As has been widely reported, today the U.S. Supreme Court ruled that the Affordable Care Act’s (ACA) individual health insurance mandate does not violate the Constitution because it may be viewed as a permissible tax on individuals who do not obtain health insurance. The only provision of the law that the Court invalidated is a Medicaid provision that threatened states with the loss of existing Medicaid funding if they decline to comply with the ACA’s Medicaid coverage extension. By preserving the vast majority of the landmark health reform law, the Court avoided the policy chaos that would have resulted from striking down the ACA in its entirety. There is now legal certainty for state and federal governments, health care providers and suppliers, drug and device manufacturers, employers and individuals. As discussed below, the focus in Washington will return to continuing implementation of the law. Nevertheless, although the legal battle is over, the political fight will continue and likely reverberate through the coming Presidential and Congressional election campaigns.  See our report below. In other news, the Reed Smith Health Industry Washington Watch blog reports on the following recent health policy developments:

  • Regulatory Developments. CMS is considering using its “inherent reasonableness” authority to establish special Medicare payment limits for retail diabetic testing supplies, and several other Medicare payment rules are awaiting final regulatory clearance. The IRS has proposed regulations to implement ACA standards for charitable hospitals.
  • Other HHS Developments. HHS has announced that health insurers will pay $1.1 billion in rebates under the ACA’s medical loss ratio provision, and the Department has launched prescription drug monitoring pilot projects. CMS has outlined conditions for provider use of certain repackaged medications.
  • Legislative Developments. Congress has approved the Food and Drug Administration Safety and Innovation Act, and the House of Representatives approved the Counterfeit Drug Penalty Enhancement Act.
  • GAO & OIG Developments. The GAO has issued reports on the privacy and security of prescription drug data and home and community-based services (HCBS) waiver programs. Recent OIG reports address Medicare claims for diabetic testing supplies, physician electronic health record use, and HCBS programs.
  • Odds & Ends. MACPAC released a report to Congress on Medicaid and CHIP policy.
  • Health Industry Events. Upcoming events include meetings/calls on hospital value-based purchasing, the Medicare Shared Savings Program/Advance Payment Model, the Medicare clinical lab fee schedule, and Medicare hospital outpatient payment policy.