this week announced that it will partner with Text4Baby, a free national health texting service, to promote enrollment in both Medicaid and the Children’s Health Insurance Program (CHIP). Text4Baby, whose partners include the National Healthy Mothers, Healthy Babies Coalition, Voxiva, which provides the mobile health platforms, and a host of wireless carriers will begin by sending more than 184,000 current Text4Baby users a new message alerting them to the availability of free and low-cost health coverage through Medicaid and CHIP.  The message will provide a connection to the InsureKidsNow phone number and website for information about how to sign up.  Additional messages will be periodically texted to provide Text4Baby users information about the importance of prenatal visits for women and the value of health coverage for keeping children healthy and getting the care they need when they are sick.   More information on efforts to enroll children in Medicaid and CHIP is available here.

HHS Releases Actuarial Value Guidance

Late last week, the Department of Health and Human Services (HHS) released guidance regarding the calculation of actuarial values under the ACA. The bulletin sets some federal standards, but also allows for state flexibility in calculating actuarial value. The guidance is available here.


From the States

For full coverage of state exchange activities, check out this week’s State of the States: Health Insurance Exchange Developments here.

HHS Approves Rate Hikes In AK, FL and WA

HHS drew attention this week as media outlets, including Politico, reported that HHS had approved insurance premium rate increases in Alaska (26 percent), Florida (23.3 percent) and Washington (20.4 percent). HHS does not actually have the power to block rate increases under the ACA. However, if HHS determines a rate hike to be “unreasonable,” the insurer must either withdraw the rate and refund its customers or publicly justify the excessive rate.

Vermont House Passes Exchange Legislation

Late last week, the Vermont House passed H559, a bill to create the rules under which Vermont’s health care exchange will operate. In May 2011, Vermont had approved legislation to authorize an exchange, yet that legislation stopped short of defining many important details, including the types of plans that could be offered on Vermont’s exchange and the size of companies that would be required to use it. Passage of the bill was slowed as opponents tried to undo the bill’s requirement that all health care plans sold to individuals or small businesses with less than 50 employees be sold exclusively on the state-run health exchange. These efforts were unsuccessful. Therefore, under the legislation, all plans sold to individuals and small businesses in the state would be sold through the exchange. H559 now heads to the Senate for consideration.

22 Plans Apply to Manage Duals in California

Twenty-two health plans in 10 counties in California have applied to help manage care for dual eligibles under the state’s dual eligible pilot program. Selected plans are expected to be announced by the end of March. All submitted applications have been posted online here.

Health Insurance Exchanges: State of the States update.

This Week in the States. After last week’s excitement surrounding HHS funding announcements, developments for exchanges have returned to the norm.

In her appearance this week before the House Committee on Energy and Commerce, Department of Health and Human Services (HHS) Secretary Kathleen Sebelius was reminded by Representative Joe Pitts (R-PA) that HHS still has not issued many regulations necessary – including guaranteed issue, community rating and final essential health benefits guidance, among others – for states to move forward with exchange development. Sebelius did not give an indication of when states and the industry could expect more details, but did say HHS is “trying to make sure that when [they] release an interim rule and move to a final rule, that these are workable with states.” Late last week, HHS did release its initial guidance regarding actuarial value calculation. That information is available here.

In Oregon, legislation that would allow the state to implement its health insurance exchange was finally passed by the Joint Ways and Means Subcommittee on Capital Construction with two amendments. In its new form, HB4164 will allow certain school districts that currently receive coverage through the Oregon Educator Benefits Board to use the exchange beginning in 2015. Oregon previously enacted legislation authorizing a health insurance exchange in June of 2011.

On the other side of the nation, New Jersey progressed toward passing legislation to create a health insurance exchange after S1319 was approved by the Senate Commerce Committee. Exchange legislation is now waiting for passage in both the House and Senate.

Meanwhile, facing legislative deadlock in his state of Illinois, Governor Pat Quinn is now considering using an executive order to move exchange planning forward in the future. But do not expect a decision soon; Governor Quinn still wants to give the legislature time to act and will likely hold off on making a decision for a few more months.

Finally, in North Carolina, no major decisions were made at Tuesday’s meeting by the Health Reform Health Benefits Exchanges and Insurance Oversight Workgroup (NC HBE). However, the Workgroup discussed reevaluating their current projected annual administrative costs for operating an exchange. Previously, NC HBE estimated that operating an exchange would cost $2.60 per participant and have a cumulative cost of $25.5 million. This differs considerably from an analysis of peer exchanges that budget for administrative costs ranging between $7 and $12 per participant.

Looking ahead, exchange enthusiasts will gather in Washington, DC next week (March 7-8) for the latest in a series of exchange conferences hosted by AHIP.  More details are available here.

Weekly Health Policy Update: Exchange Funding, Text4Baby, and Actuarial Value Guidance