Now that the health care bill is law, an array of groups — representing doctors, insurers, small businesses and others — have switched to their post-passage game plans. Among their top goals: Helping shape the all-important regulations being written by the Obama administration. Here’s a sampling of their priorities and who will be pushing them.
National Federation of Independent Business
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AARP
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American Nurses Association
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Families USA
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National Governors Association
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America’s Health Insurance Plans
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American Hospital Association
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American Medical Association
Represents: 350,000 small businesses
Making The Case: Amanda Austin, director of federal public policy
Priority: Simple tax credit rules and flexibility
Many small businesses are eligible this year for tax credits to help pay the cost of insuring workers. But if getting the credits is too complicated then the tax breaks “might as well not exist,” Austin says. Business owners also want flexibility and clarity on a “grandfathering” clause that exempts existing policies from some new rules that could add to the costs of insuring workers, as long as the businesses don’t make significant changes in their policies. “If a business owner changes a deductible,” she asks, does that mean that the policies aren’t grandfathered?
Making The Case: Nancy LeaMond, executive vice president of social impact
Priority: “Doughnut hole” money, coverage for the uninsured
The government begins to close the so-called doughnut hole, or coverage gap, in the Medicare drug plan with a $250 payment this year to participants. Checks are scheduled to go out in June, a fast-approaching deadline AARP will be watching. AARP also will be monitoring how benefits are defined in a new temporary insurance plan for people who have been denied coverage for health reasons. Given that Congress has set a $5 billion limit on the federal contribution to the plan, officials have to strike a balance between giving a lot of people a little coverage and giving a few people a lot of coverage.
Represents: About three million registered nurses
Making The Case: Michelle Artz, chief associate director, government affairs
Priorities: Expanding nurses’ responsibilities
With more Americans getting insurance amid a growing shortage of primary care physicians, nurses want to take on a larger role in providing medical care. Nurse practitioners will be permitted under the new law to direct medical teams in a demonstration project providing home-based care to Medicare beneficiaries with chronic diseases. Nurses want similar authority in areas where their training and state laws permit, such as in “medical homes,” which are primary care practices designed to coordinate patient services. “We want to make sure that nurses are recognized appropriately as providers of services that they are educated and trained to do and is within their scope of practice,” says Artz.
Represents: Consumer groups
Making The Case: Ron Pollack, executive director
Priorities: Aggressive enrollment of consumers
Enroll America, a new initiative led by his group, is working with drug makers, hospitals, insurers, physicians and others to make it as easy as possible for Americans to enroll in Medicaid or sign up for subsidies and private insurance. The group is pushing for enrollment sites at hospitals and community health centers, and for application forms that are readily understood and printed in a variety of languages. “There’s been so much mythology” about the bill, he says. “The more people understand the specific provisions in the legislation, the more they are actually going to like it.”
Represents: The nation’s governors
Making The Case: Kathleen Nolan, health division director
Priorities: Guidance on high-risk pools; authority to experiment
A new federal program to offer coverage to people who are uninsured because of medical problems must be set up by the end of June. Twenty-eight states and the District of Columbia have elected to run their own programs, called high-risk pools; in other states, the federal government will create one. “Even as we speak, states are having to make decisions about this, but there’s very little information about how the (new program) will work and who is on the hook for it,” says Nolan. Down the road, NGA wants states to have broad authority to try new ideas for, say, cost control or quality improvement, across several programs: state employee plans, Medicaid and exchanges where insurers will market policies.
Represents: Approximately 1,300 health insurers
Making The Case: Karen Ignagni, president and chief executive officer
Priorities: Spending requirements, benefits design
New rules requiring insurers next year to spend at least 80 percent of premiums for medical benefits for patients — as opposed to administration and profit — could cause problems in the individual market, Ignagni says. That’s because of the cost of payments insurers make to sales agents who sell the policies on their behalf. Some are multi-year agreements that could still be in place when the 80 percent requirement begins. “You just can’t tear up those contracts,” Ignagni says. And when the health insurance exchanges begin in 2014, insurers want the package of benefits to be comprehensive but not make insurance so expensive that it’s unaffordable.
Represents: More than 5,000 hospitals and health care systems
Making The Case: Linda Fishman, senior vice president for public policy analysis and development.
Priorities: Insurance exchanges; Medicaid payment rates
Hospitals want a say in how state-based insurance exchanges are set up in 2014. The exchanges are marketplaces where individuals and small businesses can buy coverage. How many insurers are approved to sell in an exchange, and rules governing benefits and other issues, ultimately can affect hospitals. That’s because insurers negotiate with hospitals over payment rates and participation in provider networks. Hospitals also want to boost payment rates for Medicaid, the state-federal program for the poor, which will be greatly expanded. Currently, Fishman says, the program pays hospitals an average of 88 cents for every dollar of medical costs.
Represents: About 250,000 doctors
Making The Case: Dr. J. James Rohack, president
Priorities: Medicare spending board; physician payment cuts
The AMA wants to make sure that a new panel created to recommend ways to control Medicare spending doesn’t result in physician pay cuts; Rohack says they would hurt patients’ access to care. The group has been battling for repeal of an existing pay formula that has repeatedly called for cuts in doctors’ pay. Congress steps in almost every year to block the cuts, but the situation remains a major sore point with physicians. The AMA also will urge regulators to help simplify physicians’ dealings with insurers, hoping to cut costs. And it wants to weigh in on the design of pilot programs to explore alternatives to medical liability lawsuits.