Obama touts ACA results ...

Not far into its public education campaign for healthcare reform, the Obama administration last week touted what it sees as some of the law's best provisions, while the House voted to delay what it views as two of the worst.

The lower chamber capitalized on the administration's decision earlier this month to delay for one year the law's employer mandate when it approved the Authority for Mandate Delay Act from Rep. Tim Griffin (R-Ark.) to write the administrative delay into statute. House members also passed the Fairness for American Families Act, by Rep. Todd Young (R-Ind.), which would postpone for a year the individual mandate that is a linchpin of the law. House Republicans now have tried dozens of times to repeal, defund or roll back President Barack Obama's signature domestic policy achievement.

Countering those moves to scuttle the Patient Protection and Affordable Care Act, the administration released a report by HHS showing average premiums were lower than originally projected for health plans being offered on the state insurance exchanges. And Obama heralded more insurance rebates to consumers in a news conference that the Democratic Congressional Campaign Committee called “a major speech to kick-start the defense of Obamacare.”

Thomas Mann, a senior fellow at the Brookings Institution, said there's no way for the Griffin and Young bills—which garnered support from 35 and 22 Democrats, respectively—to move beyond the House floor. “What you've got is a small number of Democrats sort of seeing a way in difficult districts of taking a vote they might be able to use to ward off some Republican attacks,” Mann said, adding that neither vote will have any bearing on the law.

What could really harm the ACA, he argued, is if enough young, healthy adults don't purchase insurance in 2014—leading to higher premiums in the reformed insurance market—or if glitches on the state exchanges are bad enough to drive away consumers. “This will all be played out in implementation,” Mann said, “not in the factious politics of Congress.”

The House votes occurred in between a series of announcements last week that buoyed Obama's efforts to highlight how the ACA is leading to lower costs for consumers.

To start, the California Department of Managed Health Care approved 2014 rates from 13 insurers that want to participate in Covered California, the state's health exchange, that were submitted in May. At the time, exchange officials said the rates filed for the 2014 individual market ranged from 2% above to 29% below the 2013 average premium for comparable small-group plans in California's most populous regions.

And in New York, insurance regulators approved 2014 rates for individual-market health plans from 17 insurers on the state insurance exchange that they say are on average more than 50% lower than premiums for comparable plans currently available.

Meanwhile, HHS last week released a report that found individual market rates in 10 states and the District of Columbia on average have come in 18% lower than the Congressional Budget Office originally projected for next year. That report was released on the same day Obama held a news conference in which he highlighted the ACA-mandated insurance rebates to insured consumers based on insurers taking too much of premium revenue for administrative costs and profits.

“Last year, millions of Americans opened letters from their insurance companies—but instead of the usual dread that comes from getting a bill—they were pleasantly surprised with a check,” Obama said. “In 2012, 13 million rebates went out in all 50 states,” he said, adding that another $8.5 million in rebates, averaging $100 per consumer, will be sent this summer.

As House members and the administration focused largely on the ACA last week, senators were busy examining the federal electronic health-record incentive program, which some of them would like to see delayed or ended, particularly for rural providers. HHS officials showed little appetite for any delay in Stage 2 meaningful-use requirements despite bipartisan worries on Capitol Hill about the inability of rural hospitals to meet those conditions.

The concern for rural providers arose during a Senate Finance Committee hearing on the status of the EHR incentive program authorized by the 2009 economic stimulus law, which has provided $15 billion to Medicare and Medicaid providers who demonstrate meaningful use of certified EHR systems.

Democratic and Republican senators representing rural states repeatedly highlighted a number of challenges that providers in those states have in meeting the program's requirements. Failure to adopt and use qualifying digital record-keeping systems will not only result in lost incentive payments, but also continuous penalties for Medicare providers beginning in 2015.

HHS officials responded by highlighting the growing EHR-adoption rate—which reached about 80% of eligible hospitals, or about 3,880—according to the department's May figures.

“We're open to the dialogue, but I would much rather see rural hospitals be able to move up rather than they are going to fall behind,” Dr. Farzad Mostashari, national coordinator for health information technology at HHS, told the panel about any delay.

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