For instance, providers will be watching as closely as states for expected federal guidance on the benchmark benefits that the law requires Medicaid programs to offer to their new enrollees. The benefits and services it covers are likely to differ from the standard benefits many Medicaid plans have offered their enrollees and those differences could affect the providers who care for them.
Meanwhile, the legal certainty that now exists after the high court's ruling means that states no longer have a reason to hold back on certain provisions—namely the state insurance marketplaces. But they now face a tighter deadline to meet requirements.
In six months, states must show legal authority to proceed with an exchange; hire the personnel to staff the exchange; and develop the information system requirements that will allow exchanges to take in information and distribute it to the public in a way that will allow them to make informed decisions, according to Joel Michaels, a partner at McDermott Will & Emery.
The day after the court decision, HHS announced it would make more funding available to build state-based health insurance exchanges. It said it would provide states with 10 additional opportunities to apply for funding to set up state-based exchanges, state partnership exchanges or to prepare state systems for a federally facilitated exchange. Obama administration officials said they would continue to work with states wherever they are in the exchange process and noted that some are ahead while others are behind. To date, the federal government has distributed $850 million toward exchange building.
For the Medicare program, the decision means continuing implementation of the many provisions that the law established, such as phasing in coverage in the Medicare Part D drug benefit coverage gap, or “doughnut hole”; reducing federal payments to Medicare Advantage plans over time and providing bonus payments to plans that receive high-quality ratings; continuing to reduce annual payment updates to providers (other than physicians); and making adjustments for productivity improvements.
“Medicare spending will grow relatively slower in the next decade than it has in previous years because the law includes significant savings to the program,” Tricia Neuman, senior vice president and director of the Kaiser Family Foundation's program on Medicare policy, told Modern Healthcare. “This had the effect of sustaining the life of the trust fund.”
The $155 billion in reduced payments over 10 years that hospitals accepted under the law from Medicare and Medicaid includes $36 billion from disproportionate-share hospital payments—special funds hospitals are given to treat a higher-than-average number of indigent patients—and $112 billion from yearly reductions to the hospital. Those reductions to Medicare and Medicaid payments are expected to be offset over the long term by sharp increases in the share of patients having insurance, as provided by the new health reforms.