January 2011

The United States House of Representatives passed HR 2, a bill to repeal the Affordable Care Act (ACA), in a straight party-line vote. The United States Senate, as expected, voted down the bill, also on a party-line vote.  As a result, the implementation of the ACA continues unless compromise legislation is passed, or the United States Supreme Court rules the bill to be unconstitutional.  In the meantime, four House Committees - Ways and Means; Energy and Commerce; Education and the Workforce; and, Judiciary - will hold oversight hearings and draft bills that would replace elements of the ACA. 



Malpractice liability is expected to be the first issue addressed by the House Committees. Introduced bills highlight two approaches to changing the system: HR 314 would help states create specialized “health courts” featuring a judge with medical expertise, or a panel of neutral experts to award damages. The second bill, HR 157, would protect physicians from litigation stemming from care provided as emergency services. Other measures introduced would allow consumers to purchase insurance across state lines; codify President Obama’s executive order clarifying that no federal funds could be used for abortions; and, eliminate tax breaks for health insurance premiums on policies that cover abortion-related services.

Health Care Reform Litigation

A United States District Court Judge in Pensacola, Florida, ruled on a lawsuit brought by thirty-three (33) states, including Ohio, regarding the so-called "individual mandate", the provision that individuals who can afford it must purchase health care in 2014 or pay a penalty was ruled unconstitutional by the Court. Two other district court judges have rejected challenges to the law's requirement that Americans start buying health insurance in 2014. Absent compromise legislation being passed by Congress and signed by the President, it is likely the ultimate fate of the ACA will be determined by the United States Supreme Court.

Federal Appropriations

The Budget Committee for the House of Representatives announced overall budget allocations for the remainder of federal fiscal year (FFY) 2011, which expires September 30th.  Since the 110th Congress did not pass a FFY 2011 budget, the federal government has been operating under a series of Continuing Resolutions.  Under the House plan, all programs not considered as part of national security (i.e., that includes all disability programs) would be reduced an average of 15%.  In the United States Senate, the Commitment to Prosperity (CAP) Act would cap all federal spending - including Social Security and Medicaid - at a set level that would be tied to the Gross Domestic Product.  There is language in the bill that ties all spending levels together; in other words, if spending in one category exceeds the cap, there have to be cuts to other areas and the fear of disability advocates in the nation's capital is that those cuts would come from entitlement programs.

Medicaid

Arizona became the first state to ask for a waiver from the maintenance of eligibility (MOE) requirements in the Affordable Care Act (ACA).  The ACA prohibits states from reducing eligibility and adding to the uninsured before the Medicaid expansion begins in 2014. As referenced in the opening article of this publication, thirty-two (32) other states, including Ohio, have requested waivers as well. State fiscal emergencies across the Nation have raised discussions about reducing maintenance of effort requirements and/or extending the Enhanced Federal Medicaid Assistance Percentage.  Unfortunately, the division of political power between the House and Senate will likely result in neither happening.  In the meantime, Department of Health & Human Services Director Kathleen Sebelivs responded that she was unsure if the legislation granted her the authority to waive MOE requirements and encouraged states to examine other alternatives.

Civil Rights 

Nobel Learning Communities, Inc. (NLC), a private, for-profit entity that operates a nationwide network of more than 180 schools, including some in Ohio, has agreed to pay $215,000 and change its’ policies regarding admissions in an agreement reached with the United States Department of Justice.  The 2009 lawsuit alleged that NLC discriminated against children with disabilities violating Title III of the Americans with Disabilities Act by denying them admission to its schools. The children had disabilities including autism spectrum disorder, Down Syndrome, Attention Deficit Hyperactivity Disorder, and global developmental delays.

National Perspective is a publication of the Ohio Association of County Boards of DD, designed to update Association members on national and federal issues of interest.