Tuesday Tidbits

Of course, the Supreme Court did not issue its decision on the constitutionality of the Affordable Care Act yesterday. The Court has two more decision days this term, next Monday June 18, and the following Monday June 25. It would be just the FEHBlog's luck if the Court issued its decision next Monday when he is on vacation.

The FEHBlog noted on Sunday that the American Medical Association was urging calm in the face of the impending decision. Kaiser Health News reports that several large health insurers took the same tack by "promising to continue following some of the rules in the federal health law that are already in effect." It's, of course, presumptuous to assume that the Supreme Court will strike down the entire law, but if it does, it will be up to Congress and not just the insurance companies or the doctors to pick up the pieces. For example, the health insurers indicated that they have no problem keeping on covering employees' children up to age 26. But while the employers and insurers could agree to do so, the tax code in effect before the ACA would have imputed income tax on the premiums paid to cover adult children. What's more Congress never aligned the FEHB Act's dependent eligibility provision with the ACA. So, if worse comes to worse for the Obama administration's position before the Supreme Court, Congress will have to act quickly.

There's an interesting piece in the Hill's Healthwatch about the ACA. The ACA requires non-grandfathered group health plans to cover preventive services with grade A or B recommendations from the U.S. Preventives Services Task Force with no employee cost sharing. OPM has applied this requirement to all FEHB plans regardless of grandfathered plan status. The PSTF recently lowered the recommendation of PSA testing below the mandate threshold. Health plans can continue to cover this prostate cancer test without cost sharing but they aren't required to do so. According to this article, Sen. Kay Hutchinson (R TX) went nuts about this decision.   "Hutchison denounced the group as a 'panel of bureaucrats' denying access to a vital test by 'fiat.'" But the decision affects the cost of the test, not access to the test.

The AMA News advises its readers on three way to challenge insurer policies -- joining with organized medicine, getting government assistance, and going to the media. Of course the fourth means -- litigation -- is offered by my profession. It's too bad that the AMA News can't shift the focus to trying to work together with insurers, an approach that does succeed.

Speaking of government assistance, Modern Healthcare reports on a New York State attorney general press release concerning two medical expense balance billing settlement -- one with an insurer and the other with a medical group.

Finally, Health Affairs released national health expenditures study today that finds

For 2011–13, US health spending is projected to grow at 4.0 percent, on average—slightly above the historically low growth rate of 3.8 percent in 2009. Preliminary data suggest that growth in consumers’ use of health services remained slow in 2011, and this pattern is expected to continue this year and next.

After 2013, the ACA's exchanges and multitude of other requirements kick in and the health care spending curve tilts up sharply according to this report.

In 2014, health spending growth is expected to accelerate to 7.4 percent as the major coverage expansions from the Affordable Care Act begin. For 2011 through 2021, national health spending is projected to grow at an average rate of 5.7 percent annually, which would be 0.9 percentage point faster than the expected annual increase in the gross domestic product during this period.